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Sample records for adults undergoing surgery

  1. Anesthetic considerations for adults undergoing fontan conversion surgery.

    PubMed

    Mossad, Emad B; Motta, Pablo; Vener, David F

    2013-06-01

    There are currently in North America more adults with congenital heart disease than children. This article discusses the anesthetic considerations in adults with single-ventricle physiology and prior repairs who present for Fontan conversion surgery as a demonstration of the challenges of caring for adults undergoing interventions for the repair of congenital heart defects. The care of these patients requires an understanding of the impact of passive pulmonary blood flow and single systemic ventricular physiology. The perioperative morbidity in this patient population remains high.

  2. Modified ultrafiltration in adult patients undergoing cardiac surgery.

    PubMed

    Zakkar, Mustafa; Guida, Gustavo; Angelini, Gianni D

    2015-03-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was the impact of modified ultrafiltration on adult patients undergoing cardiac surgery in terms of inflammatory and metabolic changes, blood loss and early clinical outcomes. A total of 155 papers were identified using the search as described below. Of these, six papers presented the best evidence to answer the clinical question as they reported data to reach conclusions regarding the issues of interest for this review. The author, date and country of publication, patient group, study type and weaknesses and relevant outcomes were tabulated. Modified ultrafiltration in adult patients undergoing cardiac surgery seems to attenuate the levels of inflammatory molecules associated with surgery, reduces blood loss and blood transfusion and improves cardiac output, index and systemic vascular resistance. However, this was not translated in any reduction in length of stay in intensive care unit or hospital. Most studies were single-centre prospective non-blinded trials that included a small cohort of elective coronary artery bypass grafting patients, which makes it underpowered to provide unbiased evidence regarding clinical outcomes. Properly designed and conducted prospective randomized studies are required to answer whether the beneficial effect of modified ultrafiltration on systemic inflammatory molecules associated with surgery can translate with improvement in clinical outcome.

  3. Risk Factors of Emergence Agitation in Adults Undergoing General Anesthesia for Nasal Surgery

    PubMed Central

    Kim, Hyo-Jin; Kim, Hyo-Yeol; Kim, Jin-Kyoung; Choi, Seung-Won

    2015-01-01

    Objectives To identify the incidence and the risk factors of emergence agitation in adults undergoing general anesthesia for nasal surgery. Methods We retrospectively examined 792 patients aged ≥18 years who underwent general anesthesia for elective nasal surgery between July 2012 and August 2013. Patients in the postanesthesia care unit with a Richmond Agitation Sedation Scale≥+1 at any time were considered to have emergence agitation. Results The overall incidence of emergence agitation is 22.2%. From multivariate regression analysis, the following six variables were found to be significantly associated with emergence agitation (P<0.05): younger age, recent smoking, sevoflurane anesthesia, postoperative pain on the numerical rating scale (NRS)≥5, presence of a tracheal tube, and presence of a urinary catheter. Presence of a tracheal tube was the greatest risk factor, increasing the risk of developing emergence agitation by approximately fivefold (odds ratio, 5.448; 95% confidence interval, 2.973 to 9.982). Younger age was also a strong risk factor (odds ratio, 0.975 for each 1-year increase; 95% confidence interval, 0.964 to 0.987). Current smoking, sevoflurane anesthesia, postoperative pain of NRS≥5, and the presence of a urinary catheter nearly doubled the risk of emergence agitation. Conclusion Emergence agitation following general anesthesia is a common complication in adult nasal surgery patients. To reduce the occurrence and consequences of agitation episodes, elimination of the associated risk factors is necessary, especially in at-risk patients. PMID:25729495

  4. Burden of Geriatric Events Among Older Adults Undergoing Major Cancer Surgery

    PubMed Central

    Saliba, Debra; Kwan, Lorna; Moore, Alison A.; Litwin, Mark S.

    2016-01-01

    Purpose Most malignancies are diagnosed in older adults who are potentially susceptible to aging-related health conditions; however, the manifestation of geriatric syndromes during surgical cancer treatment is not well quantified. Accordingly, we sought to assess the prevalence and ramifications of geriatric events during major surgery for cancer. Patients and Methods Using Nationwide Inpatient Sample data from 2009 to 2011, we examined hospital admissions for major cancer surgery among elderly patients (ie, age ≥ 65 years) and a referent group age 55 to 64 years. From these observations, we identified geriatric events that included delirium, dehydration, falls and fractures, failure to thrive, and pressure ulcers. We then estimated the collective prevalence of these events according to age, comorbidity, and cancer site and further explored their relationship with other hospital-based outcomes. Results Within a weighted sample of 939,150 patients, we identified at least one event in 9.2% of patients. Geriatric events were most common among patients age ≥ 75 years, with a Charlson comorbidity score ≥ 2, and who were undergoing surgery for cancer of the bladder, ovary, colon and/or rectum, pancreas, or stomach (P < .001). Adjusting for patient and hospital characteristics, those patients who experienced a geriatric event had a greater likelihood of concurrent complications (odds ratio [OR], 3.73; 95% CI, 3.55 to 3.92), prolonged hospitalization (OR, 5.47; 95% CI, 5.16 to 5.80), incurring high cost (OR, 4.97; 95% CI, 4.58 to 5.39), inpatient mortality (OR, 3.22; 95% CI, 2.94 to 3.53), and a discharge disposition other than home (OR, 3.64; 95% CI, 3.46 to 3.84). Conclusion Many older patients who receive cancer-directed surgery experience a geriatric event, particularly those who undergo major abdominal surgery. These events are linked to operative morbidity, prolonged hospitalization, and more expensive health care. As our population ages, efforts focused on

  5. Incidence and risk factors for postoperative cognitive dysfunction in older adults undergoing major noncardiac surgery: A prospective study

    PubMed Central

    Shoair, Osama A.; Grasso II, Mario P.; Lahaye, Laura A.; Daniel, Ronsard; Biddle, Chuck J.; Slattum, Patricia W.

    2015-01-01

    Background & Aims: Postoperative cognitive dysfunction (POCD) is a decline in cognitive function that occurs after surgery. The purpose of this study was to estimate the incidence and identify potential risk factors of POCD in older adults undergoing major noncardiac surgery. Materials and Methods: A total of 69 patients aged 65 years or older undergoing major noncardiac surgery were enrolled. Patients’ cognitive function was assessed before and 3 months after surgery using a computerized neurocognitive battery. A nonsurgical control group of 54 older adults was recruited to adjust for learning effects from repeated administration of neurocognitive tests. Data about potential risk factors for POCD were collected before, during, and after surgery, including patient, medication, and surgery factors. The incidence of POCD was calculated using the Z-score method. A multivariable logistic regression model was used to identify risk factors for POCD. Results: POCD was present in eleven patients (15.9%, 95% confidence interval [CI] = 7.3-24.6) 3 months after major noncardiac surgery. Carrying the apolipoprotein E4 (APOE4) genotype (odds ratio [OR] = 4.74, 95% CI = 1.09-22.19), using one or more highly anticholinergic or sedative-hypnotic drugs at home prior to surgery (OR = 5.64, 95% CI = 1.35-30.22), and receiving sevoflurane for anesthesia (OR = 6.43, 95% CI = 1.49-34.66) were associated with the development of POCD. Conclusions: POCD was observed in 15.9% of older adults after major noncardiac surgery. Risk factors for POCD in these patients were carrying the APOE4 genotype, using one or more highly anticholinergic or sedative-hypnotic drugs prior to surgery, and receiving sevoflurane for anesthesia. PMID:25788770

  6. Hypovitaminosis D and Cervical Disk Herniation among Adults Undergoing Spine Surgery

    PubMed Central

    Stoker, Geoffrey E.; Buchowski, Jacob M.; Chen, Christopher T.; Kim, Han Jo; Park, Moon Soo; Riew, K. Daniel

    2013-01-01

    Study Design Single-center, retrospective study. Objective Suboptimal concentrations of vitamin D have been linked to hip and knee osteoarthritis in large, population-based cohort studies. We sought to examine the association of vitamin D levels with intervertebral disk disease. Methods From January 2010 through May 2011, 91 consecutive, eligible adult spine surgery patients who had undergone cervical magnetic resonance imaging (MRI) and preoperative serum 25-hydroxyvitamin D (s25D) measurement were retrospectively included. MRI was read for C2–T1 disk herniation and degeneration (grades I to V). Logistic regressions were performed. Results Compared with the 384 disks of nondeficient patients, 162 disks of vitamin D-deficient (< 20 ng/mL) patients were more frequently herniated (40% versus 27%, p = 0.004); deficiency was not predictive of individual disk grade (unadjusted odds ratio [uOR] = 0.98, p = 0.817). On regression analysis, deficiency was associated with increased number of herniations per patient (uOR = 2.17, 95% confidence interval [CI] = 1.22 to 3.87, p = 0.009; adjusted odds ratio [aOR] = 2.12, 95% CI = 1.11 to 4.03, p = 0.023). When disks were analyzed individually, and levels (e.g., C5 to C6), additionally controlled for, deficiency correlated with greater likelihood of herniation per disk (uOR = 1.81, 95% CI = 1.22 to 2.66, p = 0.003; aOR = 2.06, 95% CI = 1.25 to 3.41, p = 0.005). Conclusion Among adults undergoing spine surgery at our institution, vitamin D deficiency was associated with cervical disk herniation. Considering the current epidemics of vitamin D insufficiency and neck pain, further investigation is warranted, as these data were retrospectively collected and subject to sampling bias. PMID:24436874

  7. The impact of adverse events on health care costs for older adults undergoing nonelective abdominal surgery

    PubMed Central

    Bailey, Jonathan G.; Davis, Philip J.B.; Levy, Adrian R.; Molinari, Michele; Johnson, Paul M.

    2016-01-01

    Background Postoperative complications have been identified as an important and potentially preventable cause of increased hospital costs. While older adults are at increased risk of experiencing complications and other adverse events, very little research has specifically examined how these events impact inpatient costs. We sought to examine the association between postoperative complications, hospital mortality and loss of independence and direct inpatient health care costs in patients 70 years or older who underwent nonelective abdominal surgery. Methods We prospectively enrolled consecutive patients 70 years or older who underwent nonelective abdominal surgery between July 1, 2011, and Sept. 30, 2012. Detailed patient-level data were collected regarding demographics, diagnosis, treatment and outcomes. Patient-level resource tracking was used to calculate direct hospital costs (2012 $CDN). We examined the association between complications, hospital mortality and loss of independence cost using multiple linear regression. Results During the study period 212 patients underwent surgery. Overall, 51.9% of patients experienced a nonfatal complication (32.5% minor and 19.4% major), 6.6% died in hospital and 22.6% experienced a loss of independence. On multivariate analysis nonfatal complications (p < 0.001), hospital mortality (p = 0.021) and loss of independence at discharge (p < 0.001) were independently associated with health care costs. These adverse events respectively accounted for 30%, 4% and 10% of the total costs of hospital care. Conclusion Adverse events were common after abdominal surgery in older adults and accounted for 44% of overall costs. This represents a substantial opportunity for better patient outcomes and cost savings with quality improvement strategies tailored to the needs of this high-risk surgical population. PMID:26999476

  8. Reduced Long-Term Relative Survival in Females and Younger Adults Undergoing Cardiac Surgery: A Prospective Cohort Study

    PubMed Central

    Enger, Tone Bull; Pleym, Hilde; Stenseth, Roar; Greiff, Guri; Wahba, Alexander; Videm, Vibeke

    2016-01-01

    Objectives To assess long-term survival and mortality in adult cardiac surgery patients. Methods 8,564 consecutive patients undergoing cardiac surgery in Trondheim, Norway from 2000 until censoring 31.12.2014 were prospectively followed. Observed long-term mortality following surgery was compared to the expected mortality in the Norwegian population, matched on gender, age and calendar year. This enabled assessment of relative survival (observed/expected survival rates) and relative mortality (observed/expected deaths). Long-term mortality was compared across gender, age and surgical procedure. Predictors of reduced survival were assessed with multivariate analyses of observed and relative mortality. Results During follow-up (median 6.4 years), 2,044 patients (23.9%) died. The observed 30-day, 1-, 3- and 5-year mortality rates were 2.2%, 4.4%, 8.2% and 13.8%, respectively, and remained constant throughout the study period. Comparing observed mortality to that expected in a matched sample from the general population, patients undergoing cardiac surgery showed excellent survival throughout the first seven years of follow-up (relative survival ≥ 1). Subsequently, survival decreased, which was more pronounced in females and patients undergoing other procedures than isolated coronary artery bypass grafting (CABG). Relative mortality was higher in younger age groups, females and patients undergoing aortic valve replacement (AVR). The female survival advantage in the general population was obliterated (relative mortality ratio (RMR) 1.35 (1.19–1.54), p<0.001). Increasing observed long-term mortality seen with ageing was due to population risk, and younger age was independently associated with increased relative mortality (RMR per 5 years 0.81 (0.79–0.84), p<0.001)). Conclusions Cardiac surgery patients showed comparable survival to that expected in the general Norwegian population, underlining the benefits of cardiac surgery in appropriately selected patients. The

  9. Risk of perioperative blood transfusions and postoperative complications associated with serotonergic antidepressants in older adults undergoing hip fracture surgery.

    PubMed

    Seitz, Dallas P; Bell, Chaim M; Gill, Sudeep S; Reimer, Cara L; Herrmann, Nathan; Anderson, Geoffrey M; Newman, Alice; Rochon, Paula A

    2013-12-01

    Serotonergic antidepressants (SAds) are associated with bleeding-related adverse events. An increased risk of bleeding with SAds may have important implications in surgical settings. Our study evaluates the risk of red blood cell (RBC) transfusions and postoperative complications associated with SAds among older adults undergoing hip fracture surgery. We conducted a retrospective cohort study of individuals 66 years or older who underwent hip fracture surgery in Ontario, Canada. The risk of RBC transfusion among current users of SAds and nonserotonergic antidepressants (NSAds) was compared with recent former SAd users. Secondary outcomes included measures of postoperative morbidity and mortality. Subgroup analyses were undertaken in groups who were coprescribed other medications known to effect bleeding. Multivariable logistic regression was utilized to determine the odds ratios (ORs) for antidepressants and postoperative outcomes. A total 11,384 individuals were included in the study sample. Current SAd users had an increased risk of RBC transfusion compared with recent former users of SAds (OR, 1.28; 95% confidence interval, 1.14-1.43) as did current NSAd users (OR, 1.17; 95% confidence interval, 1.03-1.33). The risk of RBC transfusion with SAds or NSAds was further increased among individuals receiving antiplatelet agents. However, postoperative morbidity and mortality were not increased among either group of antidepressant users. In conclusion, SAds are associated with an increased risk of RBC transfusions, although this does not appear to result in major postoperative complications. Clinicians should be aware of this increased risk, although routine discontinuation of antidepressants before surgery is likely unwarranted in most cases.

  10. Comparison of ondansetron and combination of ondansetron and dexamethasone as a prophylaxis for postoperative nausea and vomiting in adults undergoing elective laparoscopic surgery

    PubMed Central

    Bhattarai, Basant; Shrestha, Santosh; Singh, Jeevan

    2011-01-01

    Background: Laparoscopic surgeries are the second most common cause of postoperative nausea and vomiting (PONV), which would cause unexpected delay in hospital discharge. This study intends to compare the efficacy and safety of the combination of ondansetron and dexamethasone with ondansetron alone given as prophylaxis for PONV in adults undergoing elective laparoscopic surgery. Materials and Methods: One hundred adult patients undergoing elective laparoscopic surgeries were selected and were randomly divided into 2 groups of 50 each. Group I received 4 mg of ondansetron intravenously (i.v.), whereas Group II received ondansetron 4 mg and dexamethasone 4 mg i.v. just before induction of anesthesia. Postoperatively, the patients were assessed for episodes of nausea, vomiting, and need for rescue antiemetic at intervals of 0–2, 3, 6, 12, and 24 h. Postoperative pain scores and time for the first analgesic dose were also noted. Results: Results were analyzed statistically. Complete response defined as no nausea or emesis and no need for rescue antiemetic during first 24 h, was noted in 76% of patients who received ondansetron alone, while similar response was seen in 92% of patients in combination group. Rescue antiemetic requirement was less in combination group (8%) as compared with ondansetron group. Conclusion: Combination of ondanserton and dexamethasone is more effective in preventing post operative nausea vomiting in patients undergoing laparoscopic surgery than ondansetron alone. PMID:21769200

  11. Effect-site concentration of remifentanil for preventing cough during emergence in elderly patients undergoing nasal surgery: a comparison with adult patients

    PubMed Central

    Yoo, Ji Young; Kim, Jong Yeop; Kwak, Hyun Jeong; Lee, Dong Chul; Kim, Go Wun; Lee, Sook Young; Chae, Yun Jeong

    2016-01-01

    Purpose Prevention of cough during emergence after nasal surgery is important for avoiding surgical site bleeding. We investigated the remifentanil effect-site concentration in 50% (EC50) of the elderly patients undergoing nasal surgery for smooth emergence without cough and compared it with that of adult patients. Methods Twenty-two elderly (aged 65–80 years) and 25 adult patients (aged 20–60 years) with an American Society of Anesthesiologists physical status I/II undergoing nasal surgery were enrolled. Anesthesia was maintained with sevoflurane and remifentanil. Remifentanil EC50 and EC95 for preventing cough were determined using the modified Dixon’s up-and-down method and isotonic regression with bootstrapping approach. Recovery profiles were also recorded. Results With Dixon’s up-and-down method, the EC50 of remifentanil in elderly patients (2.40±0.25 ng/mL) was not significantly different from that of adults (2.33±0.30 ng/mL) (P=0.687). With isotonic regression, the EC95 of remifentanil in elderly patients (3.32 [95% confidence interval: 3.06–3.38] ng/mL) was not significantly different from that of adults (3.30 [95% confidence interval: 2.96–3.37] ng/mL). However, eye opening time (14.1±3.8 vs 12.0±2.9 seconds), extubation time (17.2±4.1 vs 14.0±3.0 seconds), and postanesthesia care unit duration (44.5±7.6 vs 38.7±3.4 minutes) in elderly patients were significantly longer than those in adults (P<0.05). Conclusion Remifentanil EC50 for preventing cough after nasal surgery with sevoflurane anesthesia did not differ between elderly and adult patients. However, delayed awakening and respiratory adverse events may warrant attention in elderly patients. PMID:27672319

  12. Hyperlactatemia in patients undergoing adult cardiac surgery under cardiopulmonary bypass: Causative factors and its effect on surgical outcome

    PubMed Central

    Naik, Rakesh; George, Gladdy; Karuppiah, Sathappan; Philip, Madhu Andrew

    2016-01-01

    Objectives of the Study: To identify the factors causing high lactate levels in patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) and to assess the association between high blood lactate levels and postoperative morbidity and mortality. Methods: A retrospective observational study including 370 patients who underwent cardiac surgeries under cardiopulmonary bypass. The patients were divided into 2 groups based on serum lactate levels; those with serum lactate levels greater than or equal to 4 mmol/L considered as hyperlactatemia and those with serum lactate levels less than 4 mmol/L. Blood lactate samples were collected intraoperatively and postoperatively in the ICU. Preoperative and intraoperative risk factors for hyperlactatemia were identified using the highest intraoperative value of lactate. The postoperative morbidity and mortality associated with hyperlactatemia was studied using the overall (intraoperative and postoperative values) peak lactate levels. Preoperative clinical data, perioperative events and postoperative morbidity and mortality were recorded. Results: Intraoperative peak blood lactate levels of 4.0 mmol/L or more were present in 158 patients (42.7%). Females had higher peak intra operative lactate levels (P = 0.011). There was significant correlation between CPB time (Pearson correlation coefficient r = 0.024; P = 0.003) and aortic cross clamp time (r = 0.02, P = 0.007) with peak intraoperative blood lactate levels. Patients with hyperlactatemia had significantly higher rate of postoperative morbidity like atrial fibrillation (19.9% vs. 5.3%; P = 0.004), prolonged requirement of inotropes (34% vs. 11.8%; P = 0.001), longer stay in the ICU (P = 0.013) and hospital (P = 0.001). Conclusions: Hyperlactatemia had significant association with post-operative morbidity. Detection of hyperlactatemia in the perioperative period should be considered as an indicator of inadequate tissue oxygen delivery and must be aggressively

  13. Evaluation of the influence of pulmonary hypertension in ultra-fast-track anesthesia technique in adult patients undergoing cardiac surgery

    PubMed Central

    da Silva, Paulo Sérgio; Cartacho, Márcio Portugal Trindade; de Castro, Casimiro Cardoso; Salgado Filho, Marcello Fonseca; Brandão, Antônio Carlos Aguiar

    2015-01-01

    Objective To evaluate the influence of pulmonary hypertension in the ultra-fast-track anesthesia technique in adult cardiac surgery. Methods A retrospective study. They were included 40 patients divided into two groups: GI (without pulmonary hypertension) and GII (with pulmonary hypertension). Based on data obtained by transthoracic echocardiography. We considered as the absence of pulmonary hypertension: a pulmonary artery systolic pressure (sPAP) <36 mmHg, with tricuspid regurgitation velocity <2.8 m/s and no additional echocardiographic signs of PH, and PH as presence: a sPAP >40 mmHg associated with additional echocardiographic signs of PH. It was established as influence of pulmonary hypertension: the impossibility of extubation in the operating room, the increase in the time interval for extubation and reintubation the first 24 hours postoperatively. Univariate and multivariate analyzes were performed when necessary. Considered significant a P value <0.05. Results The GI was composed of 21 patients and GII for 19. All patients (100%) were extubated in the operating room in a medium time interval of 17.58±8.06 min with a median of 18 min in GII and 17 min in GI. PH did not increase the time interval for extubation (P=0.397). It required reintubation of 2 patients in GII (5% of the total), without statistically significant as compared to GI (P=0.488). Conclusion In this study, pulmonary hypertension did not influence on ultra-fast-track anesthesia in adult cardiac surgery. PMID:27163419

  14. INTESTINAL MALROTATION IN PATIENTS UNDERGOING BARIATRIC SURGERY

    PubMed Central

    VIDAL, Eduardo Arevalo; RENDON, Francisco Abarca; ZAMBRANO, Trino Andrade; GARCÍA, Yudoco Andrade; VITERI, Mario Ferrin; CAMPOS, Josemberg Marins; RAMOS, Manoela Galvão; RAMOS, Almino Cardoso

    2016-01-01

    ABSTRACT Background: Intestinal malrotation is a rare congenital anomaly. In adults is very difficult to recognize due to the lack of symptoms. Diagnosis is usually incidental during surgical procedures or at autopsy. Aim: To review the occurrence and recognition of uneventful intestinal malrotation discovered during regular cases of bariatric surgeries. Methods: Were retrospectively reviewed the medical registry of 20,000 cases undergoing bariatric surgery, from January 2002 to January 2016, looking for the occurrence of intestinal malrotation and consequences in the intraoperative technique and immediate evolution of the patients. Results: Five cases (0,025%) of intestinal malrotation were found. All of them were males, aging 45, 49, 37,52 and 39 years; BMI 35, 42, 49, 47 and 52 kg/m2, all of them with a past medical history of morbid obesity. The patient with BMI 35 kg/m2 suffered from type 2 diabetes also. All procedures were completed by laparoscopic approach, with no conversions. In one patient was not possible to move the jejunum to the upper abdomen in order to establish the gastrojejunostomy and a sleeve gastrectomy was performed. In another patient was not possible to fully recognize the anatomy due to bowel adhesions and a single anastomosis gastric bypass was preferred. No leaks or bleeding were identified. There were no perioperative complications. All patients were discharged 72 h after the procedure and no immediate 30-day complications were reported. Conclusion: Patients with malrotation can successfully undergo laparoscopic bariatric surgery. May be necessary changes in the surgical original strategy regarding the malrotation. Surgeons must check full abdominal anatomical condition prior to start the division of the stomach. PMID:27683770

  15. Preoperative evaluation of the adult patient undergoing non-cardiac surgery: guidelines from the European Society of Anaesthesiology.

    PubMed

    De Hert, Stefan; Imberger, Georgina; Carlisle, John; Diemunsch, Pierre; Fritsch, Gerhard; Moppett, Iain; Solca, Maurizio; Staender, Sven; Wappler, Frank; Smith, Andrew

    2011-10-01

    The purpose of these guidelines on the preoperative evaluation of the adult non-cardiac surgery patient is to present recommendations based on available relevant clinical evidence. The ultimate aims of preoperative evaluation are two-fold. First, we aim to identify those patients for whom the perioperative period may constitute an increased risk of morbidity and mortality, aside from the risks associated with the underlying disease. Second, this should help us to design perioperative strategies that aim to reduce additional perioperative risks. Very few well performed randomised studies on the topic are available and many recommendations rely heavily on expert opinion and are adapted specifically to the healthcare systems in individual countries. This report aims to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthetists all over Europe to integrate - wherever possible - this knowledge into daily patient care. The Guidelines Committee of the European Society of Anaesthesiology (ESA) formed a task force with members of subcommittees of scientific subcommittees and individual members of the ESA. Electronic databases were searched from the year 2000 until July 2010 without language restrictions. These searches produced 15 425 abstracts. Relevant systematic reviews with meta-analyses, randomised controlled trials, cohort studies, case-control studies and cross-sectional surveys were selected. The Scottish Intercollegiate Guidelines Network grading system was used to assess the level of evidence and to grade recommendations. The final draft guideline was posted on the ESA website for 4 weeks and the link was sent to all ESA members, individual or national (thus including most European national anaesthesia societies). Comments were collated and the guidelines amended as appropriate. When the final draft was complete, the Guidelines Committee and ESA Board ratified the guidelines.

  16. Evaluation of the estimated continuous cardiac output monitoring system in adults and children undergoing kidney transplant surgery: a pilot study.

    PubMed

    Terada, Takashi; Maemura, Yumi; Yoshida, Akiko; Muto, Rika; Ochiai, Ryoichi

    2014-02-01

    Evaluation of the estimated continuous cardiac output (esCCO) allows non-invasive and continuous assessment of cardiac output. However, the applicability of this approach in children has not been assessed thus far. We compared the correlation coefficient, bias, standard deviation (SD), and the lower and upper 95 % limits of agreement for esCCO and dye densitography-cardiac output (DDG-CO) measurements by pulse dye densitometry (PDD) in adults and children. On the basis of these assessments, we aimed to examine whether esCCO can be used in pediatric patients. DDG-CO was measured by pulse dye densitometry (PDD) using indocyanine green. Modified-pulse wave transit time, obtained using pulse oximetry and electrocardiography, was used to measure esCCO. Correlations between DDG-CO and esCCO in adults and children were analyzed using regression analysis with the least squares method. Differences between the two correlation coefficients were statistically analyzed using a correlation coefficient test. Bland-Altman plots were used to evaluate bias and SD for DDG-CO and esCCO in both adults and children, and 95 % limits of agreement (bias ± 1.96 SD) and percentage error (1.96 SD/mean DDG-CO) were calculated and compared. The average age of the adult patients (n = 10) was 39.3 ± 12.1 years, while the average age of the pediatric patients (n = 7) was 9.4 ± 3.1 years (p < 0.001). For adults, the correlation coefficient was 0.756; bias, -0.258 L/min; SD, 1.583 L/min; lower and upper 95 % limits of agreement for DDG-CO and esCCO, -3.360 and 2.844 L/min, respectively; and percentage error, 42.7 %. For children, the corresponding values were 0.904; -0.270; 0.908; -2.051 and 1.510 L/min, respectively; and 35.7 %. Due to the high percentage error values, we could not establish a correlation between esCCO and DDG-CO. However, the 95 % limits of agreement and percentage error were better in children than in adults. Due to the high percentage error, we could not confirm a correlation

  17. Complications in Adult Patients with Down Syndrome Undergoing Cervical Spine Surgery Using Current Instrumentation Techniques and rhBMP-2: A Long-Term Follow-Up.

    PubMed

    Siemionow, Kris; Hansdorfer, Mark; Janusz, Piotr; Mardjetko, Steven

    2017-03-01

    Introduction Cervical spine pathologies are common in Down syndrome (DS) patients. Cervical pathologies may cause cord compression and neurologic deterioration if left untreated. Complication rates of 73-100% have been reported in DS patients after cervical spine surgery in historical studies. This study reports updated perioperative complications rates and long-term outcome in patients with DS undergoing cervical spine surgery. Methods Retrospective review of patients with DS who have undergone cervical spine surgery from 1998 to 2011 (≥ 24 months of follow-up) was undertaken. Series of 17 adults with preoperative diagnoses that included atlantoaxial instability, stenosis, spondylosis, or cervical spondylolisthesis were evaluated. Nine patients received recombinant human bone morphogenetic protein-2 (rhBMP-2). Neurologic and ambulatory status was evaluated at regular intervals included pre- and postoperative imaging, range of motion evaluation, strength/neurologic testing, ambulation observation, and patient and caretaker pain reporting. Results A total of 20 surgical procedures were performed in 17 patients. Average follow-up was 78.7 months (range: 25-156 months). Overall, 37 complications were observed including pneumonia, respiratory distress, reintubation, dysphagia, deep venous thrombosis, sepsis, wound infection, dehiscence, neurologic complications, loss of reduction (LOR), pseudarthrosis, and hardware failure. Postoperative pneumonia was most common (23.5%). Three patients developed pseudarthrosis (all in the rhBMP-2 group); three demonstrated LOR. Neurologic complications (N = 3) included spasticity, loss of ambulation, and postoperative weakness with myelomalacia. Two were transient. Respiratory complications in the rhBMP-2 group were the most common (N = 3). The anterior approach resulted in a higher likelihood of complications than the posterior (p = 0.032). Conclusions Current techniques may improve pseudarthrosis (p = 0

  18. Constipation Risk in Patients Undergoing Abdominal Surgery

    PubMed Central

    Celik, Sevim; Atar, Nurdan Yalcin; Ozturk, Nilgun; Mendes, Guler; Kuytak, Figen; Bakar, Esra; Dalgiran, Duygu; Ergin, Sumeyra

    2015-01-01

    Background: Problems regarding bowel elimination are quite common in patients undergoing abdominal surgery. Objectives: To determine constipation risk before the surgery, bowel elimination during postoperative period, and the factors affecting bowel elimination. Patients and Methods: This is a cross-sectional study. It was conducted in a general surgery ward of a university hospital in Zonguldak, Turkey between January 2013 and May 2013. A total of 107 patients were included in the study, who were selected by convenience sampling. Constipation Risk Assessment Scale (CRAS), patient information form, medical and nursing records were used in the study. Results: The mean age of the patients was found to be 55.97 ± 15.74 (year). Most of the patients have undergone colon (37.4%) and stomach surgeries (21.5%). Open surgical intervention (83.2%) was performed on almost all patients (96.3%) under general anesthesia. Patients were at moderate risk for constipation with average scores of 11.71 before the surgery. A total of 77 patients (72%) did not have bowel elimination problem during postoperative period. The type of the surgery (P < 0.05), starting time for oral feeding after the surgery (P < 0.05), and mobilization (P < 0.05) were effective on postoperative bowel elimination. Conclusions: There is a risk for constipation after abdominal surgery. Postoperative practices are effective on the risk of constipation. PMID:26380107

  19. Intra-Operative Fluid Management in Adult Neurosurgical Patients Undergoing Intracranial Tumour Surgery: Randomised Control Trial Comparing Pulse Pressure Variance (PPV) and Central Venous Pressure (CVP)

    PubMed Central

    Salins, Serina Ruth; Kumar, Amar Nandha; Korula, Grace

    2016-01-01

    Introduction Fluid management in neurosurgery presents specific challenges to the anaesthesiologist. Dynamic para-meters like Pulse Pressure Variation (PPV) have been used successfully to guide fluid management. Aim To compare PPV against Central Venous Pressure (CVP) in neurosurgical patients to assess hemodynamic stability and perfusion status. Materials and Methods This was a single centre prospective randomised control trial at a tertiary care centre. A total of 60 patients undergoing intracranial tumour excision in supine and lateral positions were randomised to two groups (Group 1, CVP n=30), (Group 2, PPV n=30). Intra-operative fluid management was titrated to maintain baseline CVP in Group 1(5-10cm of water) and in Group 2 fluids were given to maintain PPV less than 13%. Acid base status, vital signs and blood loss were monitored. Results Although intra-operative hypotension and acid base changes were comparable between the groups, the patients in the CVP group had more episodes of hypotension requiring fluid boluses in the first 24 hours post surgery. {CVP group median (25, 75) 2400ml (1850, 3110) versus PPV group 2100ml (1350, 2200) p=0.03} The patients in the PPV group received more fluids than the CVP group which was clinically significant. {2250 ml (1500, 3000) versus 1500ml (1200, 2000) median (25, 75) (p=0.002)}. The blood loss was not significantly different between the groups The median blood loss in the CVP group was 600ml and in the PPV group was 850 ml; p value 0.09. Conclusion PPV can be used as a reliable index to guide fluid management in neurosurgical patients undergoing tumour excision surgery in supine and lateral positions and can effectively augment CVP as a guide to fluid management. Patients in PPV group had better hemodynamic stability and less post operative fluid requirement. PMID:27437329

  20. The day of your surgery - adult

    MedlinePlus

    Same-day surgery - adult; Ambulatory surgery - adult; Surgical procedure - adult; Preoperative care - day of surgery ... meet with them at an appointment before the day of surgery or on the same day of ...

  1. Patient race and the likelihood of undergoing bariatric surgery among patients seeking surgery

    PubMed Central

    Stanford, Fatima Cody; Jones, Daniel B.; Schneider, Benjamin E.; Blackburn, George L.; Apovian, Caroline M.; Hess, Donald T.; Chiodi, Sarah; Robert, Shirley; Bourland, Ashley C.; Wee, Christina C.

    2015-01-01

    Background Ethnic minority adults have disproportionately higher rates of obesity than Caucasians but are less likely to undergo bariatric surgery. Recent data suggest that minorities might be less likely to seek surgery. Whether minorities who seek surgery are also less likely to proceed with surgery is unclear. Methods We interviewed 651 patients who sought bariatric surgery at two academic medical centers to examine whether ethnic minorities are less likely to proceed with surgery than Caucasians and whether minorities who do proceed with surgery have higher illness burden than their counterparts. We collected patient demographics and abstracted clinical data from the medical records. We then conducted multivariable analyses to examine the association between race and the likelihood of proceeding with bariatric surgery within 1 year of initial interview and to compare the illness burden by race and ethnicity among those who underwent surgery. Results Of our study sample, 66 % were Caucasian, 18 % were African-American, and 12 % were Hispanics. After adjustment for socioeconomic factors, there were no racial differences in who proceeded with bariatric surgery. Among those who proceeded with surgery, illness burden was comparable between minorities and Caucasian patients with the exception that African-Americans were underrepresented among those with reflux disease (0.4, 95 % CI 0.2–0.7) and depression (0.4, 0.2–0.7), and overrepresented among those with anemia (4.8, 2.4–9.6) than Caucasian patients. Conclusions Race and ethnicity were not independently associated with likelihood of proceeding with bariatric surgery. Minorities who proceeded with surgery did not clearly have higher illness burden than Caucasian patients. PMID:25492453

  2. NUTRITIONAL STATUS AND LIFE QUALITY IN PATIENTS UNDERGOING BARIATRIC SURGERY

    PubMed Central

    da SILVA, Paulo Roberto Bezerra; de SOUZA, Marcela Ramos; da SILVA, Evane Moises; da SILVA, Silvia Alves

    2014-01-01

    Background The obesity has achieved an alarming increase in recent years, which led this disease to global epidemic condition. Aim To evaluate the nutritional status as well as the quality of life of obese patients undergoing bariatric surgery. Methods A transversal study was conducted with obese adults of both genders who underwent bariatric surgery by Fobi-Capella technique for at least 30 days. It was evaluated: age, gender, marital status, occupation, weight before surgery, current weight, height, preoperative and current BMI, weight loss and loss of excess weight percentages, presence of clinical manifestations and food intolerances. Results The sample consisted of 70 patients, being 81.4% female, 37.1% aged 30 to 39 years, 58.6% were married, 41.4% have undergone the bariatric surgery in the last 12 months. It was observed a reduction in BMI from 37.2 kg/m2 (one to three months) to 28.9 kg/m2 (>12 months) and consequent increase in weight loss and loss of excess weight percentages. The most frequent clinical manifestation was alopecia (62.9%). The most reported food intolerance was on the red meat (24%). According to the Baros questionnaire, 50% of patients were classified as having good quality of life. Conclusion The operation of Fobi-Capella proved to be effective in promoting gradual and lasting weight loss. Quality of life was considered good in most patients, indicating that the operation had a positive impact on their lives. PMID:25409963

  3. Comparative Study of Two Laryngeal Mask Airways: Proseal Laryngeal Mask Airway and Supreme Laryngeal Mask Airway in Anesthetized Paralyzed Adults Undergoing Elective Surgery

    PubMed Central

    Gill, Ravneet Kaur; Tarat, Abhijit; Pathak, Debagopal; Dutta, Suneeta

    2017-01-01

    Context: Supraglottic airway devices can act as an alternative to endotracheal intubation in both normal and difficult airway. LMA Proseal (P-LMA) and LMA Supreme (S-LMA) alongwith acting as effective ventilating device, provide port for gastric drainage. Aim: The objective of this study was to compare the two devices for effective ventilation and complications. Setting and Design: A prospective, randomized, single-blinded study was conducted in a tertiary care teaching hospital. Methods: 100 patients of ASA grade I–II undergoing elective surgery under general anaesthesia were included after ethical committee clearance and written consent. Patients were randomly allocated size 4 P-LMA (Group P) or S-LMA (Group S) (50 patients in each group). Insertion attempt, insertion time, oropharyngeal leak pressure (OLP) and complications were compared. Results: There was no difference demographically. The first insertion attempts were successful in 92% with P-LMA and 96% with S-LMA. Insertion time was faster in S-LMA. The mean OLP was 24.04 cmH2O in Group P and 20.05 cmH2O in Group S. Complications were cough, mild blood staining. Conclusion: Both can act as an effective ventilatory devices. But where LMA Proseal provides a more effective glottic seal by having a greater OLP, single use LMA Supreme provides acceptable glottic seal with easier and faster insertion, therefore, it can be accepted as better alternative to LMA Proseal. PMID:28298751

  4. Factors Affecting Patients Undergoing Cosmetic Surgery in Bushehr, Southern Iran

    PubMed Central

    Salehahmadi, Zeinab; Rafie, Seyyed Reza

    2012-01-01

    BACKGROUND Although, there have been extensive research on the motivations driving patient to undergo cosmetic procedures, there is still a big question mark on the persuasive factors which may lead individuals to undergo cosmetic surgery. The present study evaluated various factors affecting patients undergoing cosmetic surgery in Bushehr, Southern Iran. METHODS From 24th March 2011 to 24th March 2012, eighty-one women and 20 men who wished to be operated in Fatemeh Zahra Hospital in Bushehr, Southern Iran and Pars Clinic, Iran were enrolled by a simple random sampling method. They all completed a questionnaire to consider reasons for cosmetic procedures. The collected data were statistically analyzed. RESULTS Demographical, sociological and psychological factors such as age, gender, educational level, marital status, media, perceived risks, output quality, depression and self-improvement were determined as factors affecting tendency of individuals to undergo cosmetic surgery in this region. Trend to undergo cosmetic surgery was more prevalent in educational below bachelor degree, married subjects, women population of 30-45 years age group. Education level, age, marital status and gender were respectively the influential factors in deciding to undergo cosmetic surgery. Among the socio-psychological factors, self-improvement, finding a better job opportunity, rivalry, media, health status as well as depression were the most persuasive factors to encourage people to undergo cosmetic surgery too. Cost risk was not important for our samples in decision making to undergo cosmetic surgery. CONCLUSION We need to fully understand the way in which the combination of demographic, social and psychological factors influence decision-making to undergo cosmetic surgery. PMID:25734051

  5. Factors that motivate people to undergo cosmetic surgery.

    PubMed

    Furnham, Adrian; Levitas, James

    2012-01-01

    A sample of 204 British participants completed a questionnaire that assessed their attitude toward cosmetic surgery as well as measures of self-esteem, life satisfaction, self-rated physical attractiveness, religiosity and media consumption. Two factors emerged from a factor analysis of their attitudes toward surgery: likelihood to undergo, and benefits of undergoing, cosmetic surgery. Females with low self-esteem, low life satisfaction, low self-rated attractiveness and little religious beliefs who were heavy television watchers reported a greater likelihood of undergoing cosmetic surgery. Stepwise regression analysis with the two attitude factors as criterion variables showed two major predictors for likelihood: religiousness and low self-esteem, and four major predictors for benefit: religousness, media consumption, life satisfaction and sex. The role of religion is considered in this context.

  6. Parental anxiety and concern for children undergoing dermatological surgery.

    PubMed

    Hoetzenecker, Wolfram; Guenova, Emmanuella; Krug, Markus; Goetz, Angelika; Amarov, Boyko; Haefner, Hans-Martin; Breuninger, Helmut

    2014-10-01

    Parents experience anxiety and concern about their children's anesthesia and surgeries, which can adversely affect the children's outcomes. Therefore, it is important to identify the factors that influence parental fear. Because dermatological surgery is often performed in young children, we examined how a child's age and the size of the dermatological surgical area affected the levels of parental anxiety and concern. The parents' levels of anxiety and concern were accessed by parental self-reports in a prospective observational study of 106 children undergoing dermatological surgery. Correlation analysis showed that the level of parental anxiety decreased with the child's age. In contrast, the level of parental anxiety increased with the size of the surgical area. Our findings thus indicate that parents whose children undergo large-sized surgeries at a young age are at high risk. This result should be considered when performing dermatological surgery in children.

  7. Ventilation of neck breathers undergoing a diagnostic procedure or surgery.

    PubMed

    Brook, Itzhak

    2012-06-01

    Receiving sedation while undergoing a diagnostic procedure or general anesthesia for surgery is challenging for neck breathers including laryngectomees. Unfortunately, most medical personnel including nurses, medical technicians, surgeons, and anesthesiologists caring for laryngectomees before, during, and after surgery are not familiar with their unique anatomy, how they speak, and how to manage their airways during and after the operation. Methods to improve the care are discussed. Educating medical personnel about these issues can improve the care of neck breathers.

  8. Hemostatic management of patients undergoing ear-nose-throat surgery

    PubMed Central

    Thiele, Thomas; Kaftan, Holger; Hosemann, Werner; Greinacher, Andreas

    2015-01-01

    Perioperative hemostatic management is increasingly important in the field of otolaryngology. This review summarizes the key elements of perioperative risk stratification, thromboprophylaxis and therapies for bridging of antithrombotic treatment. It gives practical advice based on the current literature with focus on patients undergoing ENT surgery. PMID:26770281

  9. Cosmetic Surgery Makeover Programs and Intentions to Undergo Cosmetic Enhancements: A Consideration of Three Models of Media Effects

    ERIC Educational Resources Information Center

    Nabi, Robin L.

    2009-01-01

    The recent proliferation of reality-based television programs highlighting cosmetic surgery has raised concerns that such programming promotes unrealistic expectations of plastic surgery and increases the desire of viewers to undergo such procedures. In Study 1, a survey of 170 young adults indicated little relationship between cosmetic surgery…

  10. Spinal Anesthesia in Elderly Patients Undergoing Lumbar Spine Surgery.

    PubMed

    Lessing, Noah L; Edwards, Charles C; Brown, Charles H; Ledford, Emily C; Dean, Clayton L; Lin, Charles; Edwards, Charles C

    2017-03-01

    Spinal anesthesia is increasingly viewed as a reasonable alternative to general anesthesia for lumbar spine surgery. However, the results of spinal anesthesia in elderly patients undergoing lumbar spine decompression and combined decompression and fusion procedures are limited in the literature. The aim of this study was to report a single institution's experience using spinal anesthesia in elderly patients undergoing lumbar spine surgery. A retrospective review was conducted using a prospectively collected database of consecutive lumbar spine surgeries performed under spinal anesthesia in patients 70 years or older at a single center between December 2013 and October 2015. A total of 56 patients were included in the study; 27 patients (48%) underwent lumbar decompression and 29 patients (52%) underwent combined decompression and fusion procedures. Mean operative time was 101 minutes (range, 30-210 minutes), and mean operative blood loss was 187 mL (range, 20-700 mL). Mean maximum inpatient postoperative visual analog scale score was 6.2 (range, 1-10). Nausea occurred in 21% (12 of 56) of the patients. Mean length of stay was 2.4 days (range, 1-6 days). No mortality, stroke, permanent loss of function, or pulmonary embolism occurred. None of the cases required conversion to general anesthesia. All of the patients were ambulatory on either the day of the surgery or the next morning. These results demonstrate that spinal anesthesia is a viable method of anesthesia for patients 70 years and older undergoing lumbar spine surgery. They also demonstrate the safety of this method for patients older than 84 years and for surgeries lasting up to 3½ hours. [Orthopedics. 2017; 40(2):e317-e322.].

  11. Role of concomitant tricuspid surgery in moderate functional tricuspid regurgitation in patients undergoing left heart valve surgery.

    PubMed

    Mahesh, Balakrishnan; Wells, Francis; Nashef, Samer; Nair, Sukumaran

    2013-01-01

    Functional tricuspid regurgitation (FTR) is frequently present in patients undergoing aortic, and particularly mitral valve, surgery. Untreated FTR may lead to right heart failure. Reoperative cardiac surgery for late FTR is associated with high morbidity and mortality. Therefore, severe FTR has emerged as a Class I indication for concomitant tricuspid valve surgery in patients undergoing left valve surgery. Concomitant tricuspid valve surgery during left heart valve surgery to address moderate and mild FTR is controversial. This review addresses this issue and proposes an algorithm for the treatment of FTR in patients undergoing left heart valve surgery.

  12. Nursing students' perceptions of clients undergoing elective cosmetic surgery.

    PubMed

    Cooper, Leah Beth

    2007-01-01

    Aesthetic obsession is commonplace in current society. Supermarket a isles dedicated to beauty products, makeup, and anti-aging creams seem to expand daily. Television and publications flood the public with messages of what constitutes beauty and how to achieve the ideal. Surgical alteration of the body is swiftly becoming a form of self-care technique along with other heath-promoting behavior. Since 2003, the general acceptance of plastic surgery among all Americans surpassed 50% (American Society for Aesthetic Plastic Surgery, 2003). Elective cosmetic surgical procedures have increased by an astounding 444% since 1997 (American Society of Plastic Surgeons, 2006). This quest for body satisfaction based on modern cultural norms increases the public's need for accurate information and understanding from those in the healthcare profession. Despite a transformation in the general population's conception of cosmetic surgery and its clients, stigma still lies in many individuals, including those in the healthcare profession. As this progressively growing patient population emerges, many in healthcare question their attitudes toward plastic surgery and the patients receiving aesthetic operations. With clients undergoing plastic surgery becoming increasingly visible within the healthcare system, some unique aspects of patient care must be addressed.

  13. Preoperative Optimization of the Heart Failure Patient Undergoing Cardiac Surgery.

    PubMed

    Pichette, Maxime; Liszkowski, Mark; Ducharme, Anique

    2017-01-01

    Heart failure patients who undergo cardiac surgery are exposed to significant perioperative complications and high mortality. We herein review the literature concerning preoperative optimization of these patients. Salient findings are that end-organ dysfunction and medication should be optimized before surgery. Specifically: (1) reversible causes of anemia should be treated and a preoperative hemoglobin level of 100 g/L obtained; (2) renal function and volume status should be optimized; (3) liver function must be carefully evaluated; (4) nutritional status should be assessed and cachexia treated to achieve a preoperative albumin level of at least 30 g/L and a body mass index > 20; and (5) medication adjustments performed, such as withholding inhibitors of the renin-angiotensin-aldosterone system before surgery and continuing, but not starting, β-blockers. Levels of natriuretic peptides (brain natriuretic peptide [BNP] and N-terminal proBNP) provide additional prognostic value and therefore should be measured. In addition, individual patient's risk should be objectively assessed using standard formulas such as the EuroSCORE-II or Society of Thoracic Surgeons risk scores, which are simple and validated for various cardiac surgeries, including left ventricular assist device implantation. When patients are identified as high risk, preoperative hemodynamic optimization might be achieved with the insertion of a pulmonary artery catheter and hemodynamic-based tailored therapy. Finally, a prophylactic intra-aortic balloon pump might be considered in certain circumstances to decrease morbidity and even mortality, like in some high risk heart failure patients who undergo cardiac surgery, whereas routine preoperative inotropes are not recommended and should be reserved for patients in shock, except maybe for levosimendan.

  14. Predictors of stroke in patients undergoing cardiac surgery

    PubMed Central

    dos Santos, Handerson Nunes; Magedanz, Ellen Hettwer; Guaragna, João Carlos Vieira da Costa; dos Santos, Natalia Nunes; Albuquerque, Luciano Cabral; Goldani, Marco Antonio; Petracco, João Batista; Bodanese, Luiz Carlos

    2014-01-01

    Objective To determine the risk factors related to the development of stroke in patients undergoing cardiac surgery. Methods A historical cohort study. We included 4626 patients aged > 18 years who underwent coronary artery bypass surgery, heart valve replacement surgery alone or heart valve surgery combined with coronary artery bypass grafting between January 1996 and December 2011. The relationship between risk predictors and stroke was assessed by logistic regression model with a significance level of 0.05. Results The incidence of stroke was 3% in the overall sample. After logistic regression, the following risk predictors for stroke were found: age 50-65 years (OR=2.11 - 95% CI 1.05-4.23 - P=0.036) and age >66 years (OR=3.22 - 95% CI 1.6-6.47 - P=0.001), urgent and emergency surgery (OR=2.03 - 95% CI 1.20-3.45 - P=0.008), aortic valve disease (OR=2.32 - 95% CI 1.18-4.56 - P=0.014), history of atrial fibrillation (OR=1.88 - 95% CI 1.05-3.34 - P=0.032), peripheral artery disease (OR=1.81 - 95% CI 1.13-2.92 - P=0.014), history of cerebrovascular disease (OR=3.42 - 95% CI 2.19-5.35 - P<0.001) and cardiopulmonary bypass time > 110 minutes (OR=1.71 - 95% CI 1.16-2.53 - P=0.007). Mortality was 31.9% in the stroke group and 8.5% in the control group (OR=5.06 - 95% CI 3.5-7.33 - P<0.001). Conclusion The study identified the following risk predictors for stroke after cardiac surgery: age, urgent and emergency surgery, aortic valve disease, history of atrial fibrillation, peripheral artery disease, history of cerebrovascular disease and cardiopulmonary bypass time > 110 minutes. PMID:25140462

  15. Oral anticoagulant therapy in patients undergoing dental surgery.

    PubMed

    Weibert, R T

    1992-10-01

    The literature on dental surgery in patients receiving oral anticoagulants is reviewed, and methods of managing anticoagulant therapy to minimize the risk of complications are discussed. Although blood loss during and after oral surgery in patients receiving oral anticoagulant drugs can be substantial, research indicates that most bleeding incidents are not serious and can be controlled by local measures. Studies of 241 anticoagulant-treated patients undergoing more than 500 dental extractions during the 1950s and 1960s showed that only 9 had postoperative bleeding. More recent studies indicate that continued anticoagulation can increase the frequency of prolonged bleeding and delay wound healing. An antifibrinolytic mouthwash containing tranexamic acid can effectively suppress postoperative bleeding. Gelatin sponges, oxidized cellulose, and microcrystalline collagen are other useful hemostatic agents. A reduction in the intensity of anticoagulation therapy has been recommended; the prothrombin time should be measured shortly before the procedure in such patients. In many patients the duration of subtherapeutic anticoagulation must be minimized to reduce the possibility of thromboembolism. An option for high-risk patients is to switch them to heparin. Each patient must be evaluated individually, and the level of risk of the dental procedure and the risk of thromboembolism should be taken into account. In patients taking oral anticoagulants who must undergo dental surgery, careful control of the intensity of anticoagulation and improved methods of local hemostasis can minimize the risk of hemorrhagic complications and thromboembolism.

  16. Hemoglobin optimization and transfusion strategies in patients undergoing cardiac surgery.

    PubMed

    Najafi, Mahdi; Faraoni, David

    2015-07-26

    Although red blood cells (RBCs) transfusion is sometimes associated with adverse reactions, anemia could also lead to increased morbidity and mortality in high-risk patients. For these reasons, the definition of perioperative strategies that aims to detect and treat preoperative anemia, prevent excessive blood loss, and define "optimal" transfusion algorithms is crucial. Although the treatment with preoperative iron and erythropoietin has been recommended in some specific conditions, several controversies exist regarding the benefit-to-risk balance associated with these treatments. Further studies are needed to better define the indications, dosage, and route of administration for preoperative iron with or without erythropoietin supplementation. Although restrictive transfusion strategies in patients undergoing cardiac surgery have been shown to effectively reduce the incidence and the amount of RBCs transfusion without increase in side effects, some high-risk patients (e.g., symptomatic acute coronary syndrome) could benefit from higher hemoglobin concentrations. Despite all efforts made last decade, a significant amount of work remains to be done to improve hemoglobin optimization and transfusion strategies in patients undergoing cardiac surgery.

  17. All about ketamine premedication for children undergoing ophtalmic surgery

    PubMed Central

    Altiparmak, Başak; Akça, Başak; Yilbaş, Aysun Ankay; Çelebi, Nalan

    2015-01-01

    Ketamine is a non-barbiturate cyclohexamine derivative which produces a state of sedation, immobility, analgesia, amnesia, and dissociation from the environment. One of the most important advantages of ketamine premedication is production of balanced sedation with less respiratory depression and less changes in blood pressure or heart rate. As its effects on intracranial pressure, the possible effect of ketamine on intraocular pressure has been controversial overtime. In this study, we aimed to demostrate all the advantages and possible side effects of ketamine premedication in 100 children with retinablastoma undergoing ophthalmic surgery. All the children were premedicated with ketamine 5 mg kg-1 15 minutes before the examination orally and peroperative complications, reaction to intravenous catheter insertion, need for additive dose and intraocular pressures of children were recorded. We showed that ketamine administration orally is a safe and effective way of premedication for oncologic patients undergoing examination under general anaesthesia. The incidence of agitation, anxiety at parental separation and reaction to insertion of intravenous catheter was very low while adverse side effects were seen rarely. Intraocular pressure which is very important for most of the ophthalmic surgery patients remained in normal ranges. PMID:26885101

  18. Pharmacokinetics of ampicillin and sulbactam in patients undergoing heart surgery.

    PubMed Central

    Wildfeuer, A; Müller, V; Springsklee, M; Sonntag, H G

    1991-01-01

    The pharmacokinetics of ampicillin and sulbactam, a new beta-lactamase inhibitor, were investigated in 16 patients undergoing prosthetic cardiac valve insertion. The combination of 2 g of ampicillin and 1 g of sulbactam was administered as perioperative prophylaxis intravenously over 3 to 6 days. Several serum pharmacokinetic parameters were similar for the two drugs after three intravenous doses were given to patients following surgery. The half-lives of elimination of ampicillin and sulbactam were 79 +/- 4.9 and 88 +/- 5.9 min, the volumes of distribution were 15.6 +/- 1.4 and 17.7 +/- 1.2 liters/70 kg, and the total plasma clearances were 144.4 +/- 14.5 and 147.2 +/- 14.5 ml/min, respectively. The peak concentrations of ampicillin and sulbactam in serum were calculated to be 134.3 +/- 1.3 and 58.3 +/- 1.2 micrograms/ml, respectively. Ampicillin and sulbactam rapidly penetrated from the blood into various tissues collected during heart surgery, such as sternum, pericardium, myocardium, and endocardium. The concentrations of ampicillin in tissue ranged from 17.8 +/- 9.9 to 50 +/- 29.5 micrograms/g, and those of sulbactam in tissue ranged from 8.8 +/- 6.2 to 19.6 +/- 10.1 micrograms/g. The concentrations of ampicillin and sulbactam in serum and tissue also apparently exceeded the MICs against most beta-lactamase-producing bacteria usually involved in postoperative wound infections and prosthetic valve endocarditis. The ratio of the two compounds was approximately 2:1 in serum and in the various tissues affected by the operation. The pharmacokinetics of ampicillin and sulbactam in serum and investigated tissues suggest that the combination of the two beta-lactams will be effective in the perioperative prophylaxis of patients undergoing heart surgery. PMID:1952846

  19. Management of antithrombotic therapy in patients undergoing electrophysiological device surgery.

    PubMed

    Zacà, Valerio; Marcucci, Rossella; Parodi, Guido; Limbruno, Ugo; Notarstefano, Pasquale; Pieragnoli, Paolo; Di Cori, Andrea; Bongiorni, Maria Grazia; Casolo, Giancarlo

    2015-06-01

    The aim of this review is to formulate practical recommendations for the management of antithrombotic therapy in patients undergoing cardiac implantable electronic device (CIED) surgery by providing indications for a systematic approach to the problem integrating general technical considerations with patient-specific elements based on a careful evaluation of the balance between haemorrhagic and thromboembolic risk. Hundreds of thousands patients undergo implantation or replacement of CIEDs annually in Europe, and up to 50% of these subjects receive antiplatelet agents or oral anticoagulants. The rate of CIED-related complications, mainly infective, has also significantly increased so that transvenous lead extraction procedures are, consequently, often required. Cardiac implantable electronic device surgery is peculiar and portends specific intrinsic risks of developing potentially fatal haemorrhagic complications; on the other hand, the periprocedural suspension of antithrombotic therapy in patients with high thromboembolic risk cardiac conditions may have catastrophic consequences. Accordingly, the management of the candidate to CIED surgery receiving concomitant antithrombotic therapy is a topic of great clinical relevance yet controversial and only partially, if at all, adequately addressed in evidence-based current guidelines. In spite of the fact that in many procedures it seems reasonably safe to proceed with aspirin only or without interruption of anticoagulants, restricting to selected cases the use of bridging therapy with parenteral heparins, there are lots of variables that may make the therapeutic choices challenging. The decision-making process applied in this document relies on the development of a stratification of the procedural haemorrhagic risk and of the risk deriving from the suspension of antiplatelet or anticoagulant therapy combined to generate different clinical scenarios with specific indications for optimal management of periprocedural

  20. Anesthesia for Adults Having Eye Surgery

    MedlinePlus

    ... Español Condiciones Chinese Conditions Anesthesia for Adults Having Eye Surgery En Español What kinds of anesthesia are available for adults having eye surgery? A “general”, “local”, or “topical” anesthesia is ...

  1. Levosimendan in Patients with Left Ventricular Dysfunction Undergoing Cardiac Surgery.

    PubMed

    Mehta, Rajendra H; Leimberger, Jeffrey D; van Diepen, Sean; Meza, James; Wang, Alice; Jankowich, Rachael; Harrison, Robert W; Hay, Douglas; Fremes, Stephen; Duncan, Andra; Soltesz, Edward G; Luber, John; Park, Soon; Argenziano, Michael; Murphy, Edward; Marcel, Randy; Kalavrouziotis, Dimitri; Nagpal, Dave; Bozinovski, John; Toller, Wolfgang; Heringlake, Matthias; Goodman, Shaun G; Levy, Jerrold H; Harrington, Robert A; Anstrom, Kevin J; Alexander, John H

    2017-03-19

    Background Levosimendan is an inotropic agent that has been shown in small studies to prevent or treat the low cardiac output syndrome after cardiac surgery. Methods In a multicenter, randomized, placebo-controlled, phase 3 trial, we evaluated the efficacy and safety of levosimendan in patients with a left ventricular ejection fraction of 35% or less who were undergoing cardiac surgery with the use of cardiopulmonary bypass. Patients were randomly assigned to receive either intravenous levosimendan (at a dose of 0.2 μg per kilogram of body weight per minute for 1 hour, followed by a dose of 0.1 μg per kilogram per minute for 23 hours) or placebo, with the infusion started before surgery. The two primary end points were a four-component composite of death through day 30, renal-replacement therapy through day 30, perioperative myocardial infarction through day 5, or use of a mechanical cardiac assist device through day 5; and a two-component composite of death through day 30 or use of a mechanical cardiac assist device through day 5. Results A total of 882 patients underwent randomization, 849 of whom received levosimendan or placebo and were included in the modified intention-to-treat population. The four-component primary end point occurred in 105 of 428 patients (24.5%) assigned to receive levosimendan and in 103 of 421 (24.5%) assigned to receive placebo (adjusted odds ratio, 1.00; 99% confidence interval [CI], 0.66 to 1.54; P=0.98). The two-component primary end point occurred in 56 patients (13.1%) assigned to receive levosimendan and in 48 (11.4%) assigned to receive placebo (adjusted odds ratio, 1.18; 96% CI, 0.76 to 1.82; P=0.45). The rate of adverse events did not differ significantly between the two groups. Conclusions Prophylactic levosimendan did not result in a rate of the short-term composite end point of death, renal-replacement therapy, perioperative myocardial infarction, or use of a mechanical cardiac assist device that was lower than the rate

  2. Cangrelor in patients undergoing cardiac surgery: the BRIDGE study.

    PubMed

    Voeltz, Michele D; Manoukian, Steven V

    2013-07-01

    The benefit of long-term dual antiplatelet therapy (DAPT) in patients with acute coronary syndromes, drug-eluting stents and those at high risk for thromboembolic events has been well established in a number of well-designed randomized controlled studies. Current research in this area has focused on the development of novel antiplatelet agents for clinical use. The BRIDGE trial evaluated the use of cangrelor as a bridge to coronary artery bypass graft surgery in patients receiving extended DAPT. The BRIDGE trial results confirm the efficacy and safety of cangrelor in this population. This study is novel as it attempts to address the lapse in thienopyridine therapy required for many surgical and invasive procedures. The future of antiplatelet agents, particularly cangrelor, must also focus on bridging for high-risk patients undergoing noncoronary artery bypass graft surgical procedures. Overall, the BRIDGE trial represents a significant advance for patients appropriate for long-term DAPT.

  3. Respiratory management of the obese patient undergoing surgery

    PubMed Central

    Hodgson, Luke E.; Murphy, Patrick B.

    2015-01-01

    As a reflection of the increasing global incidence of obesity, there has been a corresponding rise in the proportion of obese patients undergoing major surgery. This review reports the physiological effect of these changes in body composition on the respiratory system and discusses the clinical approach required to maximize safety and minimize the risk to the patient. The changes in respiratory system compliance and lung volumes, which can adversely affect pulmonary gas exchange, combined with upper airways obstruction and sleep-disordered breathing need to be considered carefully in the peri-operative period. Indeed, these challenges in the obese patient have led to a clear focus on the clinical management strategy and development of peri-operative pathways, including pre-operative risk assessment, patient positioning at induction and under anesthesia, modified approach to intraoperative ventilation and the peri-operative use of non-invasive ventilation (NIV) and continuous positive airways pressure. PMID:26101653

  4. Psychologists in preoperative programmes for children undergoing surgery.

    PubMed

    Cuzzocrea, Francesca; Costa, Sebastiano; Gugliandolo, Maria Cristina; Larcan, Rosalba

    2016-06-01

    This study aimed to verify whether psychologists and game activities could reduce preoperative anxiety and promote compliance in paediatric patients. More specifically, we sought to evaluate whether it would be better to propose contextualized games or just distracting activities. A total of 104 children undergoing surgery were assigned to the following 4 conditions of treatment: (1) contextual games and psychological accompaniment, (2) only contextual games, (3) distracting activities, and (4) only psychological accompaniment. Observed children's anxiety was assessed using modified Yale Preoperative Anxiety Scale and compliant behaviours with modified form of Induction Compliance Checklist. Children in the first condition (complete intervention - contextual games and psychological accompaniment) were less anxious and more cooperative in the preoperative period and during the induction of anaesthesia than in the other three conditions. In particular, contextual activities (second condition) were found to be more efficient than psychological accompaniment (fourth condition), whereas the worst condition was proposing only distracting activities (third condition). In order to help young hospitalized patients in paediatric surgery structures, it is necessary to propose games that can prepare them for what will happen as well as the support of a psychologist.

  5. Prediction of cardiac risk in patients undergoing vascular surgery

    SciTech Connect

    Morise, A.P.; McDowell, D.E.; Savrin, R.A.; Goodwin, C.A.; Gabrielle, O.F.; Oliver, F.N.; Nullet, F.R.; Bekheit, S.; Jain, A.C.

    1987-03-01

    In an attempt to determine whether noninvasive cardiac testing could be used to assess cardiac risk in patients undergoing surgery for vascular disease, the authors studied 96 patients. Seventy-seven patients eventually underwent major vascular surgery with 11 (14%) experiencing a significant cardiac complication. Thallium imaging was much more likely to be positive (p less than 0.01) in patients with a cardiac complication; however, there was a significant number of patients with cardiac complications who had a positive history or electrocardiogram for myocardial infarction. When grouped by complication and history of infarction, thallium imaging, if negative, correctly predicted low cardiac risk in the group with a history of infarction. Thallium imaging, however, did not provide a clear separation of risk in those without a history of infarction. Age and coronary angiography, on the other hand, did reveal significant differences within the group without a history of infarction. The resting radionuclide ejection fraction followed a similar pattern to thallium imaging. It is concluded that a positive history of myocardial infarction at any time in the past is the strongest risk predictor in this population and that the predictive value of noninvasive testing is dependent on this factor. Considering these findings, a proposed scheme for assessing risk that will require further validation is presented.

  6. Postoperative urinary retention in patients undergoing elective spinal surgery.

    PubMed

    Altschul, David; Kobets, Andrew; Nakhla, Jonathan; Jada, Ajit; Nasser, Rani; Kinon, Merritt D; Yassari, Reza; Houten, John

    2017-02-01

    OBJECTIVE Postoperative urinary retention (POUR) is a common problem leading to morbidity and an increased hospital stay. There are limited data regarding its baseline incidence in patients undergoing spinal surgery and the risk factors with which it may be associated. The purpose of this study was to evaluate the incidence of POUR in elective spine surgery patients and determine the factors associated with its occurrence. METHODS The authors retrospectively reviewed the records of patients who had undergone elective spine surgery and had been prospectively monitored for POUR during an 18-month period. Collected data included operative positioning, surgery duration, volume of intraoperative fluid, length of hospital stay, and patient characteristics such as age, sex, and medical comorbidities. Dialysis patients or those with complete urinary retention preoperatively were excluded from analysis. RESULTS Of the 397 patients meeting the study inclusion criteria, 35 (8.8%) developed POUR. An increased incidence of POUR was noted in those who underwent posterior lumbar surgery, those with benign prostatic hypertrophy (BPH), those with chronic constipation or prior urinary retention, and those using a patient-controlled analgesia pump postoperatively. An increased incidence of POUR was seen with a longer operative time but not with intraoperative intravenous fluid administration. A significant relationship between the female sex and POUR was noted after controlling for BPH, yet there was no association between POUR and diabetes or intraoperative instrumentation. Postoperative retention significantly prolonged the hospital stay. Three patients developed epidural hematomas necessitating operative reexploration, and while they experienced POUR, they also developed the full constellation of cauda equina syndrome. CONCLUSIONS Awareness of the risk factors for POUR may be useful in perioperative Foley catheter management and in identifying patients who need particular

  7. Value of extended warming in patients undergoing elective surgery.

    PubMed

    Wasfie, Tarik J; Barber, Kimberly R

    2015-01-01

    Perioperative temperature management is imperative for positive surgical outcomes. This study assessed the clinical and wellbeing benefits of extending normothermia by using a portable warming gown. A total of 94 patients undergoing elective surgery were enrolled. They were randomized pre-operatively to either a portable warming gown or the standard warming procedure. The warming gown stayed with patients from pre-op to operating room to postrecovery room discharge. Core temperature was tracked throughout the study. Patients also provided responses to a satisfaction and comfort status survey. The change in average core temperature did not differ significantly between groups (P = 0.23). A nonsignificant 48% relative decrease in hypothermic events was observed for the extended warming group (P = 0.12). Patients receiving the warming gown were more likely to report always having their temperature controlled (P = 0.04) and significantly less likely to request additional blankets for comfort (P = 0.006). Clinical outcomes and satisfaction were improved for patients with extended warming.

  8. Prevalence of acute post-operative pain in patients in adult age-group undergoing inpatient abdominal surgery and correlation of intensity of pain and satisfaction with analgesic management: A cross-sectional single institute-based study

    PubMed Central

    Singh, Prashant Kumar; Saikia, Priyam; Lahakar, Mangala

    2016-01-01

    Background and Aims: Considering the paucity of regional data, this study was designed to investigate the prevalence of post-operative pain and determine if there exists any correlation between the intensity of post-operative pain and patient's level of satisfaction with their pain management after inpatient abdominal surgery at an academic tertiary care government centre. Methods: Pain intensity was measured in 120 patients with numeric rating scale at the fifth post-operative hour, second and third post-operative day. A questionnaire was used to measure the level of satisfaction with nurse's and doctor's response to their pain and overall pain management. Results: The prevalence of post-operative pain was 84.17%, 92.5% and 96.66% at the fifth post-operative hour, second and third post-operative day, respectively. Less number of patients experienced severe intensity pain on the third post-operative day (P = 0.00046), whereas the number of patients experiencing mild pain increased (P < 0.000) compared to the fifth post-operative hour. The number of patients with complete analgesia decreased on the third post-operative day (P = 0.001 compared to fifth post-operative day). The Spearman correlation coefficient between pain score on the third post-operative day and level of satisfaction with nurse's response, doctor's response to pain and the overall pain management was − 0.0218 (P = 0.8107), 0.1307 (P = 0.1553) and 0.0743 (P = 0.4195), respectively. Conclusion: There is a high prevalence of acute post-operative pain in patients undergoing inpatient abdominal surgery at our institute. There is a weak correlation between the intensity of pain and level of satisfaction with pain management. PMID:27761037

  9. Enhanced Recovery After Surgery Program in Patients Undergoing Pancreaticoduodenectomy

    PubMed Central

    Xiong, Junjie; Szatmary, Peter; Huang, Wei; de la Iglesia-Garcia, Daniel; Nunes, Quentin M.; Xia, Qing; Hu, Weiming; Sutton, Robert; Liu, Xubao; Raraty, Michael G.

    2016-01-01

    Abstract Enhanced recovery after surgery (ERAS) pathways are multimodal, evidence-based approaches to optimize patient outcome after surgery. However, the use of ERAS protocols to improve morbidity and recovery time without compromising safety following pancreaticoduodenectomy (PD) remains to be elucidated. We conducted a systemic review and meta-analysis to assess the safety and efficacy of ERAS protocols compared with conventional perioperative care (CPC) in patients following PD. PubMed, Medline, Embase, and Science Citation Index Expanded and Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library were searched between January 2000 and June 2015. The patients who underwent PD with ERAS protocols or CPC were eligible. The studies that compared postoperative length of hospital stay (PLOS), postoperative complications, or in-hospital costs in the 2 groups were included. A meta-analysis, meta-regression, sensitivity analysis, and subgroup analysis were performed to estimate the postoperative outcomes between the 2 groups and identified the potential confounders. We used the methodological index for nonrandomized studies checklist to assess methodological qualities. Weighted mean differences (WMD) or odds ratios (OR) were calculated with their corresponding 95% confidence intervals (CI). The publication bias tests were also performed through the funnel plots. In total, 14 nonrandomized comparative studies with 1409 ERAS cases and 1310 controls were analyzed. Implementation of an ERAS protocol significantly reduced PLOS (WMD: −4.17 days; 95%CI: −5.72 to −2.61), delayed gastric emptying (OR: 0.56; 95%CI: 0.44–0.71), overall morbidity (OR: 0.63; 95% CI: 0.54–0.74), and in-hospital costs compared to CPC (all P < 0.001). There were no statistically significant differences in other postoperative outcomes. Age, gender, and ERAS component implementation did not significantly contribute to heterogeneity for PLOS as shown by meta

  10. Incidental adenocarcinoma in patients undergoing surgery for stricturing Crohn's disease

    PubMed Central

    Kristo, Ivan; Riss, Stefan; Argeny, Stanislaus; Maschke, Svenja; Chitsabesan, Praminthra; Stift, Anton

    2017-01-01

    AIM To evaluate frequency and clinical course of incidental adenocarcinoma in patients with stricturing Crohn's disease (CD). METHODS In this study, consecutive patients, who were operated on for stricturing CD between 1997-2012, were included at an academic tertiary referral center. Demographic data and clinical course were obtained by an institutional database and individual chart review. Besides baseline characteristics, intraoperative findings and CD related history were also recorded. Colorectal cancer was classified and staged according to the Union for International Cancer Control (UICC). RESULTS During the study period 484 patients underwent resections due to stricturing CD. Incidental adenocarcinoma was histologically confirmed in 6 (1.2%) patients (4 males, 2 females). Patients diagnosed with colorectal cancer had a median age of 43 (27-66) years and a median history of CD of 16 (7-36) years. Malignant lesions were found in the rectum (n = 4, 66.7%), descending colon (n = 1, 16.7%) and ileocolon (n = 1, 16.7%). According to the UICC classification two patients were stages as I (33.3%), whereas the other patients were classified as stage IIA (16.7%), stage IIIB (16.7%), stage IIIC (16.7%) and stage IV (16.7%), respectively. After a median follow-up of 2 (0.03-8) years only 1 patient is still alive. CONCLUSION The frequency of incidental colorectal cancer in patients, who undergo surgery for stenotic CD, is low but associated with poor prognosis. However, surgeons need to be aware about the possibility of malignancy in stricturing CD, especially if localized in the rectum. PMID:28210083

  11. Responsive measures to prehabilitation in patients undergoing bowel resection surgery.

    PubMed

    Kim, Do Jun; Mayo, Nancy E; Carli, Franco; Montgomery, David L; Zavorsky, Gerald S

    2009-02-01

    Surgical patients often show physiological and metabolic distress, muscle weakness, and long hospital stays. Physical conditioning might help recovery. We attempted to identify the most responsive measure of aerobic fitness from a four-week pre-surgical aerobic exercise program (prehabilitation) in patients undergoing major bowel resection. Twenty-one subjects randomized two to one (exercise: control) scheduled for colorectal surgery. Fourteen subjects [Body Mass Index (BMI) = 27 +/- 6 kg/m(2); maximal oxygen uptake (VO(2max)) = 22 +/- 10 ml/kg/min] underwent 3.8 +/- 1.2 weeks (27 +/- 8 sessions) of progressive, structured pre-surgical aerobic exercise training at 40 to 65% of heart rate reserve (%HRR). Peak power output was the only maximal measure that was responsive to training [26 +/- 27%, Effects Size (ES) = 0.24; Standardized Response Mean (SRM) = 1.05; p < 0.05]. For the submaximal measures, heart rate and oxygen uptake during submaximal exercise was most responsive to training (decrease by 13% +/- 15%, ES = -0.24; SRM = -0.57; and 7% +/- 6%, ES = -0.40; SRM -0.97; p < 0.05) at an exercise intensity of 76 +/- 47 W. There was no change to maximal or submaximal measures in the control group. The distance walked over six minutes improved in both groups (by approximately 30 m), but the effect size and t-statistic were higher in the exercise group. Heart rate and oxygen uptake during submaximal exercise, and peak power output are the most responsive measures to four weeks of prehabilitation in subjects with low initial fitness.

  12. Clinical Associations of Early Dysnatremias in Critically Ill Neonates and Infants Undergoing Cardiac Surgery.

    PubMed

    Kaufman, Jon; Phadke, Daniel; Tong, Suhong; Eshelman, Jennifer; Newman, Sarah; Ruzas, Christopher; da Cruz, Eduardo M; Osorio, Suzanne

    2017-01-01

    Dysnatremias (DN) are common electrolyte disturbances in cardiac critical illness and are known risk factors for adverse outcomes in certain populations. Little information exists on DN in children with cardiac disease admitted to the cardiac intensive care unit (CICU) after undergoing cardiac surgery, either corrective or palliative. The aim was to determine the incidence and adverse outcomes associated with DN in neonates and infants undergoing cardiac surgery. Retrospective cohort and single center study performed at Children's Hospital Colorado from May 2013 to May 2014, in children under 1 year old admitted to the CICU after undergoing surgery for congenital or acquired cardiac disease. 183 subjects were analyzed.

  13. Weight and patients' decision to undergo cardiac surgery.

    PubMed

    King-Shier, Kathryn M; LeBlanc, Pamela; Mather, Charles; Sandham, Sarah; Seneviratne, Cydnee; Maitland, Andrew

    2013-05-01

    Obese patients are less likely to have cardiac surgery than normal weight patients. This could be due to physician or patient decision-making. We undertook a qualitative descriptive study to explore the influence of obesity on patients' decision-making to have cardiac surgery. Forty-seven people referred for coronary artery bypass graft (CABG) surgery were theoretically sampled. Twelve people had declined cardiac surgery. Participants underwent in-depth interviews aimed at exploring their decision-making process. Data were analyzed using conventional content analysis. Though patients' weight did not play a role in their decision, their relationship with their cardiologist/surgeon, the rapidity and orchestration of the diagnosis and treatment, appraisal of risks and benefits, previous experience with other illness or others who had cardiac surgery, and openness to other alternatives had an impact. It is possible that there is a lack of comfort or acknowledgment by all parties in discussing the influence of weight on CABG surgery risks.

  14. Role of frailty and sarcopenia in predicting outcomes among patients undergoing gastrointestinal surgery

    PubMed Central

    Wagner, Doris; DeMarco, Mara McAdams; Amini, Neda; Buttner, Stefan; Segev, Dorry; Gani, Faiz; Pawlik, Timothy M

    2016-01-01

    According to the United States census bureau 20% of Americans will be older than 65 years in 2030 and half of them will need an operation - equating to about 36 million older surgical patients. Older adults are prone to complications during gastrointestinal cancer treatment and therefore may need to undergo special pretreatment assessments that incorporate frailty and sarcopenia assessments. A focused, structured literature review on PubMed and Google Scholar was performed to identify primary research articles, review articles, as well as practice guidelines on frailty and sarcopenia among patients undergoing gastrointestinal surgery. The initial search identified 450 articles; after eliminating duplicates, reports that did not include surgical patients, case series, as well as case reports, 42 publications on the impact of frailty and/or sarcopenia on outcome of patients undergoing gastrointestinal surgery were included. Frailty is defined as a clinically recognizable state of increased vulnerability to physiologic stressors resulting from aging. Frailty is associated with a decline in physiologic reserve and function across multiple physiologic systems. Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. Unlike cachexia, which is typically associated with weight loss due to chemotherapy or a general malignancy-related cachexia syndrome, sarcopenia relates to muscle mass rather than simply weight. As such, while weight reflects nutritional status, sarcopenia - the loss of muscle mass - is a more accurate and quantitative global marker of frailty. While chronologic age is an important element in assessing a patient’s peri-operative risk, physiologic age is a more important determinant of outcomes. Geriatric assessment tools are important components of the pre-operative work-up and can help identify patients who suffer from frailty. Such data are important, as frailty and sarcopenia have repeatedly been

  15. Psychological assessment of the patient undergoing bariatric surgery.

    PubMed

    Snyder, Allison G

    2009-01-01

    The purpose of this article is to provide an overview of the critical domains assessed during the psychological evaluation of candidates for bariatric surgery. Although no formal standard exists in the literature, there is growing recognition of the important elements to be addressed and the appropriate means for collecting the necessary data to determine psychological readiness for these procedures. Information regarding the components of the clinical interview and the specific measures used for psychological testing are discussed. Given the limited data on predicting success after surgery, determining psychological contraindications for surgery is addressed. Additionally, the multiple functions served by the psychologist during this assessment procedure are highlighted along with the value of this procedure in the patients' preparation for surgery.

  16. The prevalence of iron deficiency anaemia in patients undergoing bariatric surgery.

    PubMed

    Khanbhai, M; Dubb, S; Patel, K; Ahmed, A; Richards, T

    2015-01-01

    As bariatric surgery rates continue to climb, anaemia will become an increasing concern. We assessed the prevalence of anaemia and length of hospital stay in patients undergoing bariatric surgery. Prospective data (anaemia [haemoglobin <12 g/dL], haematinics and length of hospital stay) was analysed on 400 hundred patients undergoing elective laparoscopic bariatric surgery. Results from a prospective database of 1530 patients undergoing elective general surgery were used as a baseline. Fifty-seven patients (14%) were anaemic pre-operatively, of which 98% were females. Median MCV (fL) and overall median ferritin (μg/L) was lower in anaemic patients (83 vs. 86, p=0.001) and (28 vs. 61, p<0.0001) respectively. In the elective general surgery patients, prevalence of anaemia was similar (14% vs. 16%) but absolute iron deficiency was more common in those undergoing bariatric surgery; microcytosis p<0.0001, ferritin <30 p<0.0001. Mean length of stay (days) was increased in the anaemic compared to in the non-anaemic group (2.7 vs. 1.9) and patients who were anaemic immediately post-operatively, also had an increased length of stay (2.7 vs. 1.9), p<0.05. Absolute iron deficiency was more common in patients undergoing bariatric surgery. In bariatric patients with anaemia there was an overall increased length of hospital stay.

  17. Prevention of venous thromboembolism in patients undergoing bariatric surgery.

    PubMed

    Bartlett, Matthew A; Mauck, Karen F; Daniels, Paul R

    2015-01-01

    Bariatric surgical procedures are now a common method of obesity treatment with established effectiveness. Venous thromboembolism (VTE) events, which include deep vein thrombosis and pulmonary embolism, are an important source of postoperative morbidity and mortality among bariatric surgery patients. Due to an understanding of the frequency and seriousness of these complications, bariatric surgery patients typically receive some method of VTE prophylaxis with lower extremity compression, pharmacologic prophylaxis, or both. However, the optimal approach in these patients is unclear, with multiple open questions. In particular, strategies of adjusted-dose heparins, postdischarge anticoagulant prophylaxis, and the role of vena cava filters have been evaluated, but only to a limited extent. In contrast to other types of operations, the literature regarding VTE prophylaxis in bariatric surgery is notable for a dearth of prospective, randomized clinical trials, and current professional guidelines reflect the uncertainties in this literature. Herein, we summarize the available evidence after systematic review of the literature regarding approaches to VTE prevention in bariatric surgery. Identification of risk factors for VTE in the bariatric surgery population, analysis of the effectiveness of methods used for prophylaxis, and an overview of published guidelines are presented.

  18. Plasma carnitine concentrations in patients undergoing open heart surgery.

    PubMed

    Nemoto, Shintaro; Yasuhara, Kiyomitsu; Nakamura, Katsutoshi; Miyoshi, Yutaka; Sakai, Akira

    2004-02-01

    Carnitine is an essential cofactor for fatty acid (FA) metabolism, the predominant source of ATP in the normal aerobic heart. During myocardial ischemia, FA metabolism is impaired and tissue carnitine levels are depleted. Since the heart cannot synthesize carnitine, plasma carnitine could play an important role in maintaining myocardial carnitine levels during reperfusion. The purpose of this study was to determine the incidence of abnormal plasma carnitine concentrations in open heart surgery. Blood samples were obtained from eleven patients before, immediately after, and two hours after cardiopulmonary bypass (CPB). Total and free carnitine levels were significantly reduced immediately after CPB (p<0.01) and remained depressed until two hours after CPB (p<0.01 vs. pre CPB), while acyl carnitine levels were unchanged over the course of this study. These depressed free carnitine levels might affect cardiac metabolism in the heart after open heart surgery. Carnitine supplement might be a useful adjunct in the therapy after open heart surgery.

  19. [Treatment of anemia in patients undergoing bariatric surgery].

    PubMed

    Basora Macaya, M

    2015-06-01

    Iron deficiency in patients with morbid obesity can occur before bariatric surgery due to its inflammatory component and after surgery as the result of implementing the malabsorptive techniques. For patients with morbid obesity, micronutrient deficiencies, such as vitamin B12, iron and folate, should be suspected. Iron deficiency and other hematinics should be corrected, even when anemia has not been established. Normal ferritin levels do not allow us to rule out a possible iron deficiency, given that ferritin can increase due to the chronic inflammatory condition of obesity. After bariatric surgery, patients should take iron supplements; however, these supplements are frequently poorly tolerated. Rapid and effective correction of hemoglobin levels might require the intravenous administration of iron preparations.

  20. Inappropriate use of antibiotics in patients undergoing gynecologic surgery

    PubMed Central

    Joyce, John; Langsjoen, Jessica; Sharadin, Cynthia; Kuehl, Thomas J.

    2017-01-01

    We retrospectively examined prophylactic antibiotic use and documentation of wound classification in patients having gynecologic surgery at a tertiary hospital. Of the 326 cases reviewed, 175 (54%) received prophylactic antibiotics when not indicated according to guidelines of the American College of Obstetricians and Gynecologists. Antibiotic administration varied significantly (P < 0.02) among the different types of surgery, being given in 82% of laparoscopic cases, 35% of nonobstetrical dilation and curettage and operative hysteroscopy procedures, and 51% of open abdominal procedures. There were no recorded episodes of anaphylaxis or pseudomembranous colitis. In conclusion, antibiotic use is high among gynecologic surgeons at a tertiary hospital, but this use was unnecessary. PMID:28127125

  1. GASTRIC AND JEJUNAL HISTOPATHOLOGICAL CHANGES IN PATIENTS UNDERGOING BARIATRIC SURGERY

    PubMed Central

    RODRIGUES, Rosemary Simões Nomelini; ALMEIDA, Élia Cláudia de Souza; CAMILO, Silvia Maria Perrone; TERRA-JÚNIOR, Júverson Alves; GUIMARÃES, Lucinda Calheiros; DUQUE, Ana Cristina da Rocha; ETCHEBEHERE, Renata Margarida

    2016-01-01

    ABSTRACT Background: Morbid obesity is a multifactorial disease that increasingly is being treated by surgery. Aim: To evaluate gastric histopathological changes in obese, and to compare with patients who underwent gastrojejunal bypass and the jejunal mucosa after the surgery. Methods: This is an observational study performed at a tertiary public hospital, evaluating endoscopic biopsies from 36 preoperative patients and 35 postoperative. Results: In the preoperative group, 80.6% had chronic gastritis, which was active in 38.9% (77.1% and 20.1%, respectively, in the postoperative). The postoperative group had a significant reduction in H. pylori infection (p=0.0001). A longer length of the gastric stump and a time since surgery of more than two years were associated with Helicobacter pylori infection. The jejunal mucosa was normal in 91.4% and showed slight nonspecific chronic inflammation in 8.6%. Conclusion: There was a reduction in the incidence of Helicobacter pylori infection in the postoperative group. A longer length of the gastric stump and longer time elapsed since surgery were associated with Helicobacter pylori infection. The jejunal mucosa was considered normal in an absolute majority of patients. PMID:27683773

  2. Intravenous sedation in 200 geriatric patients undergoing office oral surgery.

    PubMed

    Campbell, R L; Smith, P B

    1997-01-01

    Two hundred geriatric patients ranging from age 65 to 92 yr (mean age 72 yr) were evaluated for office oral surgery and intravenous sedation. Surgical time ranged from 6 to 129 min. Monitored anesthesia care was utilized for the administration of fentanyl, midazolam or diazepam, and methohexital. No serious complications were seen and no patients were hospitalized.

  3. Punctate keratopathy of West Indians in patients undergoing photorefractive surgery

    PubMed Central

    Galvis, Virgilio; Tello, Alejandro; Revelo, Mario L; Paredes, David; Jaramillo, Luis Carlos

    2013-01-01

    We present two cases of patients with corneal lesions compatible with punctate keratopathy of West Indians who underwent photorefractive keratectomy and laser-assisted in situ keratomileusis. Both had good postoperative results. The corneal lesions did not interfere with the refractive surgery. PMID:23355587

  4. Image Quality Analysis of Eyes Undergoing LASER Refractive Surgery

    PubMed Central

    Sarkar, Samrat; Vaddavalli, Pravin Krishna; Bharadwaj, Shrikant R.

    2016-01-01

    Laser refractive surgery for myopia increases the eye’s higher-order wavefront aberrations (HOA’s). However, little is known about the impact of such optical degradation on post-operative image quality (IQ) of these eyes. This study determined the relation between HOA’s and IQ parameters (peak IQ, dioptric focus that maximized IQ and depth of focus) derived from psychophysical (logMAR acuity) and computational (logVSOTF) through-focus curves in 45 subjects (18 to 31yrs) before and 1-month after refractive surgery and in 40 age-matched emmetropic controls. Computationally derived peak IQ and its best focus were negatively correlated with the RMS deviation of all HOA’s (HORMS) (r≥-0.5; p<0.001 for all). Computational depth of focus was positively correlated with HORMS (r≥0.55; p<0.001 for all) and negatively correlated with peak IQ (r≥-0.8; p<0.001 for all). All IQ parameters related to logMAR acuity were poorly correlated with HORMS (r≤|0.16|; p>0.16 for all). Increase in HOA’s after refractive surgery is therefore associated with a decline in peak IQ and a persistence of this sub-standard IQ over a larger dioptric range, vis-à-vis, before surgery and in age-matched controls. This optical deterioration however does not appear to significantly alter psychophysical IQ, suggesting minimal impact of refractive surgery on the subject’s ability to resolve spatial details and their tolerance to blur. PMID:26859302

  5. Pharmacologic management of the older women undergoing surgery

    PubMed Central

    Chiang, S; Gerten, KA; Granieri, E; Richter, HE

    2013-01-01

    Surgical intervention for both emergency and elective surgeries will increase as women live longer and maintain active lifestyles. Older women with operable conditions tolerate elective gynecologic and other nonvascular surgery with acceptable morbidity and mortality. However, increased medical comorbidities with associated increase in polypharmacy and perioperative risks as women age make it important to a priori optimize medical conditions and medication management perioperatively. Other considerations include assessing functional and cognitive status as these may be impaired acutely with increase prevalence of drug use during surgical hospitalization. With aging and postmenopausal status, changes associated with aging appear to play a greater role than gender in pharmacologic responses. Surgical outcomes should be optimize to maintain and even improve patients’ quality of life. PMID:19245357

  6. [Management of patients with arrhythmias undergoing thoracic surgery].

    PubMed

    Ishibashi, H; Okubo, K

    2012-07-01

    Recentry, surgical candidates have become older and have more surgical risk factors, perioperative patient management become more important than before. In the patients with significant arrhythmia observed in the preoperative period, examination of the baseline heart disease, i.e. myocardial ischemia or congestive heart failure, is mandatory and, if necessary, adequate treatment such as defibrillator, the implantation of a pacemaker, anticoagulation therapy, or other medical therapy should be performed. In the patients with atrial fibrillation, clinical prediction rules such as the congestive heart failure, hypertension, age>75, diabetes, previous stroke or transient ischemic attack (TIA) [CHADS 2] score have been developed to identify those patients at highest risk for thrombo-embolism and can be used when assessing the need for bridging anticoagulation by heparin prior to surgery. The electrical stimulus from electrocautery may inhibit demand pacemakers or may reprogram the pacemaker. An asynchronous or non-sensing pacemaker mode is recommended in patients who are pacemaker dependent and whose underlying rhythm is unreliable. The device has to be checked to ensure appropriate programming and sensing pacing thresholds after surgery. The implantable cardioverter defibrillator should be turned off during surgery and switched on in the recovery phase before discharge to the ward.

  7. Combination Treatment of Perioperative Rehabilitation and Psychoeducation Undergoing Thoracic Surgery

    PubMed Central

    Inoue, Takayuki; Nagaya, Motoki; Ito, Satoru; Nakajima, Hiroki; Hattori, Keiko; Kadono, Izumi; Yokoi, Kohei; Nishida, Yoshihiro

    2017-01-01

    Postoperative pulmonary complications are a risk associated with thoracic surgery. However, there have been few reports on cases at high risk of postoperative complications. Cancer patients often have negative automatic thoughts about illness, and these negative automatic thoughts are associated with reduced health behavior and physical activity. This case series demonstrates the successful combination treatment of perioperative rehabilitation and psychoeducation for negative automatic thoughts in two cancer patients who underwent thoracic surgery. One patient underwent pneumonectomy with laryngeal recurrent nerve paralysis; the other patient, who had a history of recurrent hepatic encephalopathy and dialysis, underwent S6 segmentectomy. Both patients had negative automatic thoughts about cancer-related stress and postoperative pain. The physical therapists conducted a perioperative rehabilitation program in which the patients were educated to replace their maladaptive thoughts with more adaptive thoughts. After rehabilitation, the patients had improved adaptive thoughts, increased physical activity, and favorable recovery without pulmonary complications. This indicates that the combination treatment of perioperative rehabilitation and psychoeducation was useful in two thoracic cancer surgery patients. The psychoeducational approach should be expanded to perioperative rehabilitation of patients with cancer. PMID:28280511

  8. Current Practice and Recommendation for Presurgical Cardiac Evaluation in Patients Undergoing Noncardiac Surgeries

    PubMed Central

    Padma, Subramanyam; Sundaram, P. Shanmuga

    2014-01-01

    The increasing number of patients with coronary artery disease (CAD) undergoing major noncardiac surgery justifies guidelines concerning preoperative cardiac evaluation. This is compounded by increasing chances for a volatile perioperative period if the underlying cardiac problems are left uncorrected prior to major noncardiac surgeries. Preoperative cardiac evaluation requires the clinician to assess the patient's probability to have CAD, severity and stability of CAD, placing these in perspective regarding the likelihood of a perioperative cardiac complication based on the planned surgical procedure. Coronary events like new onset ischemia, infarction, or revascularization, induce a high-risk period of 6 weeks, and an intermediate-risk period of 3 months before performing noncardiac surgery. This delay is unwarranted in cases where surgery is the mainstay of treatment. The objective of this review is to offer a comprehensive algorithm in the preoperative assessment of patients undergoing noncardiac surgery and highlight the importance of myocardial perfusion imaging in risk stratifying these patients. PMID:25191106

  9. EVALUATION OF UPPER GASTROINTESTINAL ENDOSCOPY IN PATIENTS UNDERGOING BARIATRIC SURGERY

    PubMed Central

    ASSEF, Maurício Saab; MELO, Tiago Torres; ARAKI, Osvaldo; MARIONI, Fábio

    2015-01-01

    Background: Obesity has become epidemic, and is associated with greater morbidity and mortality. Treatment is multidisciplinary. Surgical treatment is a consistent resource in severe obesity. The indication of preoperative upper gastrointestinal endoscopy in asymptomatic patients is controversial; however, most studies recommend its implementation in all patients. Aim: To analyze endoscopic performance in patients who were in preoperative for bariatric surgery and compare them with control group. Method: A series of 35 obese patients in preoperative period for bariatric surgery compared with a control group of 30 patients submitted to upper endoscopy. There were analyzed clinical and endoscopic data. Results: The mean age of the group of patients was 43.54 years. Most individuals in the group of patients were female with median BMI of 47.26kg/m2and in control group 24.21 kg/m2. The majority of patients were asymptomatic. Upper endoscopy was altered in 81.25% of asymptomatic patients. Endoscopic findings in the patient group were 57.1% resulting from peptic ulcer disease and 34.3% associated with GERD. The analysis of endoscopic findings in patients showed no significant difference in relation of the control group. The prevalence of H. pylori infection was 60% in patients. Conclusion: It is recommended that the upper endoscopy should be made in all patients in the preoperative bariatric surgery period, although the degree of obesity is not related to a greater number of endoscopic findings. Obese patients do not have more endoscopic findings that non-obese individuals. PMID:26537272

  10. Perioperative myocardial infarction in patients undergoing myocardial revascularization surgery

    PubMed Central

    Pretto, Pericles; Martins, Gerez Fernandes; Biscaro, Andressa; Kruczan, Dany David; Jessen, Barbara

    2015-01-01

    Introduction Perioperative myocardial infarction adversely affects the prognosis of patients undergoing coronary artery bypass graft and its diagnosis was hampered by numerous difficulties, because the pathophysiology is different from the traditional instability atherosclerotic and the clinical difficulty to be characterized. Objective To identify the frequency of perioperative myocardial infarction and its outcome in patients undergoing coronary artery bypass graft. Methods Retrospective cohort study performed in a tertiary hospital specialized in cardiology, from May 01, 2011 to April 30, 2012, which included all records containing coronary artery bypass graft records. To confirm the diagnosis of perioperative myocardial infarction criteria, the Third Universal Definition of Myocardial Infarction was used. Results We analyzed 116 cases. Perioperative myocardial infarction was diagnosed in 28 patients (24.1%). Number of grafts and use and cardiopulmonary bypass time were associated with this diagnosis and the mean age was significantly higher in this group. The diagnostic criteria elevated troponin I, which was positive in 99.1% of cases regardless of diagnosis of perioperative myocardial infarction. No significant difference was found between length of hospital stay and intensive care unit in patients with and without this complication, however patients with perioperative myocardial infarction progressed with worse left ventricular function and more death cases. Conclusion The frequency of perioperative myocardial infarction found in this study was considered high and as a consequence the same observed average higher troponin I, more cases of worsening left ventricular function and death. PMID:25859867

  11. [Perioperative management for patients with hypertrophic cardiomyopathy undergoing noncardiac surgery].

    PubMed

    Okuyama, A; Goda, Y; Kawahigashi, H; Takita, K; Okuyama, M; Kubota, M

    1992-01-01

    We had two patients with hypertrophic cardiomyopathy for noncardiac surgeries. Case 1: A 74-year-old man for right nephrectomy received epidural lidocaine and nitrous oxide combined with 0.2-0.6% isoflurane. During the operation, heart rate and blood pressure were relatively unstable, but he woke up promptly after the operation. Early on the morning of the 2nd post-operative day, he was found dead on his bed. Case 2: A 52-year-old man for gastrectomy was anesthetized with nitrous oxide and halothane with continuous propranolol infusion. Through the operative period, heart rate and blood pressure were stable and postoperative course was uneventful. In these two patients, preoperative Holter ECG showed ventricular tachycardia, which may increase the risk of a sudden death. These cases demonstrate that general anesthesia with nitrous oxide combined with halothane, can be administered with a low risk in patients with HCM for noncardiac surgery and that postoperative intensive care unit monitoring is necessary for these patients for several days to prevent a sudden death.

  12. [Nursing care in patients undergoing radiological surgery. A case report].

    PubMed

    Armero-Barranco, David; Ruiz-Mateos, María; Alcaraz-Baños, Miguel; Bernal-Páez, Fernando Luis

    2007-01-01

    We report the case of a 73-year-old man with medical diagnoses of long-standing diabetes mellitus, chronic ischemia of the lower limbs and intermittent claudication, for which the patient had been treated with minimally invasive radiological surgery. On arrival at the radiology unit, the patient had nursing diagnoses of anxiety and fear. Intraoperatively, the client had nursing diagnoses of pain, urine retention and infection risk. At discharge, a collaboration problem was detected and hemorrhagic risk. The patient received individualized nursing care. Interventions were planned following the nursing intervention classification (NIC) and the expected results for these interventions followed the Nursing Outcomes Classification (NOC) taxonomy. The application of an appropriate nursing care plan contributes to making the patient's hospital stay easier, more comfortable and less traumatic.

  13. Myocardial Oxidative Stress in Infants Undergoing Cardiac Surgery.

    PubMed

    Sznycer-Taub, Nathaniel; Mackie, Stewart; Peng, Yun-Wen; Donohue, Janet; Yu, Sunkyung; Aiyagari, Ranjit; Charpie, John

    2016-04-01

    Cardiac surgery for congenital heart disease often necessitates a period of myocardial ischemia during cardiopulmonary bypass and cardioplegic arrest, followed by reperfusion after aortic cross-clamp removal. In experimental models, myocardial ischemia-reperfusion is associated with significant oxidative stress and ventricular dysfunction. A prospective observational study was conducted in infants (<1 year) who underwent elective surgical repair of a ventricular septal defect (VSD) or tetralogy of Fallot (TOF). Blood samples were drawn following anesthetic induction (baseline) and directly from the coronary sinus at 1, 3, 5, and 10 min following aortic cross-clamp removal. Samples were analyzed for oxidant stress using assays for thiobarbituric acid-reactive substances, protein carbonyl, 8-isoprostane, and total antioxidant capacity. For each subject, raw assay data were normalized to individual baseline samples and expressed as fold-change from baseline. Results were compared using a one-sample t test with Bonferroni correction for multiple comparisons. Sixteen patients (ten with TOF and six with VSD) were enrolled in the study, and there were no major postoperative complications observed. For the entire cohort, there was an immediate, rapid increase in myocardial oxidative stress that was sustained for 10 min following aortic cross-clamp removal in all biomarker assays (all P < 0.01), except total antioxidant capacity. Infant cardiac surgery is associated with a rapid, robust, and time-dependent increase in myocardial oxidant stress as measured from the coronary sinus in vivo. Future studies with larger enrollment are necessary to assess any association between myocardial oxidative stress and early postoperative outcomes.

  14. Recommendations for management of antiplatelet therapy in patients undergoing elective noncardiac surgery after coronary stent implantation.

    PubMed

    Huang, Pei-Hsiu; Croce, Kevin J; Bhatt, Deepak L; Resnic, Frederic S

    2012-12-01

    Patients commonly undergo noncardiac surgical procedures after implantation of a coronary stent. In the case where surgery cannot be deferred until completing the minimum duration of dual antiplatelet therapy, the Brigham and Women's Hospital Cardiac Catheterization Laboratory recommends using a glycoprotein IIb/IIIa bridging protocol to minimize the risk of perioperative ischemic events. We discuss our algorithm for managing antiplatelet agents, including the newer agents, prasugrel and ticagrelor, in patients undergoing noncardiac surgery after coronary stenting and present our glycoprotein IIb/IIIa bridging strategy along with a review of the relevant pharmacodynamic and clinical evidence.

  15. Myenteric plexitis: A frequent feature in patients undergoing surgery for colonic diverticular disease

    PubMed Central

    Villanacci, Vincenzo; Sidoni, Angelo; Nascimbeni, Riccardo; Dore, Maria P; Binda, Gian A; Bandelloni, Roberto; Salemme, Marianna; Del Sordo, Rachele; Cadei, Moris; Manca, Alessandra; Bernardini, Nunzia; Maurer, Christoph A; Cathomas, Gieri

    2015-01-01

    Background Diverticular disease of the colon is frequent in clinical practice, and a large number of patients each year undergo surgical procedures worldwide for their symptoms. Thus, there is a need for better knowledge of the basic pathophysiologic mechanisms of this disease entity. Objectives Because patients with colonic diverticular disease have been shown to display abnormalities of the enteric nervous system, we assessed the frequency of myenteric plexitis (i.e. the infiltration of myenteric ganglions by inflammatory cells) in patients undergoing surgery for this condition. Methods We analyzed archival resection samples from the proximal resection margins of 165 patients undergoing left hemicolectomy (60 emergency and 105 elective surgeries) for colonic diverticulitis, by histology and immunochemistry. Results Overall, plexitis was present in almost 40% of patients. It was subdivided into an eosinophilic (48%) and a lymphocytic (52%) subtype. Plexitis was more frequent in younger patients; and it was more frequent in those undergoing emergency surgery (50%), compared to elective (28%) surgery (p = 0.007). All the severe cases of plexitis displayed the lymphocytic subtype. Conclusions In conclusion, myenteric plexitis is frequent in patients with colonic diverticular disease needing surgery, and it might be implicated in the pathogenesis of the disease. PMID:26668745

  16. Albumin Kinetics in Patients Undergoing Major Abdominal Surgery

    PubMed Central

    Norberg, Åke; Rooyackers, Olav; Segersvärd, Ralf; Wernerman, Jan

    2015-01-01

    Background The drop in plasma albumin concentration following surgical trauma is well known, but the temporal pattern of the detailed mechanisms behind are less well described. The aim of this explorative study was to assess changes in albumin synthesis and transcapillary escape rate (TER) following major surgical trauma, at the time of peak elevations in two well-recognized markers of inflammation. Methods This was a clinical trial of radiolabeled human serum albumin for the study of TER and plasma volume. Ten patients were studied immediately preoperatively and on the 2nd postoperative day after major pancreatic surgery. Albumin synthesis rate was measured by the flooding dose technique employing incorporation of isotopically labelled phenylalanine. Results Fractional synthesis rate of albumin increased from 11.7 (95% CI: 8.9, 14.5) to 15.0 (11.7, 18.4) %/day (p = 0.027), whereas the corresponding absolute synthesis rate was unchanged, 175 (138, 212) versus 150 (107, 192) mg/kg/day (p = 0.21). TER was unchanged, 4.9 (3.1, 6.8) %/hour versus 5.5 (3.9, 7.2) (p = 0.63). Plasma volume was unchanged but plasma albumin decreased from 33.5 (30.9, 36.2) to 22.1 (19.8, 24.3) g/L. (p<0.001). Conclusion Two days after major abdominal surgery, at the time-point when two biomarkers of generalised inflammation were at their peak and the plasma albumin concentration had decreased by 33%, we were unable to show any difference in the absolute synthesis rate of albumin, TER and plasma volume as compared with values obtained immediately pre-operatively. This suggests that capillary leakage, if elevated postoperatively, had ceased at that time-point. The temporal relations between albumin kinetics, capillary leakage and generalised inflammation need to be further explored. Trial Registration clinicaltrialsregister.eu: EudraCT 2010-08529-21 ClinicalTrials.gov NCT01194492 PMID:26313170

  17. Large pericardial effusion as a complication in adults undergoing SCT

    PubMed Central

    Norkin, M; Ratanatharathorn, V; Ayash, L; Abidi, MH; Al-Kadhimi, Z; Lum, LG; Uberti, JP

    2013-01-01

    Large pericardial effusion (LPE) leading to cardiac tamponade is a rare complication described in patients undergoing SCT. This complication is considered to be a manifestation of chronic GVHD; however its pathophysiology is poorly understood. Currently, there are no published data systematically describing the incidence, clinical characteristics and outcomes of LPEs in adult stem cell transplant recipients. We retrospectively evaluated 858 adult patients (512 autologous, 148 related and 198 unrelated donor) who underwent hematopoietic stem cell and BM transplants at our institution from 2005 to 2008 for the development of post transplant LPE. Seven patients (0.8%) were found to have LPEs and all these patients had undergone unrelated allografts. The median day of diagnosis post transplant was 229 (range 42–525). None of these patients had active manifestations of GVHD other than serositis at the time of LPE detection. Pericardial window (PW) was successfully placed in all patients who developed cardiac tamponade and most patients with LPE were effectively treated by increasing immunosuppression. We conclude that LPE is a rare late complication after allogeneic transplant in adults and in our study developed only after unrelated transplant. PW can be safely performed in these patients and LPEs can be successfully treated with intensification of systemic immunosupression. PMID:21113188

  18. Large pericardial effusion as a complication in adults undergoing SCT.

    PubMed

    Norkin, M; Ratanatharathorn, V; Ayash, L; Abidi, M H; Al-Kadhimi, Z; Lum, L G; Uberti, J P

    2011-10-01

    Large pericardial effusion (LPE) leading to cardiac tamponade is a rare complication described in patients undergoing SCT. This complication is considered to be a manifestation of chronic GVHD; however its pathophysiology is poorly understood. Currently, there are no published data systematically describing the incidence, clinical characteristics and outcomes of LPEs in adult stem cell transplant recipients. We retrospectively evaluated 858 adult patients (512 autologous, 148 related and 198 unrelated donor) who underwent hematopoietic stem cell and BM transplants at our institution from 2005 to 2008 for the development of post transplant LPE. Seven patients (0.8%) were found to have LPEs and all these patients had undergone unrelated allografts. The median day of diagnosis post transplant was 229 (range 42-525). None of these patients had active manifestations of GVHD other than serositis at the time of LPE detection. Pericardial window (PW) was successfully placed in all patients who developed cardiac tamponade and most patients with LPE were effectively treated by increasing immunosuppression. We conclude that LPE is a rare late complication after allogeneic transplant in adults and in our study developed only after unrelated transplant. PW can be safely performed in these patients and LPEs can be successfully treated with intensification of systemic immunosupression.

  19. Psychological and Social Factors in Undergoing Reconstructive Surgery Among Individuals With Craniofacial Conditions: An Exploratory Study

    PubMed Central

    Bemmels, Heather; Biesecker, Barbara; Schmidt, Johanna L.; Krokosky, Alyson; Guidotti, Rick; Sutton, Erica J.

    2012-01-01

    Objective Reconstructive surgery to improve psychological well-being is commonly offered to children with craniofacial conditions. Few studies have explored the challenges of reconstructive surgery beyond the physical risks: poor treatment outcomes, infection, brain damage, and death. This qualitative study aims to understand the psychological and social implications such interventions can have for individuals with craniofacial conditions. Design A total of 38 individuals between the ages of 12 and 61 with such craniofacial conditions as Sturge-Weber syndrome, Treacher Collins syndrome, Möbius syndrome, cleft lip and palate, Noonan syndrome, Crouzon syndrome, and amniotic band syndrome participated in semistructured video-recorded interviews. Participants were recruited at conferences, through study flyers, and by word of mouth. Descriptive, thematic analysis was used to identify themes related to reconstructive surgery. Results Dominant themes included undergoing surgery to reduce stigmatization, the psychological and social implications of the interventions, outcome satisfaction, parental involvement in decision making about surgery, and recommendations for parents considering surgery for their children with craniofacial conditions. Experiences with reconstructive surgery varied, with some participants expressing surgical benefits and others, disillusionment. Conclusions The range of participant attitudes and experiences reflect the complexity of reconstructive surgery. Pediatric health care teams involved in the care of children with craniofacial conditions play an important role in advising patients (and their parents) about existing treatment options. The psychological and social implications of reconstructive surgery should be relayed to help families weigh the risks and benefits of surgery in an informed and meaningful way. PMID:22315960

  20. [Management of aortic stenosis in patients undergoing non-cardiac surgery].

    PubMed

    Labbé, Vincent; Ederhy, Stéphane; Szymkiewicz, Olga; Cohen, Ariel

    2015-01-01

    There is a significant risk of cardiovascular morbidity and mortality in patients with severe aortic stenosis (valve area <1cm(2) or 0.6cm(2)/m(2) body surface area, and maximum jet velocity ≥4m/sec, and mean aortic pressure gradient ≥40mmHg) undergoing non-cardiac surgery, especially in patients with symptoms (dyspnoea, angina, syncope, or heart failure). Before any surgery, clinical assessment should search for signs of aortic stenosis which justifies echocardiographic examination, particularly in the elderly. A systematic rest echocardiography with searching aortic stenosis should be considered in patients undergoing high risk surgery. The key points of pre-operative cardiac risk assessment are: assessment of the severity of aortic stenosis, measurement of the functional capacity, evaluation of the left ventricular systolic function, search of associated coronary artery disease, estimate of the surgical risk of cardiac events, and achievement of risk indices. In symptomatic patients with severe aortic stenosis, only urgent non-cardiac surgery should be performed under careful haemodynamic monitoring. Aortic valve replacement should be considered before elective non-cardiac surgery. In asymptomatic patients with severe aortic stenosis, aortic valve replacement should be considered before non-cardiac high risk surgery. Non-cardiac surgery at low/intermediate risk can be performed provided an adapted anaesthetic technique.

  1. Body mass index, conversion rate and complications among patients undergoing robotic surgery for endometrial carcinoma.

    PubMed

    Cunningham, Mary J; Dorzin, Esther; Nguyen, Loan; Anderson, Elizabeth; Bunn, W Douglas

    2015-12-01

    A retrospective cohort study was performed to evaluate the relationship of BMI to conversion rate in patients undergoing robotic surgery for endometrial cancer. Secondary outcomes were operative times, number of lymph nodes retrieved, and complications. Women with endometrial cancer scheduled for robotic surgery from September 2008 to September 2012 were included. Women were divided into three groups based on BMI, and conversion rates to laparotomy were compared. Descriptive and comparative analyses were performed among non-obese, obese, and morbidly obese women who completed robotic surgery. 298 women were scheduled for robotic surgery for endometrial carcinoma: 87 non-obese (BMI 19-29, μ 25.23), 110 obese (BMI 30-39, μ 34.21), and 101 morbidly obese (BMI 40-71, μ 47.38). Conversion to laparotomy occurred in 18 patients (6%), with no difference in conversion rate between BMI categories. Direct comparison between converted and completed robotic patients showed no significant differences in preoperative characteristics, except that patients who required conversion had a higher number of previous abdominal surgeries. Patients completing robotic surgery underwent node dissections at similar rates in all three BMI categories. Operating room time, but not surgical time, was increased in morbidly obese patients. There were no significant differences in complications, performance of lymphadenectomy, or lymph node yields between BMI categories. Increase in BMI was not associated with an increase in rate of conversion to laparotomy or complication rate in patients undergoing robotic surgery for endometrial carcinoma. Node dissections were pathologically equivalent between BMI categories.

  2. Is it necessary to shave the pubic and genital regions of patients undergoing endoscopic urological surgery?

    PubMed

    Menéndez, Violeta; Galán, Juan Antonio; Elia, Matilde; Collado, Argimiro; Lloréns, Francisco; Fernández, Carlos; García-López, Francisco

    2004-06-01

    To determine whether postoperative urinary infections were related to shaving before undergoing endoscopic urological surgery, 90 patients were randomly assigned to shaving or not shaving. Urinary cultures revealed infection in 10 patients. Half of them had been shaved, suggesting that this practice does not affect the incidence of urinary infections.

  3. Anesthetic challenges of patients with cardiac comorbidities undergoing major urologic surgery

    PubMed Central

    2014-01-01

    The cardiac patient undergoing major urologic surgery is a complex case requiring a great attention by the anesthesiologist. Number of this group of patients having to go through this procedure is constantly increasing, due to prolonged life, increased agressiveness of surgery and increased anesthesia’s safety. The anesthesiologist usually has to deal with several problems of the patient, such as hypertension, chronic heart failure, coronary artery disease, rhythm disturbances, intraoperative hemodymanic changes, intraoperative bleeding, perioperative fluid imbalance, and metabolic disturbances. A cardiac patient undergoing major urologic surgery is a complex case requiring a great attention by the anesthesiologist. The scope of this review article is to present the most frequent issues encountered with this group of patients, and to synthetically discuss the respective strategies and maneuvers during perioperative period, which is the major challenge for the anesthesiologist. PMID:24791166

  4. Postoperative Neurocognitive Dysfunction in Patients Undergoing Cardiac Surgery after Remote Ischemic Preconditioning: A Double-Blind Randomized Controlled Pilot Study

    PubMed Central

    Meybohm, Patrick; Renner, Jochen; Broch, Ole; Caliebe, Dorothee; Albrecht, Martin; Cremer, Jochen; Haake, Nils; Scholz, Jens; Zacharowski, Kai; Bein, Berthold

    2013-01-01

    Background Remote ischemic preconditioning (RIPC) has been shown to enhance the tolerance of remote organs to cope with a subsequent ischemic event. We hypothesized that RIPC reduces postoperative neurocognitive dysfunction (POCD) in patients undergoing complex cardiac surgery. Methods We conducted a prospective, randomized, double-blind, controlled trial including 180 adult patients undergoing elective cardiac surgery with cardiopulmonary bypass. Patients were randomized either to RIPC or to control group. Primary endpoint was postoperative neurocognitive dysfunction 5–7 days after surgery assessed by a comprehensive test battery. Cognitive change was assumed if the preoperative to postoperative difference in 2 or more tasks assessing different cognitive domains exceeded more than one SD (1 SD criterion) or if the combined Z score was 1.96 or greater (Z score criterion). Results According to 1 SD criterion, 52% of control and 46% of RIPC patients had cognitive deterioration 5–7 days after surgery (p = 0.753). The summarized Z score showed a trend to more cognitive decline in the control group (2.16±5.30) compared to the RIPC group (1.14±4.02; p = 0.228). Three months after surgery, incidence and severity of neurocognitive dysfunction did not differ between control and RIPC. RIPC tended to decrease postoperative troponin T release at both 12 hours [0.60 (0.19–1.94) µg/L vs. 0.48 (0.07–1.84) µg/L] and 24 hours after surgery [0.36 (0.14–1.89) µg/L vs. 0.26 (0.07–0.90) µg/L]. Conclusions We failed to demonstrate efficacy of a RIPC protocol with respect to incidence and severity of POCD and secondary outcome variables in patients undergoing a wide range of cardiac surgery. Therefore, definitive large-scale multicenter trials are needed. Trial Registration ClinicalTrials.gov NCT00877305 PMID:23741380

  5. Continuous or discontinuous tranexamic acid effectively inhibits fibrinolysis in children undergoing cardiac surgery with cardiopulmonary bypass.

    PubMed

    Couturier, Roland; Rubatti, Marina; Credico, Carmen; Louvain-Quintard, Virginie; Anerkian, Vregina; Doubine, Sylvie; Vasse, Marc; Grassin-Delyle, Stanislas

    2014-04-01

    Tranexamic acid is given continuously or discontinuously as an anti-fibrinolytic therapy during cardiac surgery, but the effects on fibrinolysis parameters remain poorly investigated. We sought to assess the effects of continuous and discontinuous tranexamic acid on fibrinolysis parameters in children undergoing cardiac surgery with cardiopulmonary bypass (CPB). Children requiring cardiac surgery or repeat surgery by sternotomy with CPB for congenital heart disease were randomized to receive either continuous or discontinuous tranexamic acid. Blood tranexamic acid, D-dimers, tissue plasminogen activator (tPA), tPA-plasminogen activator inhibitor 1 (tPA-PAI1) complexes, fibrinogen and fibrin monomers were measured and compared to values obtained from children who did not receive tranexamic acid. Tranexamic acid inhibited the CPB-induced increase in D-dimers, with a similar potency between continuous and discontinuous regimens. Time courses for tPA, fibrin monomers, and fibrinogen were also similar for both regimen, and there was a significant difference in tPA-PAI1 complex concentrations at the end of surgery, which may be related to a significantly higher tranexamic acid concentration. Continuous and discontinuous regimen are suitable for an effective inhibition of fibrinolysis in children undergoing cardiac surgery with CPB, but the continuous regimen was previously shown to be more effective to maintain stable tranexamic acid concentrations.

  6. Inspiratory Muscle Training and Functional Capacity in Patients Undergoing Cardiac Surgery

    PubMed Central

    Cordeiro, André Luiz Lisboa; de Melo, Thiago Araújo; Neves, Daniela; Luna, Julianne; Esquivel, Mateus Souza; Guimarães, André Raimundo França; Borges, Daniel Lago; Petto, Jefferson

    2016-01-01

    Introduction Cardiac surgery is a highly complex procedure which generates worsening of lung function and decreased inspiratory muscle strength. The inspiratory muscle training becomes effective for muscle strengthening and can improve functional capacity. Objective To investigate the effect of inspiratory muscle training on functional capacity submaximal and inspiratory muscle strength in patients undergoing cardiac surgery. Methods This is a clinical randomized controlled trial with patients undergoing cardiac surgery at Instituto Nobre de Cardiologia. Patients were divided into two groups: control group and training. Preoperatively, were assessed the maximum inspiratory pressure and the distance covered in a 6-minute walk test. From the third postoperative day, the control group was managed according to the routine of the unit while the training group underwent daily protocol of respiratory muscle training until the day of discharge. Results 50 patients, 27 (54%) males were included, with a mean age of 56.7±13.9 years. After the analysis, the training group had significant increase in maximum inspiratory pressure (69.5±14.9 vs. 83.1±19.1 cmH2O, P=0.0073) and 6-minute walk test (422.4±102.8 vs. 502.4±112.8 m, P=0.0031). Conclusion We conclude that inspiratory muscle training was effective in improving functional capacity submaximal and inspiratory muscle strength in this sample of patients undergoing cardiac surgery. PMID:27556313

  7. Renal insufficiency predicts mortality in geriatric patients undergoing emergent general surgery.

    PubMed

    Yaghoubian, Arezou; Ge, Phillip; Tolan, Amy; Saltmarsh, Guy; Kaji, Amy H; Neville, Angela L; Bricker, Scott; De Virgilio, Christian

    2011-10-01

    Clinical predictors of perioperative mortality in geriatric patients undergoing emergent general surgery have not been well described. The purpose of this study was to determine the incidence of postoperative morbidity and mortality in geriatric patients and factors associated with mortality. A retrospective review of patients 65 years of age or older undergoing emergent general surgery at a public teaching hospital was performed over a 7-year period. Data collected included demographics, comorbidities, laboratory studies, perioperative morbidities, and mortality. Descriptive statistics and predictors of morbidity and mortality are described. The mean age was 74 years. Indications for surgery included small bowel obstruction (24%), diverticulitis (20%), perforated viscous (16%), and large bowel obstruction (9%). The overall complication rate was 41 per cent with six cardiac complications (14%) and seven perioperative (16%) deaths. Mean admission serum creatinine was significantly higher in patients who died (3.6 vs 1.5 mg/dL, P = 0.004). Mortality for patients with an admission serum creatinine greater than 2.0 mg/dL was 42 per cent (5 of 12) compared with 3 per cent (2 of 32) for those 2.0 mg/dL or less (OR, 10.7; CI, 1.7 to 67; P = 0.01). Morbidity and mortality in geriatric patients undergoing emergency surgery remains high with the most significant predictor of mortality being the presence of renal insufficiency on admission.

  8. Hospital Costs and Inpatient Mortality among Children Undergoing Surgery for Congenital Heart Disease

    PubMed Central

    Romley, John A; Chen, Alex Y; Goldman, Dana P; Williams, Roberta

    2014-01-01

    Objective To determine the association between hospital costs and risk-adjusted inpatient mortality among children undergoing surgery for congenital heart disease (CHD) in U.S. acute-care hospitals. Data Sources/Study Settings Retrospective cohort study of 35,446 children in 2003, 2006, and 2009 Kids' Inpatient Database (KID). Study Design Cross-sectional logistic regression of risk-adjusted inpatient mortality and hospital costs, adjusting for a variety of patient-, hospital-, and community-level confounders. Data Collection/Extraction Methods We identified relevant discharges in the KID using the AHRQ Pediatric Quality Indicator for pediatric heart surgery mortality, and linked these records to hospital characteristics from American Hospital Association Surveys and community characteristics from the Census. Principal Findings Children undergoing CHD surgery in higher cost hospitals had lower risk-adjusted inpatient mortality (p = .002). An increase from the 25th percentile of treatment costs to the 75th percentile was associated with a 13.6 percent reduction in risk-adjusted mortality. Conclusions Greater hospital costs are associated with lower risk-adjusted inpatient mortality for children undergoing CHD surgery. The specific mechanisms by which greater costs improve mortality merit further exploration. PMID:24138064

  9. Effectiveness of a Surgery Admission Unit for patients undergoing major elective surgery in a tertiary university hospital

    PubMed Central

    2010-01-01

    Background The increasing demand on hospitalisation, either due to elective activity from the waiting lists or due to emergency admissions coming from the Emergency Department (ED), requires looking for strategies that lead to effective bed management. The aim of this study was to evaluate the effectiveness of a surgery admission unit for major elective surgery patients who were admitted for same-day surgery. Methods We included all patients admitted for elective surgery in a university tertiary hospital between the 1st of September and the 31st of December 2006, as well as those admitted during the same period of 2008, after the introduction of the Surgery Admission Unit. The main outcome parameters were global length of stay, pre-surgery length of stay, proportion of patients admitted the same day of the surgery and number of cancellations. Differences between the two periods were evaluated by the T-test and Chi-square test. Significance at P < 0.05 was assumed throughout. Results We included 6,053 patients, 3,003 during 2006 and 3,050 patients during 2008. Global length of stay was 6.2 days (IC 95%:6.4-6) in 2006 and 5.5 days (IC 95%:5.8-5.2) in 2008 (p < 0.005). Pre-surgery length of stay was reduced from 0.46 days (IC 95%:0.44-0.48) in 2006 to 0.29 days (IC 95%:0.27-0.31) in 2008 (p < 0.005). The proportion of patients admitted for same-day surgery was 67% (IC 95%:69%-65%) in 2006 and 76% (IC 95%:78%-74%) in 2008 (p < 0.005). The number of cancelled interventions due to insufficient preparation was 31 patients in 2006 and 7 patients in 2008. Conclusions The implementation of a Surgery Admission Unit for patients undergoing major elective surgery has proved to be an effective strategy for improving bed management. It has enabled an improvement in the proportion of patients admitted on the same day as surgery and a shorter length of stay. PMID:20096114

  10. Risk Factors for Postoperative Pain Intensity in Patients Undergoing Lumbar Disc Surgery: A Systematic Review

    PubMed Central

    Löbner, Margrit; Stein, Janine; Konnopka, Alexander; Meisel, Hans J.; Günther, Lutz; Meixensberger, Jürgen; Stengler, Katarina; König, Hans-Helmut; Riedel-Heller, Steffi G.

    2017-01-01

    Objectives Pain relief has been shown to be the most frequently reported goal by patients undergoing lumbar disc surgery. There is a lack of systematic research investigating the course of postsurgical pain intensity and factors associated with postsurgical pain. This systematic review focuses on pain, the most prevalent symptom of a herniated disc as the primary outcome parameter. The aims of this review were (1) to examine how pain intensity changes over time in patients undergoing surgery for a lumbar herniated disc and (2) to identify socio-demographic, medical, occupational and psychological factors associated with pain intensity. Methods Selection criteria were developed and search terms defined. The initial literature search was conducted in April 2015 and involved the following databases: Web of Science, Pubmed, PsycInfo and Pubpsych. The course of pain intensity and associated factors were analysed over the short-term (≤ 3 months after surgery), medium-term (> 3 months and < 12 months after surgery) and long-term (≥ 12 months after surgery). Results From 371 abstracts, 85 full-text articles were reviewed, of which 21 studies were included. Visual analogue scales indicated that surgery helped the majority of patients experience significantly less pain. Recovery from disc surgery mainly occurred within the short-term period and later changes of pain intensity were minor. Postsurgical back and leg pain was predominantly associated with depression and disability. Preliminary positive evidence was found for somatization and mental well-being. Conclusions Patients scheduled for lumbar disc surgery should be selected carefully and need to be treated in a multimodal setting including psychological support. PMID:28107402

  11. Surgical Stress Reduction in Elderly Patients Undergoing Elective Colorectal Laparoscopic Surgery within an ERAS Protocol.

    PubMed

    Mari, Giulio; Costanzi, Andrea; Crippa, Jacopo; Falbo, Rosanna; Miranda, Angelo; Rossi, Michele; Berardi, Valter; Maggioni, Dario

    2016-01-01

    ERAS program applied to colorectal laparoscopic surgery is well known to reduce hospitalization improving short terms outcomes and minimizing the Surgical Stress Response. However its effectiveness in elderly population is yet to be demonstrated. The primary aim of this study is to compare the level of immune and nutritional serum indexes across surgery in patients aged over 70 years old undergoing elective colorectal laparoscopic surgery within an ERAS protocol or according to a Standard program. 83 patients undergoing colorectal laparoscopic surgery were enrolled and randomized in two groups (ERAS Group 40, Standard Group 43) within a larger randomized trial on a general population. Surgical stress parameters were collected preoperatively, 1, 3 and 5 days after surgery. Nutritional parameters were collected preoperatively, 1 and 5 days after surgery. Short Term Outcomes were also prospectively assessed. IL-6 levels were lower in the EG on 1, 3, and 5 days post-operatively (p 0.05). IL-6 levels in the Enhanced group returned to pre operative level 3 days after surgery. C-reactive protein level was lower in the Enhanced group on day 1, 3, and 5 (p 0.05). There was no difference in Cortisol and Prolactin levels between groups. Prealbumin serum level was higher on day 5 (p 0.05) compared to standard group. Postoperative outcomes in terms of normal bowel function and length of hospital stay were significantly improved in the ERAS group. Colorectal laparoscopic surgery within an ERAS prototcol in elderly patients affects Surgical Stress Response, decreasing IL-6 and CRP levels postoperatively and improving Prealbumin post operative synthesis.

  12. Gelastic seizures: incidence, clinical and EEG features in adult patients undergoing video-EEG telemetry.

    PubMed

    Kovac, Stjepana; Diehl, Beate; Wehner, Tim; Fois, Chiara; Toms, Nathan; Walker, Matthew C; Duncan, John S

    2015-01-01

    This study aimed to determine clinical features of adult patients with gelastic seizures recorded on video -electroencephalography (EEG) over a 5-year period. We screened video-EEG telemetry reports for the occurrence of the term "gelastic" seizures, and assessed the semiology, EEG features, and duration of those seizures. Gelastic seizures were identified in 19 (0.8%) of 2,446 admissions. The presumed epileptogenic zone was in the hypothalamus in one third of the cases, temporal lobe epilepsy was diagnosed in another third, and the remainder of the cases presenting with gelastic seizures were classified as frontal, parietal lobe epilepsy or remained undetermined or were multifocal. Gelastic seizures were embedded in a semiology, with part of the seizure showing features of automotor seizures. A small proportion of patients underwent epilepsy surgery. Outcome of epilepsy surgery was related to the underlying pathology; two patients with hippocampal sclerosis had good outcomes following temporal lobe resection and one of four patients with hypothalamic hamartomas undergoing gamma knife surgery had a good outcome.

  13. The impact of nutritional status on the outcome of Indian patients undergoing neurosurgical shunt surgery.

    PubMed

    Jain, Gaurav; Mukerji, Gaurav; Dixit, Anupam; Manshani, Novin; Yadav, Y R

    2007-11-01

    Undernutrition is common in surgical patients, is frequently unrecognised and is strongly associated with adverse outcomes such as high rates of complications and mortality, worsening functional status and prolonged hospitalisation. Owing to the associated infection and symptoms such as repeated vomiting, a high prevalence of undernutrition is expected in hydrocephalus patients, which may contribute to their poor surgical outcomes. The aim of this study was to evaluate the influence of preoperative nutritional status on the outcome of Indian patients with hydrocephalus undergoing neurosurgical shunt surgery. One hundred and twenty-four consecutive patients undergoing scheduled hydrocephalus shunt surgery were studied prospectively. All patients underwent nutritional screening according to different parameters prior to surgery. The patients were classified into normally nourished and undernourished groups. The undernourished group was further subdivided into moderately and severely undernourished. The surgical outcome was compared between these groups. A high prevalence (53%) of undernutrition was observed in these patients. Postoperative complications such as shunt infection (P = 0.0023), shunt revision (P = 0.0074) and mortality (P = 0.0003) were significantly more common in undernourished patients compared with normally nourished patients. Serum albumin emerged as the most significant independent predictor of postoperative mortality. The present study demonstrated a high prevalence of undernutrition in hydrocephalus patients in India and its adverse influence on the outcome of shunt surgery. Early preoperative nutritional status screening and its optimisation may decrease the morbidity and mortality of shunt surgery for hydrocephalus.

  14. Variation in Tracheal Reintubations Among Patients Undergoing Cardiac Surgery Across Washington State Hospitals

    PubMed Central

    Khandelwal, Nita; Dale, Christopher R.; Benkeser, David C.; Joffe, Aaron M.; Yanez, N. David; Treggiari, Miriam M.

    2014-01-01

    Background Patients requiring endotracheal reintubation have higher mortality, increased hospital length of stay and costs. To our knowledge, little is known about the variation in reintubation across hospitals among patients undergoing cardiac surgery. Objectives The objectives of this study were to: (1) Examine the variation in reintubations across Washington State hospitals that perform cardiac surgery, and (2) Explore hospital and patient characteristics associated with variation in reintubation. Design Retrospective cohort study Setting All non-federal hospitals performing cardiac surgery in Washington State Participants 15,103 patients undergoing CABG or valvular surgery between January 1, 2008 and September 30, 2011 Measurements and Main Results Patient and hospital characteristics were compared between hospitals that had a reintubation frequency ≥ 5% or < 5%. Multivariable logistic regression was used to compare the odds of reintubation across the hospitals. We tested for heterogeneity of odds of reintubation across hospitals by performing a likelihood ratio test on the hospital factor. After adjusting for patient-level characteristics and procedure type, significant heterogeneity in reintubations across hospitals was present (p=0.005). Our exploratory analyses suggested that hospitals with lower reintubations were more likely to have greater acute care days and teaching ICUs. Conclusions After accounting for patient and procedure characteristics, significant heterogeneity in the relative odds of requiring reintubation was present across 16 non-federal hospitals performing cardiac surgery in Washington State. Our findings suggest that greater hospital volume and ICU teaching status are associated with less reintubations. PMID:25802193

  15. [Assessment of nutritional status and selection of nutritional support route in patients undergoing gastrointestinal surgery].

    PubMed

    Yu, Jian-chun

    2012-05-01

    Nutritional risk and malnutrition was significantly higher in patients undergoing gastrointestinal surgery as compared to patients in other surgical departments, especially in elder patients, which would directly impact on the efficacy, cost and prognosis. Nutritional screening and assessment should be performed within 24-48 hours after admission. Patients at high risk of malnutrition should be planned with early nutrition support. The best nutrition route should be determined to improve the outcomes of surgery and nutritional support, reduce the complications, length of hospital stay and healthcare costs, and improve the quality of life in patients.

  16. Does Comorbid Obesity Impact Quality of Life Outcomes in Patients Undergoing Endoscopic Sinus Surgery?

    PubMed Central

    Steele, Toby O.; Mace, Jess C.; Deconde, Adam S.; Xiao, Christopher C.; Storck, Kristina A.; Gudis, David A.; Schlosser, Rodney J.; Soler, Zachary M.; Smith, Timothy L.

    2015-01-01

    Background Both obesity and chronic rhinosinusitis (CRS) are characterized by inflammation. Furthermore, both disease processes are independently associated with decreases in quality-of-life (QOL). We sought to investigate the role of comorbid obesity in QOL outcomes in CRS patients undergoing endoscopic sinus surgery (ESS). Methods Adult patients with medically refractory CRS (n=241) were prospectively enrolled into a multi-institutional treatment outcomes investigation. Body mass index (BMI) calculations were used to differentiate patient weight groups (normal weight: 18.5–24.9, overweight: 25.0–29.9; and obese: ≥30.0). Preoperative and postoperative QOL (Rhinosinusitis Disability Index (RSDI) and the 22-item Sinonasal Outcome Test (SNOT-22)) were evaluated compared across BMI groups and obesity subclasses. Results The prevalence of comorbid obesity was 41% (n=99). Higher prevalence of comorbid disease was found across increasing BMI groups including diabetes mellitus, asthma, and depression. No significant differences were found in mean preoperative QOL measures between any BMI groups. Significant improvement between preoperative and postoperative QOL mean scores (p≤0.050) was found for all BMI groups. Despite no significant difference in mean QOL improvement between BMI groups (p≥0.142), overweight and obese patients reported reduced relative mean percentage (%) improvement compared to normal weight participants on the RSDI total score (33% and 37% vs. 55%, respectively) and SNOT-22 total score (29% and 40% vs. 48%, respectively). Conclusions Patients with comorbid obesity experience significant improvement in average QOL gains following ESS though the percentage of relative improvement in QOL may be decreased in patients with comorbid obesity and CRS as compared to those without. PMID:26201473

  17. Adverse Hospital Events for Mentally Ill Patients Undergoing Coronary Artery Bypass Surgery

    PubMed Central

    Li, Yue; Glance, Laurent G; Cai, Xueya; Mukamel, Dana B

    2008-01-01

    Context Patients with mental disorders show higher burden of coronary heart disease, and may face special safety issues during in-hospital cardiac care. Objectives To compare the postoperative complication rate between patients with and without mental disorders undergoing isolated coronary artery bypass graft (CABG) surgery. Design, Setting, and Patients Retrospective analyses of New York state hospital claims between 1997 and 2004 (N=135,701). Complications were defined using the Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ PSI). Principal Findings Mental disorders were significantly associated with higher anesthesia complications (adjusted odds ratio [AOR]=6.44, p<.001), decubitus ulcer (AOR=1.42, p=.006), postoperative hip fracture (AOR=3.29, p<.001), and overall complication rate representing nine PSIs (AOR=1.27, p<.001). Conclusions Mentally ill patients undergoing CABG surgery are more likely to experience potentially preventable complications and injuries. The mechanism underlying this observation warrants further study. PMID:18665856

  18. Systematic review of peri-operative nutritional support for patients undergoing hepatobiliary surgery

    PubMed Central

    Liu, Yin

    2015-01-01

    Background Malnutrition is prevalent among peri-operative patients undergoing hepatobiliary surgery and is an important prognostic factor. Both hepatobiliary disease and surgical trauma significantly affects body’s metabolism and environment. Therefore, it is very important for patients with liver diseases undergoing hepatobiliary surgery to receive essential nutritional support during peri-operative period. Methods We summarized our clinical experience and reviewed of related literature to find the way for implementing the appropriate nutritional strategy. Results We found after comprehensively evaluating nutrition status, function of liver and gastrointestinal tract, nutritional strategy would be selected correctly. In severe malnutrition, initiation of enteral nutrition (EN) and/or parenteral nutrition (PN) with essential or special formulae is often recommended. Especially nasojejunal feeding is indicated that early application can improve nutritional status and liver function, reduce complications and prolong survival. Conclusions The reasonable peri-operative nutritional support therapy can improve the effect of surgical treatment and promote the patients’ recovery. PMID:26605277

  19. "Wet diapers--dry patients": an effective dressing for patients undergoing arthroscopic shoulder surgery.

    PubMed

    Kapila, Atul; Bhargava, Amit; Funk, Len; Copeland, Stephen; Levy, Ofer

    2005-02-01

    Shoulder arthroscopy is very commonly associated with postoperative leakage of irrigation fluid. This causes apprehension to patients and their relatives and leads to frequent change of dressings. We describe a simple and effective diaper dressing for patients undergoing arthroscopic shoulder surgery. It is highly absorbent, cost-effective, and easy to apply. We have used this dressing successfully in more than 1,500 shoulder arthroscopies over the last 3 years with no adverse reaction.

  20. [Preoperative tests recommendations in adult patients for ambulatory surgery].

    PubMed

    Zaballos, M; López-Álvarez, S; Argente, P; López, A

    2015-01-01

    Anesthetic assessment traditionally included a series of laboratory tests intended to detect undiagnosed diseases, and to ensure that the patient undergoes surgery following safety criteria. These tests, without a specific clinical indication, are expensive, of questionable diagnostic value and often useless. In the context of outpatient surgery, recent evidence suggests that patients of any age without significant comorbidity, ASA physical status gradei and grade ii, do not need additional preoperative tests routinely. The aim of the present recommendations is to determine the general indications in which these tests should be performed in ASA gradei and grade ii patients undergoing ambulatory surgery.

  1. PELVIC FLOOR SYMPTOMS AND QUALITY OF LIFE ANALYSES IN WOMEN UNDERGOING SURGERY FOR RECTAL PROLPASE

    PubMed Central

    ELLINGTON, DR; MANN, M; BOWLING, CB; DRELICHMAN, ER; GREER, WJ; SZYCHOWSKI, JM; RICHTER, HE

    2014-01-01

    Objective Characterize pelvic floor symptom distress and impact, sexual function and quality of life in women who underwent rectal prolapse surgery. Methods Subjects undergoing rectal prolapse surgery from 2004–2009 completed questionnaires including the Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and the Prolapse/Urinary Incontinence Sexual Questionnaire. Baseline demographic, medical, and surgical characteristics were extracted by chart review. Demographic and clinic outcomes of women undergoing transperineal and abdominal approaches were compared. Wilcoxon rank-sum test was used for continuous variables and Fisher’s exact test for categorical measures. Results 45 were identified; two deceased at follow-up. 28/43 subjects (65.1%) responded to the questionnaires. Mean time from original procedure was 3.9 ± 3.1 years. No differences in median total Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and subscale scores, and Prolapse/Urinary Incontinence Sexual Questionnaire scores in women undergoing open rectopexy versus transperineal proctectomy were seen (all p>0.05). 26 (60%) participants answered the Prolapse/Urinary Incontinence Sexual Questionnaire, nine reported sexual activity within the last month. All underwent abdominal procedures. Conclusion There are few colorectal or other pelvic floor symptoms after rectal prolapse repair. Robust prospective studies are needed to more fully characterize and understand issues associated with rectal prolapse surgery in women. PMID:25379122

  2. Influence of Music on Preoperative Anxiety and Physiologic Parameters in Women Undergoing Gynecologic Surgery.

    PubMed

    Labrague, Leodoro J; McEnroe-Petitte, Denise M

    2016-04-01

    The aim of this study was to determine the influence of music on anxiety levels and physiologic parameters in women undergoing gynecologic surgery. This study employed a pre- and posttest experimental design with nonrandom assignment. Ninety-seven women undergoing gynecologic surgery were included in the study, where 49 were allocated to the control group (nonmusic group) and 48 were assigned to the experimental group (music group). Preoperative anxiety was measured using the State Trait Anxiety Inventory (STAI) while noninvasive instruments were used in measuring the patients' physiologic parameters (blood pressure [BP], pulse [P], and respiration [R]) at two time periods. Women allocated in the experimental group had lower STAI scores (t = 17.41, p < .05), systolic (t = 6.45, p < .05) and diastolic (t = 2.80, p < .006) BP, and P rate (PR; t = 7.32, p < .05) than in the control group. This study provides empirical evidence to support the use of music during the preoperative period in reducing anxiety and unpleasant symptoms in women undergoing gynecologic surgery.

  3. Real-time monitoring of endogenous lipid peroxidation by exhaled ethylene in patients undergoing cardiac surgery.

    PubMed

    Cristescu, Simona M; Kiss, Rudolf; Hekkert, Sacco te Lintel; Dalby, Miles; Harren, Frans J M; Risby, Terence H; Marczin, Nandor

    2014-10-01

    Pulmonary and systemic organ injury produced by oxidative stress including lipid peroxidation is a fundamental tenet of ischemia-reperfusion injury, inflammatory response to cardiac surgery, and cardiopulmonary bypass (CPB) but is not routinely measured in a surgically relevant time frame. To initiate a paradigm shift toward noninvasive and real-time monitoring of endogenous lipid peroxidation, we have explored pulmonary excretion and dynamism of exhaled breath ethylene during cardiac surgery to test the hypothesis that surgical technique and ischemia-reperfusion triggers lipid peroxidation. We have employed laser photoacoustic spectroscopy to measure real-time trace concentrations of ethylene from the patient breath and from the CPB machine. Patients undergoing aortic or mitral valve surgery-requiring CPB (n = 15) or off-pump coronary artery bypass surgery (OPCAB) (n = 7) were studied. Skin and tissue incision by diathermy caused striking (> 30-fold) increases in exhaled ethylene resulting in elevated levels until CPB. Gaseous ethylene in the CPB circuit was raised upon the establishment of CPB (> 10-fold) and decreased over time. Reperfusion of myocardium and lungs did not appear to enhance ethylene levels significantly. During OPCAB surgery, we have observed increased ethylene in 16 of 30 documented reperfusion events associated with coronary and aortic anastomoses. Therefore, novel real-time monitoring of endogenous lipid peroxidation in the intraoperative setting provides unparalleled detail of endogenous and surgery-triggered production of ethylene. Diathermy and unprotected regional myocardial ischemia and reperfusion are the most significant contributors to increased ethylene.

  4. Real-time monitoring of endogenous lipid peroxidation by exhaled ethylene in patients undergoing cardiac surgery

    PubMed Central

    Cristescu, Simona M.; Kiss, Rudolf; te Lintel Hekkert, Sacco; Dalby, Miles; Harren, Frans J. M.; Risby, Terence H.

    2014-01-01

    Pulmonary and systemic organ injury produced by oxidative stress including lipid peroxidation is a fundamental tenet of ischemia-reperfusion injury, inflammatory response to cardiac surgery, and cardiopulmonary bypass (CPB) but is not routinely measured in a surgically relevant time frame. To initiate a paradigm shift toward noninvasive and real-time monitoring of endogenous lipid peroxidation, we have explored pulmonary excretion and dynamism of exhaled breath ethylene during cardiac surgery to test the hypothesis that surgical technique and ischemia-reperfusion triggers lipid peroxidation. We have employed laser photoacoustic spectroscopy to measure real-time trace concentrations of ethylene from the patient breath and from the CPB machine. Patients undergoing aortic or mitral valve surgery-requiring CPB (n = 15) or off-pump coronary artery bypass surgery (OPCAB) (n = 7) were studied. Skin and tissue incision by diathermy caused striking (>30-fold) increases in exhaled ethylene resulting in elevated levels until CPB. Gaseous ethylene in the CPB circuit was raised upon the establishment of CPB (>10-fold) and decreased over time. Reperfusion of myocardium and lungs did not appear to enhance ethylene levels significantly. During OPCAB surgery, we have observed increased ethylene in 16 of 30 documented reperfusion events associated with coronary and aortic anastomoses. Therefore, novel real-time monitoring of endogenous lipid peroxidation in the intraoperative setting provides unparalleled detail of endogenous and surgery-triggered production of ethylene. Diathermy and unprotected regional myocardial ischemia and reperfusion are the most significant contributors to increased ethylene. PMID:25128523

  5. Comparison of Perioperative Ranibizumab Injections for Diabetic Macular Edema in Patients Undergoing Cataract Surgery

    PubMed Central

    2016-01-01

    Purpose. To compare the efficacy of perioperative ranibizumab injections on diabetic macular edema (DME) in patients undergoing cataract surgery. Methods. This study included 59 eyes of 59 patients. All patients had advanced cataract with DME and underwent an uneventful phacoemulsification surgery. There were 3 subgroups. The first group received intravitreal ranibizumab injection 2 weeks preoperatively, the second group received intraoperatively, and the third group received 2 weeks postoperatively. Follow-up examinations were performed at 1 week as well as at 1 and 3 months. Results. Baseline visual acuity showed a significant increase in all groups at 1 month. In group 1, compared to baseline value, foveal thickness (FT) increased significantly at 1 month and showed a significant decrease up to month 3. In group 2, FT increased at month 1 and this continued up to month 3. In group 3, FT increased at month 1 and was almost stable up to month 3. There were not any significant differences for visual acuity and FT between the groups. Conclusions. Although intrapostoperative ranibizumab injection for DME seems to be more effective than preoperative injections in patients undergoing cataract surgery, the treatment still needs to be continued following surgery. PMID:27493795

  6. Differences in pain experience and cooperation between consecutive surgeries in patients undergoing phacoemulsification.

    PubMed

    Akkaya, Sezen; Özkurt, Yelda Buyru; Aksoy, Sibel; Kökçen, Hatice Kübra

    2016-07-23

    The purpose of this study is to compare pain experience and cooperation between consecutive surgeries in patients undergoing phacoemulsification in both eyes, using sub-Tenon's local anesthesia without sedation. In this study, 268 patients with bilateral senile cataracts were recruited. All operations were performed without sedation, using a clear corneal phacoemulsification technique and sub-Tenon's local anesthesia, by one of four surgeons. The first surgery was performed on the eye with the higher grade cataract. The other eye was operated on within 3 months by the same surgeon (mean interval 1.9 ± 1.1 months). All patients were asked to grade their pain experience during induction and maintenance of anesthesia and also during the phacoemulsification surgery, using a visual analogue scale (VAS) from 0 (no pain) to 10 (unbearable pain) administered after the surgery. The cooperation of the patient was graded from 0 (no event) to 3 (markedeye and head movement and lid squeezing) by the attending surgeon. The VAS scores and cooperation scores of the patients were the outcome measurements. The mean pain score was 2.11 ± 0.79 in the first eye and 3.33 ± 0.80 in the second eye during the administration of sub-Tenon's anesthesia, and 1.50 ± 0.60 in the first eye and 2.10 ± 0.57 in the second eye during the phacoemulsification surgery. The patient cooperation score was 1.60 ± 0.75 in the first surgery and 2.08 ± 0.72 in the second surgery. The differences between the first and second surgeries were statistically significant for all outcome measures (p < 0.01). Patients who previously underwent phaco surgery in one eye experienced more pain and showed worse cooperation during the phaco surgery in the second eye, especially if there was a short time between the surgeries, viz., less than 3 months. Therefore, if the surgeon has difficulty in the first operation gaining the patient's cooperation, the surgeon must be careful: if contralateral eye

  7. Perioperative risk factors in patients with liver disease undergoing non-hepatic surgery

    PubMed Central

    Pandey, Chandra Kant; Karna, Sunaina Tejpal; Pandey, Vijay Kant; Tandon, Manish; Singhal, Amit; Mangla, Vivek

    2012-01-01

    The patients with liver disease present for various surgical interventions. Surgery may lead to complications in a significant proportion of these patients. These complications may result in considerable morbidity and mortality. Preoperative assessment can predict survival to some extent in patients with liver disease undergoing surgical procedures. A review of literature suggests nature and the type of surgery in these patients determines the peri-operative morbidity and mortality. Optimization of premorbid factors may help to reduce perioperative mortality and morbidity. The purpose of this review is to discuss the effect of liver disease on perioperative outcome; to understand various risk scoring systems and their prognostic significance; to delineate different preoperative variables implicated in postoperative complications and morbidity; to establish the effect of nature and type of surgery on postoperative outcome in patients with liver disease and to discuss optimal anaesthesia strategy in patients with liver disease. PMID:23494910

  8. Risk factors associated with venous thromboembolism in patients undergoing spine surgery.

    PubMed

    Piper, Keaton; Algattas, Hanna; DeAndrea-Lazarus, Ian A; Kimmell, Kristopher T; Li, Yan Michael; Walter, Kevin A; Silberstein, Howard J; Vates, G Edward

    2017-01-01

    OBJECTIVE Patients undergoing spinal surgery are at risk for developing venous thromboembolism (VTE). The authors sought to identify risk factors for VTE in these patients. METHODS The American College of Surgeons National Surgical Quality Improvement Project database for the years 2006-2010 was reviewed for patients who had undergone spinal surgery according to their primary Current Procedural Terminology code(s). Clinical factors were analyzed to identify associations with VTE. RESULTS Patients who underwent spinal surgery (n = 22,434) were identified. The rate of VTE in the cohort was 1.1% (pulmonary embolism 0.4%; deep vein thrombosis 0.8%). Multivariate binary logistic regression analysis revealed 13 factors associated with VTE. Preoperative factors included dependent functional status, paraplegia, quadriplegia, disseminated cancer, inpatient status, hypertension, history of transient ischemic attack, sepsis, and African American race. Operative factors included surgery duration > 4 hours, emergency presentation, and American Society of Anesthesiologists Class III-V, whereas postoperative sepsis was the only significant postoperative factor. A risk score was developed based on the number of factors present in each patient. Patients with a score of ≥ 7 had a 100-fold increased risk of developing VTE over patients with a score of 0. The receiver-operating-characteristic curve of the risk score generated an area under the curve of 0.756 (95% CI 0.726-0.787). CONCLUSIONS A risk score based on race, preoperative comorbidities, and operative characteristics of patients undergoing spinal surgery predicts the postoperative VTE rate. Many of these risks can be identified before surgery. Future protocols should focus on VTE prevention in patients who are predisposed to it.

  9. Cognitive-behavioral based physical therapy for patients with chronic pain undergoing lumbar spine surgery: a randomized controlled trial

    PubMed Central

    Archer, Kristin R.; Devin, Clinton J.; Vanston, Susan W.; Koyama, Tatsuki; Phillips, Sharon; George, Steven Z.; McGirt, Matthew J.; Spengler, Dan M.; Aaronson, Oran S.; Cheng, Joseph S.; Wegener, Stephen T.

    2015-01-01

    The purpose of this study was to determine the efficacy of a cognitive-behavioral based physical therapy (CBPT) program for improving outcomes in patients following lumbar spine surgery. A randomized controlled trial was conducted in 86 adults undergoing a laminectomy with or without arthrodesis for a lumbar degenerative condition. Patients were screened preoperatively for high fear of movement using the Tampa Scale for Kinesiophobia. Randomization to either CBPT or an Education program occurred at 6 weeks after surgery. Assessments were completed pre-treatment, post-treatment and at 3 month follow-up. The primary outcomes were pain and disability measured by the Brief Pain Inventory and Oswestry Disability Index. Secondary outcomes included general health (SF-12) and performance-based tests (5-Chair Stand, Timed Up and Go, 10 Meter Walk). Multivariable linear regression analyses found that CBPT participants had significantly greater decreases in pain and disability and increases in general health and physical performance compared to the Education group at 3 month follow-up. Results suggest a targeted CBPT program may result in significant and clinically meaningful improvement in postoperative outcomes. CBPT has the potential to be an evidence-based program that clinicians can recommend for patients at-risk for poor recovery following spine surgery. PMID:26476267

  10. Acute kidney injury, long-term renal function and mortality in patients undergoing major abdominal surgery: a cohort analysis

    PubMed Central

    Gameiro, Joana; Neves, Joana Briosa; Rodrigues, Natacha; Bekerman, Catarina; Melo, Maria João; Pereira, Marta; Teixeira, Catarina; Mendes, Inês; Jorge, Sofia; Rosa, Rosário; Lopes, José António

    2016-01-01

    Background Acute kidney injury (AKI) is frequent during hospitalization and may contribute to adverse consequences. We aimed to evaluate long-term adverse renal function and mortality after postoperative AKI in a cohort of patients undergoing major abdominal surgery. Methods We performed a retrospective analysis of adult patients who underwent major non-vascular abdominal surgery between January 2010 and February 2011 at the Department of Surgery II of Hospital de Santa Maria–Centro Hospitalar Lisboa Norte, Portugal. Exclusion criteria were as follows: chronic kidney disease on renal replacement therapy, undergoing renal replacement therapy the week before surgery, death before discharge and loss to follow-up through January 2014. Patients were categorized according to the development of postoperative AKI in the first 48 h after surgery using the Kidney Disease: Improving Global Outcomes classification. AKI was defined by an increase in absolute serum creatinine (SCr) ≥0.3 mg/dL or by a percentage increase in SCr ≥50% and/or by a decrease in urine output to <0.5 mL/kg/h for >6 h. Adverse renal outcomes (need for long-term dialysis and/or a 25% decrease in estimated glomerular filtration rate after hospital discharge) and mortality after discharge were evaluated. Cumulative mortality was analysed with the Kaplan–Meier method and log-rank test and outcome predictive factors with the Cox regression. Significance was set at P < 0.05. Results Of 390 selected patients, 72 (18.5%) developed postoperative AKI. The median follow-up was 38 months. Adverse renal outcomes and death after hospital discharge were more frequent among AKI patients (47.2 versus 22.0%, P < 0.0001; and 47.2 versus 20.5%, P < 0.0001, respectively). The 4 year cumulative probability of death was 44.4% for AKI patients, while it was 19.8% for patients with no AKI (log-rank test, P < 0.0001). In multivariate analysis, AKI was a risk factor for adverse renal outcomes (adjusted hazard ratio 1.6, P

  11. The Information and Consent Process in Patients undergoing Elective ENT surgery: A cross-sectional survey

    PubMed Central

    Georgalas, Christos; Ganesh, Kulandaivelu; Papesch, Eva

    2008-01-01

    Background To assess the importance of different information pathways for patients undergoing elective ENT surgery (General Practitioner, Specialist consultation, pre assessment clinic and consent process as well as printed information material and non medical sources) and to correlate their relative importance with patient and doctor factors Methods – Patients Cross – sectional questionnaire survey 226 consecutive patients undergoing elective non-oncological otolaryngology procedures at a District General Hospital between May and August 2004 Results Overall patients were moderately satisfied with the information they received prior to surgery (score 63/100). Although they were generally satisfied with the quality of information they received at their outpatient consultation and at the preadmission clinic, they were less satisfied with the quality of information provided by their GPs and by the quality of self – obtained information. Most importantly, linear regression modeling showed that the overall level of information could be predicted by three factors: The quality of written information received at the hospital, the quality of self-obtained information and the information provided by the specialist at the time of listing for surgery. While patient's education level was correlated with the information process, the age and gender of the patient as well as the grade of the doctor at the outpatients were not associated with his overall levels of satisfaction. Conclusion Although the impact of the initial outpatient consultation for patients undergoing elective surgery can not be over emphasized, written information provided at the hospital as well as patient – initiated, parallel information pathways are at least as important: It is our duty to recognize them and use them for the patient's advantage. PMID:18798994

  12. Impact of obesity on recovery and pulmonary functions of obese women undergoing major abdominal gynecological surgeries.

    PubMed

    Moustafa, Ahmed A M; Abdelazim, Ibrahim A

    2016-06-01

    To determine impact of obesity on recovery parameters and pulmonary functions of women undergoing major abdominal gynecological surgeries. Eighty women undergoing major gynecological surgeries were included in this study. Anesthesia was induced by remifentanil bolus, followed by propofol and cisatracurium to facilitate oro-tracheal intubation and was maintained by balanced anesthesia of remifentanil intravenous infusion and sevoflurane in oxygen and air. Time from discontinuation of maintenance anesthesia to fully awake were recorded at 1-min intervals and time from discontinuation of anesthesia until patient was transferred to post-anesthesia care unit (PACU) and discharged from PACU was also recorded. Pulmonary function tests were performed before surgery and repeated 4 h, days 1, 2 and 3 post-operative for evaluation of forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate. Occurrence of post-operative complications, re-admission to ICU, hospital stay and morbidities were also recorded. Induction of anesthesia using remifentanil bolus injection resulted in significant decrease of heart rate and arterial pressures compared to pre-operative and pre-induction values. Recovery times were significantly shorter in obese compared to morbidly obese women. Post-operative pulmonary function tests showed significant deterioration compared to pre-operative measures but showed progressive improvement through first 3 post-operative days. Hospital stay was significantly shorter for obese compared to morbid obese women. Obesity delays recovery from general anesthesia, adversely affects pulmonary functions and increases post-operative complications. Remifentanil infusion and sevoflurane could be appropriate combination for obese and morbidly obese women undergoing major surgeries.

  13. Utility of preoperative in vitro platelet function tests for predicting bleeding risk in patients undergoing functional endoscopic sinus surgery

    PubMed Central

    Lee, A-Jin; Kim, Sang-Gyung

    2016-01-01

    Background It is necessary to predict the bleeding risk in patients undergoing functional endoscopic sinus surgery (FESS). To evaluate the adequacy of primary hemostasis, preoperative hemostatic screening tests are used. In the present study, we determined whether there is a positive correlation between prolonged closure time (CT) with collagen/epinephrine (CT-epi), prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT) and bleeding during FESS. Patients and methods We reviewed the medical records of 90 patients without bleeding histories who had undergone FESS from March 2013 to June 2014. More than 200 mL of blood loss was defined as moderate bleeding during surgery. With respect to bleeding during surgery, we determined the sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of CT-epi, PT, INR and aPTT. Results Of the 90 patients, 17 (18.9%) patients had preoperative prolonged CT values and three (17.6%) patients had bleeding. In comparison, five (6.8%) of the 73 (81.1%) patients who had undergone FESS with preoperative normal PFA values experienced bleeding (P=0.171). On the other hand, patients with prolonged PT values (2, 2.2%), prolonged INR values (3, 3.3%) or prolonged PTT values (1, 1.1%) had no bleeding episode. Preoperative CT had low sensitivity (44.4%) and PPV (23.5%). Conclusion During preoperative period, the hemostatic screening may not be helpful to detect the bleeding tendency in adult patients undergoing FESS. Routine measurement of CT-epi, PT, INR and aPTT for preoperative screening may not be recommended for FESS patients. PMID:27799837

  14. For neonates undergoing cardiac surgery does thymectomy as opposed to thymic preservation have any adverse immunological consequences?

    PubMed

    Afifi, Ahmed; Raja, Shahzad G; Pennington, Daniel J; Tsang, Victor T

    2010-09-01

    A best evidence topic in congenital cardiac surgery was written according to a structured protocol. The question addressed was whether neonatal thymectomy in patients undergoing cardiac surgery has any adverse immunological consequences. Altogether 164 papers were found using the reported search, of which nine papers represented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. The thymus is the major production site of T cells, whose stocks are built-up during foetal and early postnatal life. However, its function diminishes after the first years of life, and although thymic output is maintained into adulthood, the thymus mostly degenerates into fatty tissue in elderly adults. To date, there has been no general consensus with regard to the importance of this organ during childhood and adulthood. As a consequence, during cardiac surgery in neonates, partial or total thymectomy is routinely performed to enable better access to the heart and great vessels to correct congenital heart defects, suggesting that it may be dispensable during childhood and adulthood. Interestingly, current best available evidence from nine case-control studies suggests that neonatal thymectomy affects peripheral T-cell populations both in the short- as well as long-term and results in premature immunosenescence. However, the impact of these changes on the risk of infectious diseases or malignancy has not been thoroughly evaluated by any of these studies. Maintenance of a registry of patients undergoing neonatal thymectomy and further studies to assess the functional or clinical consequences of this practice would be valuable.

  15. Wernicke encephalopathy in subjects undergoing restrictive weight loss surgery: a systematic review of literature data.

    PubMed

    Milone, Marco; Di Minno, Matteo Nicola Dario; Lupoli, Roberta; Maietta, Paola; Bianco, Paolo; Pisapia, Anna; Gaudioso, Dario; Taffuri, Caterina; Milone, Francesco; Musella, Mario

    2014-07-01

    The use of weight loss surgery is progressively increasing, and in recent years, restrictive bariatric surgery procedures have been more often used. Although thought to be associated with a lower incidence of post-operative side effects than malabsorpitive surgery, some cases of micronutrients deficiency have been reported because of an acquired thiamine deficiency; in this clinical setting, some cases of Wernicke encephalopathy (WE) have been described. Major determinants and predictors of this major neurological complication are currently unknown. The aim of this systematic review was to analyse literature data in order to address this issue. The main result of our systematic review was that persistent vomiting is the major determinant of WE in patients undergoing restrictive weight loss surgery. In addition, early thiamine supplementation can rapidly improve the clinical conditions, avoiding permanent deficiencies. On the other hand, given the wide variability of clinical and demographic characteristics, definite prognostic factors of WE occurrence and of clinical outcome cannot be identified. In conclusion, although our results are suggestive, further ad hoc prospective studies evaluating changes in micronutrients levels according to different types of surgery are needed.

  16. The Influence of Perioperative Dexmedetomidine on Patients Undergoing Cardiac Surgery: A Meta-Analysis

    PubMed Central

    Geng, Jun; Qian, Ju; Cheng, Hao; Ji, Fuhai; Liu, Hong

    2016-01-01

    Background The use of dexmedetomidine may have benefits on the clinical outcomes of cardiac surgery. We conducted a meta-analysis comparing the postoperative complications in patients undergoing cardiac surgery with dexmedetomidine versus other perioperative medications to determine the influence of perioperative dexmedetomidine on cardiac surgery patients. Methods Randomized or quasi-randomized controlled trials comparing outcomes in patients who underwent cardiac surgery with dexmedetomidine, another medication, or a placebo were retrieved from EMBASE, PubMed, the Cochrane Library, and Science Citation Index. Results A total of 1702 patients in 14 studies met the selection criteria among 1,535 studies that fit the research strategy. Compared to other medications, dexmedetomidine has combined risk ratios of 0.28 (95% confidence interval [CI] 0.15, 0.55, P = 0.0002) for ventricular tachycardia, 0.35 (95% CI 0.20, 0.62, P = 0.0004) for postoperative delirium, 0.76 (95% CI 0.55, 1.06, P = 0.11) for atrial fibrillation, 1.08 (95% CI 0.74, 1.57, P = 0.69) for hypotension, and 2.23 (95% CI 1.36, 3.67, P = 0.001) for bradycardia. In addition, dexmedetomidine may reduce the length of intensive care unit (ICU) and hospital stay. Conclusions This meta-analysis revealed that the perioperative use of dexmedetomidine in patients undergoing cardiac surgery can reduce the risk of postoperative ventricular tachycardia and delirium, but may increase the risk of bradycardia. The estimates showed a decreased risk of atrial fibrillation, shorter length of ICU stay and hospitalization, and increased risk of hypotension with dexmedetomidine. PMID:27049318

  17. Use of Caudal Analgesia Supplemented with Low Dose of Morphine in Children Who Undergo Renal Surgery

    PubMed Central

    Chertin, Boris; Zeldin, Alexander; Kocherov, Stanislav; Ioscovich, Alexander; Ostrovsky, Israel A.; Gozal, Yaacov

    2016-01-01

    Introduction To test the efficacy and safety of caudal anesthesia (CA) supplemented by low dose morphine in children who undergo renal surgery. Materials and Methods Forty patients aged 2 months-14 years were enrolled and randomly divided into two groups of 20 patients each: Group A (bupivacaine 0.2% with fentanyl); Group B (bupivacaine with morphine). The duration of surgery and hospitalization time were recorded. Postoperative pain score was measured by Face Legs Activity Cry Consolability scale and Wong-Baker Faces scale for those who are older. Overall use of rescue analgesics was calculated. Results There was no statistical difference in the length of surgery, incidence of pruritus, postoperative nausea, vomiting and urinary retention between the two groups. However the postoperative opioid requirements were significantly higher in Group A 1.03 ± 0.9 mg/kg compared to Group B, in which only one patient required opioid therapy (p < 0.0001). Moreover the need for non-opioid rescue analgesic was higher in Group A, (36 ± 5.7 mg/kg of paracetamol) compared to morphine CA group there only 26 ± 3.6 mg/kg required during first 24 h of the postoperative period (p = 0.0312). The Face Legs Activity Cry Consolability pain score (1, 4, and 24 h after surgery) and Wong-Baker Faces scale were significantly higher in Group A. The hospitalization period was shorter in the CA morphine group, but the difference did not reach statistical significance. None developed hemodynamic instability or respiratory depression. Conclusions Our data show that CA supplemented with low dose morphine provides a longer duration of analgesia without significant side-effects in children undergoing renal surgery. PMID:27867330

  18. Extended venous thromboembolism prophylaxis in patients undergoing hip fracture surgery - the SAVE-HIP3 study.

    PubMed

    Fisher, W D; Agnelli, G; George, D J; Kakkar, A K; Lassen, M R; Mismetti, P; Mouret, P; Turpie, A G G

    2013-04-01

    There is currently limited information available on the benefits and risks of extended thromboprophylaxis after hip fracture surgery. SAVE-HIP3 was a randomised, double-blind study conducted to evaluate the efficacy and safety of extended thromboprophylaxis with the ultra-low molecular-weight heparin semuloparin compared with placebo in patients undergoing hip fracture surgery. After a seven- to ten-day open-label run-in phase with semuloparin (20 mg once daily subcutaneously, initiated post-operatively), patients were randomised to once-daily semuloparin (20 mg subcutaneously) or placebo for 19 to 23 additional days. The primary efficacy endpoint was a composite of any venous thromboembolism (VTE; any deep-vein thrombosis and non-fatal pulmonary embolism) or all-cause death until day 24 of the double-blind period. Safety parameters included major and clinically relevant non-major bleeding, laboratory data, and treatment-emergent adverse events (TEAEs). Extended thromboprophylaxis with semuloparin demonstrated a relative risk reduction of 79% in the rate of any VTE or all-cause death compared with placebo (3.9% vs 18.6%, respectively; odds ratio 0.18 (95% confidence interval 0.07 to 0.45), p < 0.001). Two patients in the semuloparin group and none in the placebo group experienced clinically relevant bleeding. TEAE rates were similar in both groups. In conclusion, the SAVE-HIP3 study results demonstrate that patients undergoing hip fracture surgery benefit from extended thromboprophylaxis.

  19. Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear

    PubMed Central

    Pihl, Kenneth; Englund, Martin; Lohmander, L Stefan; Jørgensen, Uffe; Nissen, Nis; Schjerning, Jeppe; Thorlund, Jonas B

    2017-01-01

    Background and purpose — Recent evidence has questioned the effect of arthroscopic knee surgery for middle-aged and older patients with degenerative meniscal tears with or without concomitant radiographic knee osteoarthritis (OA). We investigated the prevalence of early or more established knee OA and patients’ characteristics in a cohort of patients undergoing arthroscopic surgery for a meniscal tear. Patients and methods — 641 patients assigned for arthroscopy on suspicion of meniscus tear were consecutively recruited from February 2013 through January 2015. Of these, 620 patients (mean age 49 (18–77) years, 57% men) with full datasets available were included in the present study. Prior to surgery, patients completed questionnaires regarding onset of symptoms, duration of symptoms, and mechanical symptoms along with the knee injury and osteoarthritis outcome score (KOOS). At arthroscopy, the operating surgeon recorded information about meniscal pathology and cartilage damage. Early or more established knee OA was defined as the combination of self-reported frequent knee pain, cartilage damage, and the presence of degenerative meniscal tissue. Results — 43% of patients (269 of 620) had early or more established knee OA. Of these, a large proportion had severe cartilage lesions with almost half having a severe cartilage lesion in at least 1 knee compartment. Interpretation — Based on a definition including frequent knee pain, cartilage damage, and degenerative meniscal tissue, early or more established knee OA was present in 43% of patients undergoing knee arthroscopy for meniscal tear. PMID:27798972

  20. Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear.

    PubMed

    Pihl, Kenneth; Englund, Martin; Lohmander, L Stefan; Jørgensen, Uffe; Nissen, Nis; Schjerning, Jeppe; Thorlund, Jonas B

    2017-02-01

    Background and purpose - Recent evidence has questioned the effect of arthroscopic knee surgery for middle-aged and older patients with degenerative meniscal tears with or without concomitant radiographic knee osteoarthritis (OA). We investigated the prevalence of early or more established knee OA and patients' characteristics in a cohort of patients undergoing arthroscopic surgery for a meniscal tear. Patients and methods - 641 patients assigned for arthroscopy on suspicion of meniscus tear were consecutively recruited from February 2013 through January 2015. Of these, 620 patients (mean age 49 (18-77) years, 57% men) with full datasets available were included in the present study. Prior to surgery, patients completed questionnaires regarding onset of symptoms, duration of symptoms, and mechanical symptoms along with the knee injury and osteoarthritis outcome score (KOOS). At arthroscopy, the operating surgeon recorded information about meniscal pathology and cartilage damage. Early or more established knee OA was defined as the combination of self-reported frequent knee pain, cartilage damage, and the presence of degenerative meniscal tissue. Results - 43% of patients (269 of 620) had early or more established knee OA. Of these, a large proportion had severe cartilage lesions with almost half having a severe cartilage lesion in at least 1 knee compartment. Interpretation - Based on a definition including frequent knee pain, cartilage damage, and degenerative meniscal tissue, early or more established knee OA was present in 43% of patients undergoing knee arthroscopy for meniscal tear.

  1. An update on predictive biomarkers for major adverse cardiovascular events in patients undergoing vascular surgery.

    PubMed

    Patelis, Nikolaos; Kouvelos, George N; Koutsoumpelis, Andreas; Moris, Demetrios; Matsagkas, Miltiadis I; Arnaoutoglou, Eleni

    2016-09-01

    Cardiovascular complications signify a major cause of morbidity and mortality in patients undergoing vascular surgery adversely affecting both short- and long-term prognosis. During the last decade, unmet needs for a distinct cardiovascular risk assessment have led to an intensive research for establishment of biomarkers with sufficient predictive value. This literature review aims in examining the value of several biomarkers in predicting the incidence of major adverse cardiac events in vascular surgery patients. We reviewed the English language literature and analyzed the biomarkers as independent predictors or in correlation with other factors. We found several biomarkers showing a significant predictive value for a major adverse cardiovascular event in patients undergoing vascular surgery. These biomarkers can be used in clinical practice as outcome predictors, although sensitivity and specificity varies. Detection of subclinical cardiovascular damage may improve total risk estimation and facilitate clinical assessment of patients at risk for future cardiovascular events. The wide variety of sensitivity and specificity in predicting a MACE of these biomarkers exert the need for future trials in which these markers will be tested as adjunctive tools of cardiovascular risk estimation scoring systems.

  2. The myocardial protective effect of dexmedetomidine in high-risk patients undergoing aortic vascular surgery

    PubMed Central

    Soliman, Rabie; Zohry, Gomaa

    2016-01-01

    Objective: The aim of the study was to assess the effect of dexmedetomidine in high-risk patients undergoing aortic vascular surgery. Design: A randomized prospective study. Setting: Cairo University, Egypt. Materials and Methods: The study included 150 patients undergoing aortic vascular surgery. Intervention: The patients were classified into two groups (n = 75). Group D: The patients received a loading dose of 1 μg/kg dexmedetomidine over 15 min before induction and maintained as an infusion of 0.3 μg/kg/h to the end of the procedure. Group C: The patients received an equal volume of normal saline. The medication was prepared by the nursing staff and given to anesthetist blindly. Measurements: The monitors included the heart rate, mean arterial blood pressure, central venous pressure, electrocardiogram (ECG), serum troponin I level, end-tidal sevoflurane, and total dose of morphine in addition transthoracic echocardiography to the postoperative in cases with elevated serum troponin I level. Main Results: The dexmedetomidine decreased heart rate and minimized the changes in blood pressure compared to control group (P < 0.05). Furthermore, it decreased the incidence of myocardial ischemia reflected by troponin I level, ECG changes, and the development of new regional wall motion abnormalities (P < 0.05). Dexmedetomidine decreased the requirement for nitroglycerin and norepinephrine compared to control group (P < 0.05). The incidence of hypotension and bradycardia was significantly higher with dexmedetomidine (P < 0.05). Conclusion: The dexmedetomidine is safe and effective in patients undergoing aortic vascular surgery. It decreases the changes in heart rate and blood pressure during the procedures. It provides cardiac protection in high-risk patients reflected by decreasing the incidence of myocardial ischemia and serum level of troponin. The main side effects of dexmedetomidine were hypotension and bradycardia. PMID:27716690

  3. Lipomatous Hypertrophy of the Atrial Septum in a Patient Undergoing Coronary Artery Bypass Surgery

    PubMed Central

    Weyand, Michael; Agaimy, Abbas

    2016-01-01

    Background. Lipomatous hypertrophy of the atrial septum (LHAS) is a rare entity characterized by mass-forming deposition of fatty tissue within the atrial septum. To date, <300 cases have been reported; many of them were autopsy findings. The clinical presentation of LHAS varies from incidental asymptomatic mass (most frequent form) to severe life-threatening cardiovascular complications necessitating emergency cardiac surgery. Case Presentation. Here, we present the successful surgical resection of such a massive LHAS which was found incidentally on preoperative investigation of a 71-year-old patient with progressive coronary heart disease. Histology confirmed the diagnosis of lipomatous hypertrophy of the atrial septum. Conclusions. The described case report illustrates an unusual example of LHAS in a patient undergoing a planned coronary artery bypass surgery. In this case, surgical intervention was justified to avoid later outflow obstructions. PMID:28078155

  4. Transient Intraoperative Central Diabetes Insipidus in Moyamoya Patients Undergoing Revascularization Surgery: A Mere Coincidence?

    PubMed

    Hong, Joe C; Ramos, Emilio; Copeland, Curtis C; Ziv, Keren

    2016-04-15

    We present 2 patients with Moyamoya disease undergoing revascularization surgery who developed transient intraoperative central diabetes insipidus with spontaneous resolution in the immediate postoperative period. We speculate that patients with Moyamoya disease may be predisposed to a transient acute-on-chronic insult to the arginine vasopressin-producing portion of their hypothalamus mediated by anesthetic agents. We describe our management, discuss pertinent literature, and offer possible mechanisms of this transient insult. We hope to improve patient safety by raising awareness of this potentially catastrophic complication.

  5. The effects of clown intervention on worries and emotional responses in children undergoing surgery.

    PubMed

    Fernandes, Sara Costa; Arriaga, Patrícia

    2010-04-01

    This study investigated whether clown intervention could reduce preoperative worries and the affective responses of children undergoing minor surgery. Parental anxiety was also tested. Child's age, previous hospitalization, and temperament were tested as predictors of the child's responses during this preoperative phase. Seventy children were assigned to one of two groups: children accompanied by their parents and a pair of clowns or, those accompanied by the parents but without the clowns. The results emphasized the relevance of clown intervention on the reduction of preoperative worries and emotional responses, not only in children but also in their parents.

  6. Indocyanine green angiography of the anterior segment in patients undergoing strabismus surgery

    PubMed Central

    Chan, T.; Rosenbaum, A.; Rao, R.; Schwartz, S.; Santiago, P.; Thayer, D.

    2001-01-01

    BACKGROUND—Anterior segment imaging using fluorescein angiography is only suitable in lightly pigmented irides as the brown pigmentation of the iris masks fluorescein transmission. Indocyanine green (ICG) angiography has excellent penetration of pigment epithelium and, therefore, has potential application in detecting perfusion changes of dark irides after strabismus surgery.
METHODS—A prospective study was conducted on patients older than 15 years undergoing strabismus surgery. A fundus camera was focused on the arteriolar tufts of the pupillary margin and 50 mg of ICG (concentration of 12.5 mg/ml) was given intravenously. Images were then obtained at 1 minute intervals of 5 minutes' duration.
RESULTS—45 patients with a mean age of 54.6 years and a mean follow up period of 8.6 weeks were studied. There were 23 patients in the primary surgery group, 11 in the secondary surgery group, and 11 in the staged group. Iris ICG angiograms were successfully performed in all patients. No persistent filling defect was detected in the primary and secondary horizontal recti surgery groups or in the secondary or staged vertical and combined vertical rectus groups 6-8 weeks postoperatively. 57% of both primary vertical and combined vertical and horizontal groups showed defects in the early postoperative phase. Only three cases demonstrated late perfusion defects in this series.
CONCLUSION—ICG can detect iris perfusion changes in dark irides after strabismus surgery. Iris reperfusion was achieved in the majority of the cases.

 PMID:11159489

  7. Effects of music therapy under general anesthesia in patients undergoing abdominal surgery

    PubMed Central

    Kahloul, Mohamed; Mhamdi, Salah; Nakhli, Mohamed Said; Sfeyhi, Ahmed Nadhir; Azzaza, Mohamed; Chaouch, Ajmi; Naija, Walid

    2017-01-01

    ABSTRACT Background: Music therapy, an innovative approach that has proven effectiveness in many medical conditions, seems beneficial also in managing surgical patients. The aim of this study is to evaluate its effects, under general anesthesia, on perioperative patient satisfaction, stress, pain, and awareness. Methods: This is a prospective, randomized, double-blind study conducted in the operating theatre of visceral surgery at Sahloul Teaching Hospital over a period of 4 months. Patients aged more than 18 undergoing a scheduled surgery under general anesthesia were included. Patients undergoing urgent surgery or presenting hearing or cognitive disorders were excluded. Before induction, patients wore headphones linked to an MP3 player. They were randomly allocated into 2 groups: Group M (with music during surgery) and group C (without music). Hemodynamic parameters, quality of arousal, pain experienced, patient’s satisfaction, and awareness incidence during anesthesia were recorded. Results: One hundred and forty patients were included and allocated into 2 groups that were comparable in demographic characteristics, surgical intervention type and anesthesia duration. Comparison of these two groups regarding the hemodynamic profile found more stability in group M for systolic arterial blood pressure. A calm recovery was more often noted in group M (77.1% versus 44%, p < 10–3). The average Visual Analog Scale (VAS) score was lower in the intervention group (33.8 ± 13.63 versus 45.1 ± 16.2; p < 10–3). The satisfaction rate was significantly higher among the experimental group (81.4% versus 51.4%; p < 10–3). The incidence of intraoperative awareness was higher in group C (8 cases versus 3 cases) but the difference was not statistically significant. Conclusion: Music therapy is a non-pharmacological, inexpensive, and non-invasive technique that can significantly enhance patient satisfaction and decrease patients’ embarrassing experiences related

  8. Mitophagy and mitochondrial biogenesis in atrial tissue of patients undergoing heart surgery with cardiopulmonary bypass

    PubMed Central

    Andres, Allen M.; Tucker, Kyle C.; Thomas, Amandine; Taylor, David J.R.; Jahania, Salik M.; Dabir, Reza; Pourpirali, Somayeh; Brown, Jamelle A.; Westbrook, David G.; Ballinger, Scott W.; Mentzer, Robert M.

    2017-01-01

    Mitophagy occurs during ischemia/reperfusion (I/R) and limits oxidative stress and injury. Mitochondrial turnover was assessed in patients undergoing cardiac surgery involving cardiopulmonary bypass (CPB). Paired biopsies of right atrial appendage before initiation and after weaning from CPB were processed for protein analysis, mitochondrial DNA/nuclear DNA ratio (mtDNA:nucDNA ratio), mtDNA damage, mRNA, and polysome profiling. Mitophagy in the post-CPB samples was evidenced by decreased levels of mitophagy adapters NDP52 and optineurin in whole tissue lysate, decreased Opa1 long form, and translocation of Parkin to the mitochondrial fraction. PCR analysis of mtDNA comparing amplification of short vs. long segments of mtDNA revealed increased damage following cardiac surgery. Surprisingly, a marked increase in several mitochondria-specific protein markers and mtDNA:nucDNA ratio was observed, consistent with increased mitochondrial biogenesis. mRNA analysis suggested that mitochondrial biogenesis was traniscription independent and likely driven by increased translation of existing mRNAs. These findings demonstrate in humans that both mitophagy and mitochondrial biogenesis occur during cardiac surgery involving CPB. We suggest that mitophagy is balanced by mitochondrial biogenesis during I/R stress experienced during surgery. Mitigating mtDNA damage and elucidating mechanisms regulating mitochondrial turnover will lead to interventions to improve outcome after I/R in the setting of heart disease. PMID:28239650

  9. General anesthesia in tetanus patient undergoing emergency surgery: A challenge for anesthesiologist

    PubMed Central

    Mahajan, Reena; Kumar, Amit; Singh, Shiv Kumar

    2014-01-01

    Tetanus is an acute often fatal disease produced by gram positive obligate anaerobic bacterium Clostridium tetani. Tetanolysin damages local tissue and provides optimal conditions for bacterial multiplication. It is therefore important to perform a wide debridement of any wound suspected of being a portal of entry for the bacteria. Little evidence exists to recommend specific anesthetic protocols. We encountered a child scheduled for fracture both bone forearm with developing tetanus. Initial management done with intravenous (i.v) diazepam, phenobarbitone, and metronidazole. After premedication with midazolam and fentanyl, induction was done by propofol 60 mg, vecuronium 2.5 mg, ventilated with O2+ N2O 50:50 with sevoflurane 2% and tracheal intubation was done with 5.5 ID cuffed PVC endotracheal tube. Anesthesia was maintained with sevoflurane 2% and vecuronium intermittently when required. Intraop vitals were stable. On completion of surgery, reversal given and patient was extubated uneventfully and shifted to recovery room. Little evidence exists to recommend specific anesthetic technique for tetanus patient posted for surgery. When present, obvious wounds should be surgically debrided. Ideally patients considered for surgery should undergo anesthesia and surgery before severe autonomic dysfunction develops. Most anesthetic managements are based on limited evidence. However, we used sevoflurane and vecuronium successfully, further study is needed to establish their efficacy and safety. Major challenges lie in the control of muscle rigidity and spasm, autonomic disturbances and prevention of complications. PMID:25886114

  10. Cerebral oxygenation monitoring in patients with bilateral carotid stenosis undergoing urgent cardiac surgery: Observational case series

    PubMed Central

    Aktuerk, Dincer; Mishra, Pankaj Kumar; Luckraz, Heyman; Garnham, Andrew; Khazi, Fayaz Mohammed

    2016-01-01

    Background: Patients with significant bilateral carotid artery stenosis requiring urgent cardiac surgery have an increased risk of stroke and death. The optimal management strategy remains inconclusive, and the available evidence does not support the superiority of one strategy over another. Materials and Methods: A number of noninvasive strategies have been developed for minimizing perioperative stroke including continuous real-time monitoring of cerebral oxygenation with near-infrared spectroscopy (NIRS). The number of patients presenting with this combination (bilateral significant carotid stenosis requiring urgent cardiac surgery) in any single institution will be small and hence there is a lack of large randomized studies. Results: This case series describes our early experience with NIRS in a select group of patients with significant bilateral carotid stenosis undergoing urgent cardiac surgery (n = 8). In contrast to other studies, this series is a single surgeon, single center study, where the entire surgery (both distal ends and proximal ends) was performed during single aortic clamp technique, which effectively removes several confounding variables. NIRS monitoring led to the early recognition of decreased cerebral oxygenation, and corrective steps (increased cardiopulmonary bypass flow, increased pCO2, etc.,) were taken. Conclusion: The study shows good clinical outcome with the use of NIRS. This is our “work in progress,” and we aim to conduct a larger study. PMID:26750675

  11. Systemic Trans- and Postoperative Evaluations of Patients Undergoing Dental Implant Surgery

    PubMed Central

    Goiato, Marcelo Coelho; Junior, Joel Ferreira Santiago; Pellizzer, Eduardo Piza; Moreno, Amália; Villa, Luiz Marcelo Ribeiro; de Carvalho Dekon, Stefan Fiuza; de Carvalho, Paulo Sérgio Perri; dos Santos, Daniela Micheline

    2016-01-01

    OBJECTIVE: The aims of this study were to examine the trans- and postoperative systemic characteristics of patients undergoing dental implant surgery and to investigate the relationship between pre- and post- surgery anxiety levels. MATERIAL AND METHODS: Thirty-nine patients were analyzed in 3 call centers to determine anxiety levels, pain levels, and preoperative and postoperative histories using the State–Trait (STAI) questionnaire. RESULTS: A total of 93 dental implants were installed, with a success rate of 100%. The most frequently reported systemic disease was hypertension. There was a significantly higher rate of effective clamping (torque) to the mandibular bone than to the maxillary bone. The association between postoperative surgical complications and longer operative time was not significant, but there was a significant correlation between the alteration of mouth opening and daily routine activities and a significant decrease in anxiety levels between the day of surgery and the postoperative time point (p=0.006). CONCLUSION: A longer surgical time was associated with surgery-related complications and with a higher anxiety index on the preoperative evaluation. PMID:27074177

  12. Infection and Venous Thromboembolism in Patients Undergoing Colorectal Surgery: What Is the Relationship?

    PubMed Central

    Monn, M. Francesca; Hui, Xuan; Lau, Brandyn D.; Streiff, Michael; Haut, Elliott R.; Wick, Elizabeth C.; Efron, Jonathan E.; Gearhart, Susan L.

    2015-01-01

    BACKGROUND There is evidence demonstrating an association between infection and venous thromboembolism. We recently identified this association in the postoperative setting; however, the temporal relationship between infection and venous thromboembolism is not well defined OBJECTIVE We sought to determine the temporal relationship between venous thromboembolism and postoperative infectious complications in patients undergoing colorectal surgery. DESIGN, SETTING, AND PATIENTS A retrospective cohort analysis was performed using data for patients undergoing colorectal surgery in the National Surgical Quality Improvement Project 2010 database. MAIN OUTCOME MEASURES The primary outcome measures were the rate and timing of venous thromboembolism and postoperative infection among patients undergoing colorectal surgery during 30 postoperative days. RESULTS Of 39,831 patients who underwent colorectal surgery, the overall rate of venous thromboembolism was 2.4% (n = 948); 729 (1.8%) patients were diagnosed with deep vein thrombosis, and 307 (0.77%) patients were diagnosed with pulmonary embolism. Eighty-eight (0.22%) patients were reported as developing both deep vein thrombosis and pulmonary embolism. Following colorectal surgery, the development of a urinary tract infection, pneumonia, organ space surgical site infection, or deep surgical site infection was associated with a significantly increased risk for venous thromboembolism. The majority (52%–85%) of venous thromboembolisms in this population occurred the same day or a median of 3.5 to 8 days following the diagnosis of infection. The approximate relative risk for developing any venous thromboembolism increased each day following the development of each type of infection (range, 0.40%–1.0%) in comparison with patients not developing an infection. LIMITATIONS We are unable to account for differences in data collection, prophylaxis, and venous thromboembolism surveillance between hospitals in the database

  13. Comparing Postoperative Pain Experiences of the Adolescent and Adult Athlete After Anterior Cruciate Ligament Surgery

    PubMed Central

    Stanish, William D.; Reardon, Gerald; Coady, Catherine; Sullivan, Michael J. L.

    2003-01-01

    Objective: To examine age-related differences in pain, catastrophizing, and affective distress (depression and anxiety) after athletic injury and knee surgery. Design and Setting: Participants were assessed with measures of pain intensity, pain-related catastrophizing, depression, and anxiety symptoms at 24 hours after anterior cruciate ligament (ACL) surgery. Subjects: Twenty patients (10 adolescents, 10 adults) with an acute complete tear of the ACL. Measurements: Pain was assessed by Visual Analog Scale (VAS), catastrophizing with the Pain Catastrophizing Scale (PCS), depressive symptoms with the Beck Depression Inventory (BDI), and anxiety with the state form of the State-Trait Anxiety Inventory (STAI-S). Results: At 24 hours postsurgery, adolescents reported greater pain, catastrophizing, and anxiety than adults. Ancillary analyses showed that helplessness and rumination were significant contributors to the differences in catastrophizing. Further, an analysis of covariance showed that controlling for the effects of catastrophizing, the adolescent and adult differences in pain scores were reduced to a null effect. Conclusions: After ACL surgery, athletic adolescents and adults differed significantly in pain, catastrophizing, and anxiety. Catastrophizing seemed to be a particularly strong factor in postoperative pain differences between adolescents and adults, with clinical-management implications. These data indicate the need for continued research into specific pain- and age-related factors during the acute postoperative period for athletes undergoing ACL surgery. PMID:12937527

  14. Subcutaneous Heparin Versus Low-Molecular-Weight Heparin as Thromboprophylaxis in Patients Undergoing Colorectal Surgery

    PubMed Central

    McLeod, Robin S.; Geerts, William H.; Sniderman, Kenneth W.; Greenwood, Celia; Gregoire, Roger C.; Taylor, Brian M.; Silverman, Richard E.; Atkinson, Kenneth G.; Burnstein, Marcus; Marshall, John C.; Burul, Claude J.; Anderson, David R.; Ross, Theodore; Wilson, Stephanie R.; Barton, Paul

    2001-01-01

    Objective To compare the effectiveness and safety of low-dose unfractionated heparin and a low-molecular-weight heparin as prophylaxis against venous thromboembolism after colorectal surgery. Methods In a multicenter, double-blind trial, patients undergoing resection of part or all of the colon or rectum were randomized to receive, by subcutaneous injection, either calcium heparin 5,000 units every 8 hours or enoxaparin 40 mg once daily (plus two additional saline injections). Deep vein thrombosis was assessed by routine bilateral contrast venography performed between postoperative day 5 and 9, or earlier if clinically suspected. Results Nine hundred thirty-six randomized patients completed the protocol and had an adequate outcome assessment. The venous thromboembolism rates were the same in both groups. There were no deaths from pulmonary embolism or bleeding complications. Although the proportion of all bleeding events in the enoxaparin group was significantly greater than in the low-dose heparin group, the rates of major bleeding and reoperation for bleeding were not significantly different. Conclusions Both heparin 5,000 units subcutaneously every 8 hours and enoxaparin 40 mg subcutaneously once daily provide highly effective and safe prophylaxis for patients undergoing colorectal surgery. However, given the current differences in cost, prophylaxis with low-dose heparin remains the preferred method at present. PMID:11224634

  15. Population pharmacokinetics of ϵ-aminocaproic acid in adolescents undergoing posterior spinal fusion surgery

    PubMed Central

    Stricker, P. A.; Gastonguay, M. R.; Singh, D.; Fiadjoe, J. E.; Sussman, E. M.; Pruitt, E. Y.; Goebel, T. K.; Zuppa, A. F.

    2015-01-01

    Background Despite demonstrated efficacy of ϵ-aminocaproic acid (EACA) in reducing blood loss in adolescents undergoing spinal fusion, there are no population-specific pharmacokinetic data to guide dosing. The aim of this study was to determine the pharmacokinetics of EACA in adolescents undergoing spinal fusion surgery and make dosing recommendations. Methods Twenty children ages 12–17 years were enrolled, with 10 children in each of two groups based on diagnosis (idiopathic scoliosis or non-idiopathic scoliosis). Previously reported data from infants undergoing craniofacial surgery were included in the model to enable dosing recommendations over a wide range of weights, ages, and diagnoses. A population non-linear mixed effects modelling approach was used to characterize EACA pharmacokinetics. Results Population pharmacokinetic parameters were estimated using a two-compartment disposition model with allometrically scaled weight and an age effect on clearance. Pharmacokinetic parameters for the typical patient were a plasma clearance of 153 ml min−1 70 kg−1 (6.32 ml min−1 kg−0.75), intercompartmental clearance of 200 ml min−1 70 kg−1 (8.26 ml min−1 kg−0.75), central volume of distribution of 8.78 litre 70 kg−1 (0.13 litre kg−1), and peripheral volume of distribution of 15.8 litre 70 kg−1 (0.23 litre kg−1). Scoliosis aetiology did not have a clinically significant effect on drug pharmacokinetics. Conclusions The following dosing schemes are recommended according to patient weight: weight <25 kg, 100 mg kg−1 loading dose and 40 mg kg−1 h−1 infusion; weight ≤25 kg–<50 kg, 100 mg kg−1 loading dose and 35 mg kg−1 h−1 infusion; and weight ≥50 kg, 100 mg kg−1 loading dose and 30 mg kg−1 h−1 infusion. An efficacy trial employing this dosing strategy is warranted. Clinical trial registration NCT01408823. PMID:25586726

  16. Thromboprophylaxis with apixaban and the risk of pulmonary embolism in patients undergoing knee replacement surgery

    PubMed Central

    Aryal, Madan Raj; Pandit, Anil; Ghimire, Sushil; Pathak, Ranjan; Karmacharya, Paras; Poudel, Dilli Ram; Shamoun, Fadi E.

    2015-01-01

    Background Apixaban, a novel oral anticoagulant, is also used for deep vein thrombosis (DVT) prophylaxis. In this study, we sought to critically evaluate the differences in the rates of symptomatic DVT and bleeding, and analyze the rates of pulmonary embolism (PE) in subgroups of patients from ADVANCE I and II trials given their similar indication and design. Methods Studies were identified through electronic literature searches of MEDLINE, clinicaltrial.gov, SCOPUS, and EMBASE up to January 2014. Phase III RCTs involving use of apixaban and enoxaparin for thromboprophylaxis in patients undergoing total knee or hip replacement were included. Study-specific odds ratios were calculated and between-study heterogeneity was assessed using the I2 statistics. Results In three studies involving 11,659 patients, the risk of symptomatic DVT (pooled OR 0.38, 95% CI 0.16–0.90, I2=0%, p=0.03) and bleeding (pooled OR 0.87, 95% CI 0.77–0.99, I2=0%, p=0.03) was less in apixaban group compared to the enoxaparin group. However, it was interesting to note that on subgroup analysis, the risk of PE was higher with apixaban when used for thromboprophylaxis in knee replacement surgery (pooled OR 2.58, 95% CI 1.10–6.04, I 2=0%, p=0.03). Conclusion Apixaban was found to be associated with lower risk of symptomatic DVT and bleeding compared to enoxaparin when used for thromboprophylaxis in patients undergoing knee and hip replacement surgeries. However, it was associated with higher risk of PE in patients undergoing knee replacement. PMID:26333856

  17. Perioperative intravenous lidocaine infusion on postoperative pain relief in patients undergoing upper abdominal surgery.

    PubMed

    Baral, B K; Bhattarai, B K; Rahman, T R; Singh, S N; Regmi, R

    2010-12-01

    Due to unpleasant nature and physiological consequences of postoperative pain, search of safe and effective modalities for its management has remained a subject of interest to clinical researchers. Analgesic action of lidocaine infusion in patients with chronic neuropathic pain is well known but its place in relieving postoperative pain is yet to be established. The study aimed to assess the effectiveness of perioperative intravenous lidocaine infusion on postoperative pain intensity and analgesic requirement. Sixty patients undergoing major upper abdominal surgery were recruited in this randomized double blinded study. Thirty patients received lidocaine 2.0% (intravenous bolus 1.5 mg/kg followed by an infusion of 1.5 mg/kg/h), and 30 patients received normal saline according to randomization. The infusion started 30 min before skin incision and stopped 1 h after the end of surgery. Postoperative pain intensity and analgesic (diclofenac) requirement were assessed at the interval 15 minutes for 1 hour then 4 hourly up to 24 hours. The pain intensity at rest and movement as well as the total postoperative analgesic (diclofenac) requirement were significantly lower (142.50 +/- 37.80 mg vs.185.00 +/- 41.31 mg, P<0.001) in lidocaine group. The extubation time was significantly longer in lidocaine group (14.43 +/- 3.50 minutes vs. 6.73 +/- 1.76 minutes, P<0.001). The time for the first dose of analgesic requirement was longer in lidocaine group (60.97 +/- 18.05 minutes vs.15.73 +/- 7.46 minutes, P<0.001). It can be concluded that perioperative infusion of low dose of lidocaine decreases the intensity of postoperative pain, reduces the postoperative analgesic consumption, without causing significant adverse effects in patients undergoing upper abdominal surgery.

  18. The prevalence of glaucoma in patients undergoing surgery for eyelid entropion or ectropion

    PubMed Central

    Golan, Shani; Rabina, Gilad; Kurtz, Shimon; Leibovitch, Igal

    2016-01-01

    Purpose and design The aim of this study was to establish the prevalence of known glaucoma in patients undergoing ectropion or entropion surgical repair. In this study, retrospective review of case series was performed. Participants All patients who underwent ectropion or entropion surgery in a tertiary medical center between 2007 and 2014 were included. The etiology of eyelid malpositioning was involutional or cicatricial. Methods The medical files of the study participants were reviewed for the presence and type of glaucoma, medical treatment, duration of treatment, and the amount of drops per day. These data were compared to a matched control group of 101 patients who underwent blepharoplasty for dermatochalasis in the same department during the same period. Main outcome measure In this study, the prevalence of glaucoma in individuals with ectropion or entropion was the main outcome measure. Results A total of 227 patients (57% men, mean age: 79.2 years) who underwent ectropion or entropion surgery comprised the study group and 101 patients who underwent upper blepharoplasty for dermatochalasis comprised the control group. Compared to four patients in the control group (4%, P=0.01), 30 of the study patients (13.2%) had coexisting glaucoma. Of 30 glaucomatous patients, 25 had primary open-angle glaucoma for a mean duration of 10.3 years. The glaucomatous patients were treated with an average of 2.7 antiglaucoma medications. Conclusion An increased prevalence of known glaucoma in patients undergoing ectropion or entropion repair surgery was found. This observation may indicate that the chronic usage of topical anti-glaucoma eyedrops may lead to an increased risk of developing eyelid malpositions, especially in elderly patients. PMID:27785003

  19. Perioperative administration of propranolol to women undergoing ovarian cancer surgery: A pilot study

    PubMed Central

    Jang, Hye-In; Lim, Soo-Hyun; Lee, Yoo-Young; Kim, Tae-Joong; Lee, Jeong-Won; Kim, Byoung-Gie; Bae, Duk-Soo

    2017-01-01

    Objective This study was done to evaluate whether perioperative propranolol (ß-blocker) in ovarian cancer patients undergoing debulking surgery reduced perioperative tumor growth induced by surgical stress. Methods This was a prospective randomized single institution analysis. The primary objective was to compare the changes in CA 125 level (changes between preoperation day 2 and postoperative day 7). As a study arm, patients received a low dose of propranolol 40 mg/day (4×10 mg) starting two days before surgery and 40 mg twice daily for three days following surgery. Results Twenty-two patients were enrolled and 16 were evaluable for efficacy. The drug was well tolerated. The mean decrease of CA 125 during the seven perioperative days was 83.1±8.9% in the propranolol group and 72.4±14.7% in the placebo group. The difference was statistically significant (P=0.044). The change of C-reactive protein, cortisol, and anxiety score (State-Trait Anxiety Inventory-X1) were not different between the two groups. Conclusion This preliminary result is the first to directly test the role of perioperative propranolol on tumor growth. Even with the small sample size and short term use of the drug, perioperative propranolol was effective in reducing tumor burden (as measured by CA 125) suggesting its potential benefits in decreasing perioperative tumor growth. PMID:28344958

  20. [Anesthetic management of patients with dilated cardiomyopathy undergoing non-cardiac surgery].

    PubMed

    Maekawa, Takuji

    2014-01-01

    There is little information on the perioperative management of patients with dilated cardiomyopathy (DCM) undergoing non-cardiac surgery. The presence of a history or signs of heart failure and un-diagnosed DCM preoperatively, may be associated with an increased risk during non-cardiac surgery. In these patients, preoperative assessment of LV function, including echocardiography, and assessment of an individual's capacity to perform a spectrum of common daily tasks may be recommended to quantify the severity of systolic function. It is important to prevent low cardiac output and arrhythmia for the perioperative management of patients with DCM. Sympathetic hyperactivity often causes atrial or ventricular tachyarrhythmia, which could worsen systemic hemodynamics in these patients. In particular, the prevention of life-threatening arrhythmia, such as, ventricular tachycardia or ventricular fibrillation is important. To prevent perioperative low output syndrome, inotropic support, using catecholamines or phosphodiesterase inhibitors with or without vasodilators should be performed under careful monitoring. It is desirable to use a pulmonary-artery catheter during moderate to high risk surgery, because the optimum level of left ventricular pre-load is very narrow in these patients. Every effort must be made to detect postoperative heart failure by careful monitoring, including PAC, and physical examination.

  1. Clinical effectiveness of centrifugal pump to produce pulsatile flow during cardiopulmonary bypass in patients undergoing cardiac surgery.

    PubMed

    Gu, Y John; van Oeveren, Willem; Mungroop, Hubert E; Epema, Anne H; den Hamer, Inez J; Keizer, Jorrit J; Leuvenink, Ron P; Mariani, Massimo A; Rakhorst, Gerhard

    2011-02-01

    Although the centrifugal pump has been widely used as a nonpulsatile pump for cardiopulmonary bypass (CPB), little is known about its performance as a pulsatile pump for CPB, especially on its efficacy in producing hemodynamic energy and its clinical effectiveness. We performed a study to evaluate whether the Rotaflow centrifugal pump produces effective pulsatile flow during CPB and whether the pulsatile flow in this setting is clinically effective in adult patients undergoing cardiac surgery. Thirty-two patients undergoing CPB for elective coronary artery bypass grafting were randomly allocated to a pulsatile perfusion group (n = 16) or a nonpulsatile perfusion group (n = 16). All patients were perfused with the Rotaflow centrifugal pump. In the pulsatile group, the centrifugal pump was adjusted to the pulsatile mode (60 cycles/min) during aortic cross-clamping, whereas in the nonpulsatile group, the pump was kept in its nonpulsatile mode during the same period of time. Compared with the nonpulsatile group, the pulsatile group had a higher pulse pressure (P < 0.01) and a fraction higher energy equivalent pressure (EEP, P = 0.058). The net gain of pulsatile flow, represented by the surplus hemodynamic energy (SHE), was found much higher in the CPB circuit than in patients (P < 0.01). Clinically, there was no difference between the pulsatile and nonpulsatile groups with regard to postoperative acute kidney injury, endothelial activation, or inflammatory response. Postoperative organ function and the duration of hospital stay were similar in the two patient groups. In conclusion, pulsatile CPB with the Rotaflow centrifugal pump is associated with a small gain of EEP and SHE, which does not seem to be clinically effective in adult cardiac surgical patients.

  2. Current Practice and Utility of Chromosome Microarray Analysis in Infants Undergoing Cardiac Surgery

    PubMed Central

    Buckley, Jason R.; Kavarana, Minoo N.; Chowdhury, Shahryar M.; Scheurer, Mark A.

    2014-01-01

    Objective Traditionally, karyotype and fluorescence in situ hybridization (FISH) were used for cytogenetic testing of infants with congenital heart disease who underwent cardiac surgery at our institution. Recently, chromosome microarray analysis (CMA) has been performed in lieu of the traditional tests. A standardized approach to cytogenetic testing does not exist in this population. The purpose of this study was to assess the utility of CMA based on our current ordering practice. Design We reviewed the records of all infants (< 1 year old) who underwent cardiac surgery at our institution from January 2010 to June 2013. Data included results of all cytogenetic testing performed. Diagnostic yield was calculated as the percentage of significant abnormal results obtained by each test modality. Patients were grouped by classification of congenital heart disease (CHD). Results Two hundred and seventy-five (51%) of 535 infants who underwent cardiac surgery had cytogenetic testing. Of those tested, 154 (56%) had multiple tests performed and at least 18% were redundant or overlapping. The utilization of CMA has increased each year since its implementation. The diagnostic yield for karyotype, FISH and CMA was 10%, 12% and 14% respectively. CMA yield was significantly higher in patients with septal defects (33%, p = 0.01) compared to all other CHD classes. CMA detected abnormalities of unknown clinical significance in 13% of infants tested. Conclusions In our center, redundant cytogenetic testing is frequently performed in infants undergoing cardiac surgery. The utilization of chromosome microarray analysis has increased over time and abnormalities of unknown clinical significance are detected in an important subset of patients. A screening algorithm that risk-stratifies based on classification of CHD and clinical suspicion may provide a practical, data-driven approach to genetic testing in this population and limit unnecessary resource utilization. PMID:25494910

  3. Lung protective ventilation in patients undergoing major surgery: a systematic review incorporating a Bayesian approach

    PubMed Central

    Zhang, Zhongheng; Hu, Xiaoyun; Zhang, Xia; Zhu, Xiuqi; Chen, Liqian; Zhu, Li; Hu, Caibao; Du, Bin

    2015-01-01

    Objective Protective ventilation (PV) has been validated in patients with acute respiratory distress syndrome. However, the effect of PV in patients undergoing major surgery is controversial. The study aimed to explore the beneficial effect of PV on patients undergoing a major operation by systematic review and meta-analysis. Setting Various levels of medical centres. Participants Patients undergoing general anaesthesia. Interventions PV with low tidal volume. Primary and secondary outcome measures Study end points included acute lung injury (ALI), pneumonia, atelectasis, mortality, length of stay (LOS) in intensive care unit (ICU) and hospital. Methods Databases including PubMed, Scopus, EBSCO and EMBASE were searched from inception to May 2015. Search strategies consisted of terms related to PV and anaesthesia. We reported OR for binary outcomes including ALI, mortality, pneumonia, atelectasis and other adverse outcomes. Weighted mean difference was reported for continuous outcomes such as LOS in the ICU and hospital, pH value, partial pressure of carbon dioxide, oxygenation and duration of mechanical ventilation (MV). Main results A total of 22 citations were included in the systematic review and meta-analysis. PV had protective effect against the development of ALI as compared with the control group, with an OR of 0.41 (95% CI 0.19 to 0.87). PV tended to be beneficial with regard to the development of pneumonia (OR 0.46, 95% CI 0.16 to 1.28) and atelectasis (OR 0.68, 95% CI 0.46 to 1.01), but statistical significance was not reached. Other adverse outcomes such as new onset arrhythmia were significantly reduced with the use of PV (OR 0.47, 95% CI 0.48 to 0.93). Conclusions The study demonstrates that PV can reduce the risk of ALI in patients undergoing major surgery. However, there is insufficient evidence that such a beneficial effect can be translated to more clinically relevant outcomes such as mortality or duration of MV. Trial registration number The study

  4. Third-space fluid shift in elderly patients undergoing gastrointestinal surgery: Part II: nursing assessment.

    PubMed

    Wotton, Karen; Redden, Maurine

    2002-08-01

    Third-space fluid shift is the mobilisation of body fluid to a non-contributory space rendering it unavailable to the circulatory system. It is a recurrent clinical phenomenon requiring swift identification to minimise deleterious effects. Nurses experience difficulties however in its early identification, diagnosis and subsequent treatment because of the lack of consensual and consistent information regarding third-spacing. This article, part II, building on the previous article, explores the clinical validly and reliability of signs and symptoms of both phases of third-space fluid shift. In addition it reinforces the use multiple patient assessment cues if nurses are to differentiate between, and accurately respond to, the various causes of both hypovolaemia and hypervolaemia. It assists nurses to increase their knowledge and uderstanding of third-space fluid shift in patients undergoing gastrointestinal surgery.

  5. [Nursing practice of care to patients undergoing elective surgery in the immediate preoperative period].

    PubMed

    de Sena, Adnairdes Cabral; do Nascimento, Eliane Regina Pereira; Maia, Ana Rosete Camargo Rodrigues

    2013-09-01

    Research that aimed to analyze the care of nurses to patients, in the daily professional practice, provided in the preoperative period for patients undergoing elective surgery. It is a descriptive research with a qualitative approach that involved 15 nurses from Surgical Units and two nurses from the Surgical Centre of a hospital in the southern region of Brazil. Data was collected in semi-structured interviews conducted from April to July 2011. Data was analyzed using the Collective Subject Discourse (CSD) technique. The information obtained generated three CDS focused on the following ideas: administrative care, instruction in the preoperative period and surgical care in the immediate preoperative period. The results showed that caring consists mostly of giving instructions to the patient in the preoperative period. It is concluded that the care was directed to the physical aspects to the detriment of the psychological, in disagreement with the assistance methodology adopted in the hospital, supported by the Theory of Basic Human Needs.

  6. Perioperative Evaluation of Patients with Pulmonary Conditions Undergoing Non-Cardiothoracic Surgery

    PubMed Central

    Diaz-Fuentes, Gilda; Hashmi, Hafiz Rizwan Talib; Venkatram, Sindhaghatta

    2016-01-01

    This review describes the perioperative management of patients with suspected or established pulmonary conditions undergoing non-cardiothoracic surgery, with a focus on common pulmonary conditions such as obstructive airway disease, pulmonary hypertension, obstructive sleep apnea, and chronic hypoxic respiratory conditions. Considering that postoperative pulmonary complications are common and given the increasing number of surgical procedures and the size of the aging population, familiarity with current guidelines for preoperative risk assessment and intra- and postoperative patient management is recommended to decrease the morbidity and mortality. In particular, smoking cessation and pulmonary rehabilitation are perioperative strategies for improving patients’ short- and long-term outcomes. Understanding the potential risk for pulmonary complications allows the medical team to appropriately plan the intra- and postoperative care of each patient. PMID:27867301

  7. Electrical Impedance Tomography-guided PEEP Titration in Patients Undergoing Laparoscopic Abdominal Surgery

    PubMed Central

    He, Xingying; Jiang, Jingjing; Liu, Yuli; Xu, Haitao; Zhou, Shuangqiong; Yang, Shibo; Shi, Xueyin; Yuan, Hongbin

    2016-01-01

    Abstract The aim of the study is to utilize electrical impedance tomography (EIT) to guide positive end-expiratory pressure (PEEP) and to optimize oxygenation in patients undergoing laparoscopic abdominal surgery. Fifty patients were randomly assigned to the control (C) group and the EIT (E) group (n = 25 each). We set the fraction of inspired oxygen (FiO2) at 0.30. The PEEP was titrated and increased in a 2-cm H2O stepwise manner, from 6 to 14 cm H2O. Hemodynamic variables, respiratory mechanics, EIT images, analysis of blood gas, and regional cerebral oxygen saturation were recorded. The postoperative pulmonary complications within the first 5 days were also observed. We chose 10 cm H2O and 8 cm H2O as the “ideal” PEEP for the C and the E groups, respectively. EIT-guided PEEP titration led to a more dorsal shift of ventilation. The PaO2/FiO2 ratio in the E group was superior to that in the C group in the pneumoperitoneum period, though the difference was not significant (330 ± 10 vs 305.56 ± 4 mm Hg; P = 0.09). The C group patients experienced 8.7% postoperative pulmonary complications versus 5.3% among the E group patients (relative risk 1.27, 95% confidence interval 0.31–5.3, P = 0.75). Electrical impedance tomography represents a new promising technique that could enable anesthesiologists to assess regional ventilation of the lungs and optimize global oxygenation for patients undergoing laparoscopic abdominal surgery. PMID:27057904

  8. [Qualitative analysis of platelet rich plasma prepared by acute plateletpheresis in patients undergoing heart surgery].

    PubMed

    Wei, Hai-Yan; Ding, Zheng-Nian; Shi, Hong-Wei; Ge, Ya-Li; Chen, Xin

    2014-04-01

    This study was aimed to evaluate the efficiency and effectiveness of platelet-rich plasma(PRP) prepared by acute plateletpheresis in patients undergoing open heart surgery, and to analyze the quality of prepared platelet-rich plasma. Whole blood from 20 patients with ASAII-III was collected and PRP was harvested by machine after induction of anesthesia. Platelet count (Plt), mean platelet volume (MPV), platelet distribution width (PDW), plasma pH, plasma lactic acid (LA) concentration, and lactic dehydrogenase (LDH) concentration, germiculture result, CD62p and PAC-1 positive rate of inactivated and activated platelets by ADP in the whole blood before plateletpheresis (T1) , in the PRP after plateletpheresis (T2) and PRP before back-transfusion (T3) were determinated. The results showed that as compared with whole blood the platelet count in the PRP at T2 was (783 ± 184) ×10(9)/L, MPV, PDW and pH significantly decreased (P < 0.01) , while the plasma LDH, LA concentration, CD62p and PAC-1 positive rate of inactivated platelets were not significantly different from the whole blood at T1. In the PRP at T3, the platelet count, MPV, PDW and pH significantly decreased (P < 0.01) , while plasma LDH concentration, CD62p and PAC-1 positive rate of inactivated platelet significantly increased (P < 0.05 or P < 0.01) compared with the whole blood at T1. There were no significant difference among the CD62p and PAC-1 positive rate of activated platelets in the whole blood and PRP. It is concluded that PRP can be efficiently obtained from the patients undergoing open heart surgery by acute plateletpheresis, and the platelets in PRP are not activated during the preparing process. Some platelets in PRP are activated during the preserving process, but the whole activating function of platelets keeps normal.

  9. Endocyclophotodestruction in Glaucoma Patients Undergoing Combined Surgery of Pars Plana Vitrectomy and Phacoemulsification

    PubMed Central

    Kołodziejski, Łukasz; Robaszkiewicz, Jacek; Grabska-Liberek, Iwona

    2014-01-01

    Background The purpose of this trail was to assess the effect of a novel intraoperative endocyclophotodestruction method on intraocular pressure in patients undergoing combined procedure of phacovitrectomy to determine the efficacy of this combined surgical approach. Material/Methods The study sample included 87 subjects divided into 2 groups: Group I consisted of 52 patients who underwent intraoperative endocyclophotodestruction performed during phacovitrectomy. Group II consisted of 35 controls. The follow-up duration was 12 months. The preoperative (baseline) intraocular pressure (IOP) was determined and later assessed postoperatively at the following time points: on 1 day and at 1, 2, 3, 6, and 12 months. Other evaluated parameters were the number of topical antiglaucoma medications, and the cyclophotodestruction circumference-to-outflow resistance ratio (R). Results The mean postoperative reduction of intraocular pressure was by 4.26 mmHg at 6 months and by 4.91 mmHg at 12 months. The number of topical antiglaucoma medications was reduced postoperatively from the mean preoperative value of 1.66 to 0.69 at 6 months and 1.04 at 12 months. Conclusions The results show a significant reduction of intraocular pressure in patients undergoing the combined triple-procedure surgery and postoperative decrease in the number of topical medications. The best outcomes in terms of IOP decrease and reduced number of medications were achieved in patients with low outflow coefficient. Endocyclophotodestruction is an alternative IOP-reducing technique to be used in patients with glaucoma who require phacovitrectomy. It is recommended for patients with low outflow coefficient in whom posterior pole abnormalities constitute the main indications for surgery. PMID:25317973

  10. Effects of different general anaesthetic techniques on immune responses in patients undergoing surgery for tongue cancer.

    PubMed

    Zhang, T; Fan, Y; Liu, K; Wang, Y

    2014-03-01

    The aim of this study was to investigate the effects of different general anaesthesia techniques on immune responses in patients undergoing surgery for tongue cancer. Sixty American Society of Anesthesiologists physical status 1 or 2 patients undergoing elective reconstructive surgery for tongue cancer were randomised to three groups. Group 1 received propofol induction and maintenance (TIVA), group 2 received propofol induction and sevoflurane maintenance (MIXED) and group 3 received sevoflurane induction and maintenance (SEVO). All patients received an infusion of remifentanil. Blood samples were obtained at eight time-points: 30 minutes before induction (T0); one hour (T1), three hours (T2) and five hours (T3) after induction; at the end of the operation (T4); and 24 hours (T5), 48 hours (T6) and 72 hours (T7) after operation. The T lymphocyte subsets (including CD3(+) cells, CD3(+)CD4(+) cells and CD3(+)CD8(+)cells) and CD4(+)/CD8(+) ratio, natural killer cells and B lymphocytes were analysed by flow cytometry. All immunological indicators except CD3(+)CD8(+) cells were significantly decreased in all groups at T1~T5 compared to T0 (P <0.05). The percentages of CD3(+) cells, CD3(+)CD4(+) cells and natural killer cells, and the CD4(+)/CD8(+) ratios were significantly lower in the MIXED groups and SEVO groups but not the TIVA group at T6 as compared with T0 (P <0.05). There were minor but statistically significant differences in the percentages of CD3(+) cells, CD3(+)CD4(+) cells and natural killer cells, and the CD4(+)/CD8(+) ratios between the SEVO group and the TIVA group at T2approxT6 (P <0.05). These findings suggest that propofol has slightly less effect on cellular immune responses than sevoflurane.

  11. Clinical Characteristics and Outcomes of Patients With Myocardial Infarction and Cardiogenic Shock Undergoing Coronary Artery Bypass Surgery: Data From The Society of Thoracic Surgeons National Database

    PubMed Central

    Acharya, Deepak; Gulack, Brian C.; Loyaga-Rendon, Renzo Y.; Davies, James E.; He, Xia; Brennan, J. Matthew; Thourani, Vinod H.; Williams, Matthew L.

    2016-01-01

    Background Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is associated with substantial mortality. We evaluated outcomes of patients in The Society of Thoracic Surgeons Adult Cardiac Surgery Database who underwent coronary artery bypass graft surgery (CABG) in the setting of AMI-CS. Methods All patients with AMI-CS who underwent nonelective CABG or CABG with ventricular assist device implantation within 7 days after myocardial infarction were enrolled. The primary analysis sample consisted of patients who underwent surgery between June 2011 and December 2013. Baseline characteristics, operative findings, outcomes, and the utilization of mechanical circulatory support (MCS) were assessed in detail in this population. We also evaluated trends in unadjusted mortality for all patients undergoing CABG or CABG with ventricular assist device for AMI-CS from January 2005 to December 2013. Results A total of 5,496 patients met study criteria, comprising 1.5% of all patients undergoing CABG during the study period. Overall operative mortality was 18.7%, decreasing from 19.3% in 2005 to 18.1% in 2013 (p < 0.001). Use of MCS increased from 5.8% in 2011 to 8.8% in 2013 (p = 0.008). Patients receiving MCS had a high proportion of cardiovascular risk factors or high clinical acuity. Patients requiring preoperative and patients requiring intraoperative or postoperative MCS had operative mortality of 37.2% and 58.4%, respectively. Patients undergoing CABG as a salvage procedure had an operative mortality of 53.3%, and a high incidence of reoperation (21.8%), postoperative respiratory failure requiring prolonged ventilation (59.7%), and renal failure (18.5%). Conclusions Most patients undergoing CABG for AMI-CS have a sizeable but not prohibitive risk. Patients who require MCS and those undergoing operation as a salvage procedure reflect higher risk populations. PMID:26718859

  12. Effects of Low-Flow Sevoflurane Anesthesia on Pulmonary Functions in Patients Undergoing Laparoscopic Abdominal Surgery

    PubMed Central

    Doger, Cihan; Kahveci, Kadriye; Ornek, Dilsen; But, Abdulkadir; Aksoy, Mustafa; Gokcinar, Derya; Katar, Didem

    2016-01-01

    Objective. The aim of this prospective, randomized study was to investigate the effects of low-flow sevoflurane anesthesia on the pulmonary functions in patients undergoing laparoscopic cholecystectomy. Methods. Sixty American Society of Anesthesiologists (ASA) physical status classes I and II patients scheduled for elective laparoscopic cholecystectomy were included in the study. Patients were randomly allocated to two study groups: high-flow sevoflurane anesthesia group (Group H, n = 30) and low-flow sevoflurane anesthesia group (Group L, n = 30). The fresh gas flow rate was of 4 L/min in high-flow sevoflurane anesthesia group and 1 L/min in low-flow sevoflurane anesthesia group. Heart rate (HR), mean arterial blood pressure (MABP), peripheral oxygen saturation (SpO2), and end-tidal carbon dioxide concentration (ETCO2) were recorded. Pulmonary function tests were performed before and 2, 8, and 24 hours after surgery. Results. There was no significant difference between the two groups in terms of HR, MABP, SpO2, and ETCO2. Pulmonary function test results were similar in both groups at all measurement times. Conclusions. The effects of low-flow sevoflurane anesthesia on pulmonary functions are comparable to high-flow sevoflurane anesthesia in patients undergoing laparoscopic cholecystectomy. PMID:27413741

  13. Effects of Low-Flow Sevoflurane Anesthesia on Pulmonary Functions in Patients Undergoing Laparoscopic Abdominal Surgery.

    PubMed

    Doger, Cihan; Kahveci, Kadriye; Ornek, Dilsen; But, Abdulkadir; Aksoy, Mustafa; Gokcinar, Derya; Katar, Didem

    2016-01-01

    Objective. The aim of this prospective, randomized study was to investigate the effects of low-flow sevoflurane anesthesia on the pulmonary functions in patients undergoing laparoscopic cholecystectomy. Methods. Sixty American Society of Anesthesiologists (ASA) physical status classes I and II patients scheduled for elective laparoscopic cholecystectomy were included in the study. Patients were randomly allocated to two study groups: high-flow sevoflurane anesthesia group (Group H, n = 30) and low-flow sevoflurane anesthesia group (Group L, n = 30). The fresh gas flow rate was of 4 L/min in high-flow sevoflurane anesthesia group and 1 L/min in low-flow sevoflurane anesthesia group. Heart rate (HR), mean arterial blood pressure (MABP), peripheral oxygen saturation (SpO2), and end-tidal carbon dioxide concentration (ETCO2) were recorded. Pulmonary function tests were performed before and 2, 8, and 24 hours after surgery. Results. There was no significant difference between the two groups in terms of HR, MABP, SpO2, and ETCO2. Pulmonary function test results were similar in both groups at all measurement times. Conclusions. The effects of low-flow sevoflurane anesthesia on pulmonary functions are comparable to high-flow sevoflurane anesthesia in patients undergoing laparoscopic cholecystectomy.

  14. Perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery

    PubMed Central

    Degnan, Meredith; Brodt, Jessica; Rodriguez-Blanco, Yiliam

    2016-01-01

    Aim: The aim of this study was to describe our institutional experience, primarily with general anesthesiologists consulting with cardiac anesthesiologists, caring for left ventricular assist device (LVAD) patients undergoing noncardiac surgery. Materials and Methods: This is a retrospective review of the population of patients with LVADs at a single institution undergoing noncardiac procedures between 2009 and 2014. Demographic, perioperative, and procedural data collected included the type of procedure performed, anesthetic technique, vasopressor requirements, invasive monitors used, anesthesia provider type, blood product management, need for postoperative intubation, postoperative disposition and length of stay, and perioperative complications including mortality. Statistical Analysis: Descriptive statistics for categorical variables are presented as frequency distributions and percentages. Continuous variables are expressed as mean ± standard deviation and range when applicable. Results: During the study, 31 patients with LVADs underwent a total of 74 procedures. Each patient underwent an average of 2.4 procedures. Of the total number of procedures, 48 (65%) were upper or lower endoscopies. Considering all procedures, 81% were performed under monitored anesthesia care (MAC). Perioperative care was provided by faculty outside of the division of cardiac anesthesia in 62% of procedures. Invasive blood pressure monitoring was used in 27 (36%) procedures, and a central line, peripherally inserted central catheter or midline was in place preoperatively and used intraoperatively for 38 (51%) procedures. Vasopressors were not required in the majority (65; 88%) of procedures. There was one inhospital mortality secondary to multiorgan failure; 97% of patients survived to discharge after their procedure. Conclusion: At our institution, LVAD patients undergoing noncardiac procedures most frequently require endoscopy. These procedures can frequently be done safely under

  15. Seizure frequency and social outcome in drug resistant epilepsy patients who do not undergo epilepsy surgery.

    PubMed

    Carreño, Mar; Becerra, Juan Luis; Castillo, Joaquín; Maestro, Iratxe; Donaire, Antonio; Fernández, Santiago; Bargalló, Nuria; Setoain, Xavier; Pintor, Luis; Bailles, Eva; Rumià, Jordi; Boget, Teresa; Vernet, Oriol; Fumanal, Sandra

    2011-09-01

    Little is known about the long term prognosis of refractory epilepsy patients who do not undergo epilepsy surgery. We performed a telephone survey and chart review of patients who underwent presurgical evaluation in our Unit but did not have surgery, from 1998 until 2004. We contacted 84 patients; mean follow-up was 6.7 years. Four patients (4.7%) had died, presumably of SUDEP. Ten patients (13.1%) were seizure free. In most patients with seizures, frequency remained stable (24/80, 30%) or had decreased by ≥50% (26 patients, 30.9%). Most patients (69, 86.2%) believed their health was similar or better respect to the moment they underwent presurgical evaluation. Employment situation was stable in 64/80 patients (80%), but 11 had received new disability wages. Family situation was also generally unchanged (69/80 patients, 86.2%). Most patients were not taking antidepressants. Seizure free patients scored higher in satisfaction with life. This information can be used to counsel refractory patients.

  16. The effects of informed consent format on preoperative anxiety in patients undergoing inferior third molar surgery

    PubMed Central

    Heras-Meseguer, Marisa; Azcárate-Velázquez, Francisco; Hita-Iglesias, Pilar; Ruiz-de-León-Hernández, Gonzalo; Hernández-Pacheco, Esther; Gutiérrez-Pérez, José L.

    2014-01-01

    Objectives: To evaluate the effect of informed consent format on preoperative anxiety of patients. Material and Methods: We performed a prospective study (91 patients) undergoing lower third molar extraction. Patients were distributed into three groups. Informed consent for surgery was obtained through a written document, an oral interview or a video recording. Afterwards, patients were asked about their anxiety level and the effect the informed consent had had on it. Results: Whereas the information conveyed both in oral and written formats relieved the patient to some extent (in a scale of -3 to +3) 0.97±1.21 and 0.29±0.97, respectively), the video recording increased patient’s anxiety in a statistically significant way (in a scale of -3 to +3, -0.57±1.43). The difference obtained between the values obtained in oral and written information was not statistically significant. Discussion: The most adequate format, according to our study, would be the oral format. Key words:Anxiety, satisfaction, third molar surgery, Spielberger State-Trait Anxiety Inventory. PMID:24316709

  17. Heart rate and outcome in patients with cardiovascular disease undergoing major noncardiac surgery.

    PubMed

    Biccard, B M

    2008-07-01

    There is an increasing awareness that an elevated resting heart rate is associated with increased all-cause mortality in the general population and that this may be an independent coronary risk factor This review was undertaken to determine whether heart rate is predictive of increased mortality and major morbidity in noncardiac surgical patients and whether heart rate manipulation improves perioperative outcome. A search of Medline from 1966 until October 2007 was conducted using the terms "heart rate", "surgery", "cardiac", "morbidity", "mortality" and "perioperative". The main findings were that an elevated perioperative heart rate, an absolute increase in heart rate and heart rate lability are independent predictors of both short- and long-term adverse outcomes in patients at cardiovascular risk undergoing major noncardiac surgery. Although prospective nonrandomised and retrospective data suggest heart rate control improves perioperative outcome, there is conflicting evidence from randomised trials that perioperative heart rate control improves outcome. This may be because drug-associated bradycardia influences mortality in the perioperative period. Further studies reporting the absolute heart rate, the absolute change of heart rate and the time period of the observations are needed to identify 'early warning systems', which may allow earlier triage and improved outcome. Enthusiasm for this approach must be tempered by the appreciation that a J-shaped relationship probably exists between heart rate and morbidity, particularly following bradycardic therapy. Therefore, any bradycardic manipulation of heart rate in the perioperative period must be accompanied by simultaneous attention to other physiological variables associated with increased morbidity and mortality.

  18. Evaluation of Prognostic Nutritional Index in Patients Undergoing Radical Surgery with Nonsmall Cell Lung Cancer.

    PubMed

    Qiu, Chen; Qu, Xiao; Shen, Hongchang; Zheng, Chunlong; Zhu, Linhai; Meng, Long; Du, Jiajun

    2015-01-01

    The prognostic nutritional index (PNI) has been reported to be a prognostic indicator in some malignant tumors. However, its prognostic value in nonsmall cell lung cancer (NSCLC) has not been fully investigated. A retrospective review of 1416 patients with NSCLC who underwent radical surgery between January 2006 and December 2011 was conducted. To obtain optimal cutoff levels of PNI, running log-rank statistics was applied. Survival was calculated by the Kaplan-Meier method. The prognostic significance of PNI, together with various clinicopathological factors, was evaluated by multivariate analysis. The optimal cutoff point for PNI was 52. The 1-, 3-, and 5-yr survival rates in patients with PNI of less than 52 were 80.0%, 61.3%, and 50.4%, respectively, and were significantly more unfavorable than those in patients with PNI 52 or higher (84.7%, 71.5%, and 60.3%, respectively, P < 0.001). Multivariate analysis suggested that gender (P = 0.026), age (P < 0.001), PNI (P = 0.005), differentiation (P = 0.024), pathology T category (P = 0.003), and pathology N category (P < 0.001) were revealed to be independent prognostic factors. Our results indicate that PNI is an independent predictor of survival for patients undergoing radical surgery with NSCLC.

  19. Impact of respiratory therapy in vital capacity and functionality of patients undergoing abdominal surgery

    PubMed Central

    Fernandes, Shanlley Cristina da Silva; dos Santos, Rafaella Souza; Giovanetti, Erica Albanez; Taniguchi, Corinne; Silva, Cilene Saghabi de Medeiros; Eid, Raquel Afonso Caserta; Timenetsky, Karina Tavares; Carnieli-Cazati, Denise

    2016-01-01

    ABSTRACT Objective To evaluate the vital capacity after two chest therapy techniques in patients undergoing abdominal surgical. Methods A prospective randomized study carried out with patients admitted to the Intensive Care Unit after abdominal surgery. We checked vital capacity, muscular strength using the Medical Research Council scale, and functionality with the Functional Independence Measure the first time the patient was breathing spontaneously (D1), and also upon discharge from the Intensive Care Unit (Ddis). Between D1 and Ddis, respiratory therapy was carried out according to the randomized group. Results We included 38 patients, 20 randomized to Positive Intermittent Pressure Group and 18 to Volumetric Incentive Spirometer Group. There was no significant gain related to vital capacity of D1 and Ddis of Positive Intermittent Pressure Group (mean 1,410mL±547.2 versus 1,809mL±692.3; p=0.979), as in the Volumetric Incentive Spirometer Group (1,408.3mL±419.1 versus 1,838.8mL±621.3; p=0.889). We observed a significant improvement in vital capacity in D1 (p<0.001) and Ddis (p<0.001) and in the Functional Independence Measure (p<0.001) after respiratory therapy. The vital capacity improvement was not associated with gain of muscle strength. Conclusion Chest therapy, with positive pressure and volumetric incentive spirometer, was effective in improving vital capacity of patients submitted to abdominal surgery. PMID:27462894

  20. Effects of postoperative parenteral nutrition with different lipid emulsions in patients undergoing major abdominal surgery

    PubMed Central

    Demirer, Seher; Sapmaz, Ali; Kepenekci, Ilknur; Aydintug, Semih; Balci, Deniz; Sonyurek, Pinar; Kose, Kenan

    2016-01-01

    Purpose This study was designed to investigate the effects of total parenteral nutrition (PN) using different lipid emulsions in patients undergoing major abdominal surgery. Methods Fifty-two patients were randomized to receive soybean oil + medium chain triglycerides (MCT) (group I), soybean oil + olive oil (group II), soybean oil + olive oil + fish oil (group III) as a lipid source. PN was started on postoperative day 1 and patients were maintained on PN for a minimum period of 4 days. Laboratory variables (CRP, prealbumin, transferrin) were measured before surgery and on postoperative days. Results Three treatment groups were included in the study. Patients in group I received long chain triglycerides (LCT) + LCT/MCT emulsion (%75 LCT + %25 LCT/MCT); Patients in group II received olive oil based emulsion (80% olive oil + 20% soybean oil, ClinOleic); Patients in group III received fish oil in addition to olive oil based emulsion (%85 ClinOleic + %15 Omegaven; Fresenius Kabi). The following 14 parameters were assessed: body weight, CRP, prealbumin, transferrin, tumor necrosis factor-α, interleukin-6, total antioxidant status, thiobarbituric acid reactive substances, oxidized low density lipoprotein-2, complete blood cell, international normalized ratio, D-dimer, activated partially thromboplastin time, prothrombin time. All other parameters showed no differences among the groups. Conclusion The results of our trial demonstrate a potential beneficial effect of soybean oil/olive oil based lipid emulsions for use in PN regarding inflammatory response and oxidant capacity in the treatment of patients. PMID:27904853

  1. Obesity and post-operative complications in patients undergoing non-bariatric surgery.

    PubMed

    Doyle, S L; Lysaght, J; Reynolds, J V

    2010-12-01

    As the prevalence of obesity continues to rise in society, an increasing number of patients undergoing non-bariatric surgery will be obese. Obesity is known to increase morbidity and mortality in the general population and thus is perceived as a risk factor for adverse post-surgical outcomes. This association is not clear-cut, however, and there is a lack of consensus in the literature on the risk between obesity and specific complications, in particular relating to infection, wound healing, respiratory and venous thromboembolism. The paucity of studies, as well as a lack of consistency of definition of obesity, with an over-reliance on body mass index rather than body composition analysis, may underlie this confusion. Emerging concepts position central/visceral adipose tissue as potentially key to the pathogenesis of the comorbidities associated with obesity, thus this article reviews emerging research investigating the association between visceral obesity, the metabolic syndrome and resulting post-operative complications. It is hypothesized that the state of chronic inflammation and dysmetabolism observed in visceral obese patients negatively influences post-operative outcomes and represents a potential target for pharmaconutrition. The need for further research investigating the influence of visceral adiposity on immune function post surgery and its impact on post-operative morbidity and mortality is highlighted.

  2. Preoperative characteristics predicting intraoperative hypotension and hypertension among hypertensives and diabetics undergoing noncardiac surgery.

    PubMed Central

    Charlson, M E; MacKenzie, C R; Gold, J P; Ales, K L; Topkins, M; Shires, G T

    1990-01-01

    We prospectively studied patients with hypertension and diabetes undergoing elective noncardiac surgery with general anesthesia to test the hypothesis that patients at high risk for prognostically significant intraoperative hemodynamic instability could be identified by their preoperative characteristics. Specifically we hypothesized that patients with a low functional capacity, decreased plasma volume, or significant cardiac comorbidity would be at high risk for intraoperative hypotension and those with a history of severe hypertension would be at risk for intraoperative hypertension. Patients who had a preoperative mean arterial pressure (MAP) greater than or equal to 110, a walking distance of less than 400 m, or a plasma volume less than 3000 cc were at increased risk of intraoperative hypotension (i.e., more than 1 hour of greater than or equal to 20 mmHg decreases in the MAP). Hypotension was also more common among patients having intra-abdominal or vascular surgery, and among those who had operations longer than 2 hours. Patients older than 70 years or with a decreased plasma volume were at increased risk of having more than 15 minutes of intraoperative elevations of greater than or equal to 20 mmHg over the preoperative MAP in combination with intraoperative hypotension; this was also more common when surgery lasted more than 2 hours. Patients who had intraoperative hypotension tended to have an immediate decrease in MAP at the onset of anesthesia and were often purposefully maintained at MAPs less than their usual level during surgery with fentanyl and neuromuscular blocking agents. Patients who had intraoperative hyper/hypotension tended to have repeated elevations in MAP above their preoperative levels during the course of surgery, and such elevations precipitated interventions with neuromuscular blocking agents and/or fentanyl. Neither pattern was more common among patients who developed net intraoperative negative fluid balances. Both hypotension and

  3. Estimating cancer risks to adults undergoing body CT examinations.

    PubMed

    Huda, Walter; He, Wenjun

    2012-06-01

    The purpose of the study is to estimate cancer risks from the amount of radiation used to perform body computed tomography (CT) examination. The ImPACT CT Patient Dosimetry Calculator was used to compute values of organ doses for adult body CT examinations. The radiation used to perform each examination was quantified by the dose-length product (DLP). Patient organ doses were converted into corresponding age and sex dependent cancer risks using data from BEIR VII. Results are presented for cancer risks per unit DLP and unit effective dose for 11 sensitive organs, as well as estimates of the contribution from 'other organs'. For patients who differ from a standard sized adult, correction factors based on the patient weight and antero-posterior dimension are provided to adjust organ doses and the corresponding risks. At constant incident radiation intensity, for CT examinations that include the chest, risks for females are markedly higher than those for males, whereas for examinations that include the pelvis, risks in males were slightly higher than those in females. In abdominal CT scans, risks for males and female patients are very similar. For abdominal CT scans, increasing the patient age from 20 to 80 resulted in a reduction in patient risks of nearly a factor of 5. The average cancer risk for chest/abdomen/pelvis CT examinations was ∼26 % higher than the cancer risk caused by 'sensitive organs'. Doses and radiation risks in 80 kg adults were ∼10 % lower than those in 70 kg patients. Cancer risks in body CT can be estimated from the examination DLP by accounting for sex, age, as well as patient physical characteristics.

  4. National Adult Cardiac Surgery Registry: past, present and future.

    PubMed

    Uva, Miguel Sousa; Mota, João Carlos

    2003-10-01

    A task force commission was created with the support of the Portuguese Society for Cardiothoracic and Vascular Surgery with the aim of organizing a National Adult Cardiac Surgery Registry, collecting clinical data and types of cardiac surgical procedure performed in Portugal. Selected variables include risk factors, cardiac status, preoperative hemodynamics, surgical procedure, hospital stay and mortality. Information is collected into a database in each institution and sent via the internet to a central database responsible for grouping and data analysis. It is hoped that this National Registry, through standardized data collection, will provide information on cardiac surgery activity in Portugal and its risk adjusted results.

  5. Preoperative Laboratory Testing in Patients Undergoing Elective, Low-Risk Ambulatory Surgery

    PubMed Central

    Benarroch-Gampel, Jaime; Sheffield, Kristin M.; Duncan, Casey B.; Brown, Kimberly M.; Han, Yimei; Townsend, Courtney M.; Riall, Taylor S.

    2012-01-01

    Background Routine preoperative laboratory testing for ambulatory surgery is not recommended. Methods Patients who underwent elective hernia repair (N = 73,596) were identified from the National Surgical Quality Improvement Program (NSQIP) database (2005–2010). Patterns of preoperative testing were examined. Multivariate analyses were used to identify factors associated with testing and postoperative complications. Results A total of 46,977 (63.8%) patients underwent testing, with at least one abnormal test recorded in 61.6% of patients. In patients with no NSQIP comorbidities (N = 25,149) and no clear indication for testing, 54% received at least one test. In addition, 15.3% of tested patients underwent laboratory testing the day of the operation. In this group, surgery was done despite abnormal results in 61.6% of same day tests. In multivariate analyses, testing was associated with older age, ASA (American Society of Anesthesiologists) class >1, hypertension, ascites, bleeding disorders, systemic steroids, and laparoscopic procedures. Major complications (reintubation, pulmonary embolus, stroke, renal failure, coma, cardiac arrest, myocardial infarction, septic shock, bleeding, or death) occurred in 0.3% of patients. After adjusting for patient and procedure characteristics, neither testing nor abnormal results were associated with postoperative complications. Conclusions Preoperative testing is overused in patients undergoing low-risk, ambulatory surgery. Neither testing nor abnormal results were associated with postoperative outcomes. On the basis of high rates of testing in healthy patients, physician and/or facility preference and not only patient condition currently dictate use. Involvement from surgical societies is necessary to establish guidelines for preoperative testing. PMID:22868362

  6. Preoperative platelet count and postoperative blood loss in patients undergoing hip surgery: an inverse correlation.

    PubMed

    Monreal, M; Lafoz, E; Llamazares, J; Roncales, J; Roca, J; Granero, X

    1996-01-01

    In a previous study we tried to assess the clinical usefulness of platelet count (PlC) to confirm whether postoperative pulmonary embolism could be suspected early. Unexpectedly, the 19 patients who subsequently developed pulmonary embolism had significantly lower mean PlC levels even before surgery. In an attempt to discover whether the preoperative PlC levels were associated with a different incidence of postoperative blood loss, we decided to retrospectively study the relationship between preoperative PlC levels and the consequences of blood loss. There were 459 consecutive patients undergoing hip surgery. After excluding 5 patients who died during the first 3 postoperative days, and 16 patients who bled from a definitive anatomic site, there were 438 patients. Blood loss was considered to be excessive when two or more of the following conditions were present: (1) total transfusion requirements exceeding 1,000 ml whole blood or 2 units of packed red cells; (2) a drop in hemoglobin level of 5 g/dl or more, and (3) a hemoglobin level below 8 g/dl at any moment during the first 8 postoperative days. Blood loss was considered to be excessive in 91 patients. Preoperative PlC levels were significantly lower in these patients as compared to patients without the condition (204 +/- 52 vs. 236 +/- 79 x 10(9) liter-1; p = 0.0002). When patients were classified according to the quartiles of preoperative PlC, the odds ratio of developing excessive blood loss was 0.69 (95% CI: 0.38-1.26) in patients in the second quartile; 0.57 (95% CI: 0.30-1.06) in the third quartile, and 0.27 (95% CI: 0.13-0.57) in patients in the highest quartile. After adjusting for age, sex, type of surgery and type of prophylaxis, the preoperative PlC levels maintained a statistically significant inverse correlation with postoperative blood loss.

  7. Role of Enteral Immunonutrition in Patients Undergoing Surgery for Gastric Cancer

    PubMed Central

    Song, Guo-Min; Tian, Xu; Liang, Hui; Yi, Li-Juan; Zhou, Jian-Guo; Zeng, Zi; Shuai, Ting; Ou, Yang-Xiang; Zhang, Lei; Wang, Yan

    2015-01-01

    Abstract Gastric cancer (GC) is one of the most common upper gastrointestinal malignancies. Surgical resection remains the mainstay of curative treatment for GC. Enteral immunonutrition (EIN) has been increasingly used to enhance host immunity and relieve inflammatory response of patients undergoing surgery for GC; however, conclusions across studies still remain unclear. We aimed to evaluate the effects of EIN for such patients. We searched some electronic databases including PubMed, EBSCO-Medline, Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE to identify any latent studies which investigated the effects of EIN compared with standard EN on GC patients who undergoing surgery until the end of December 30, 2014. Relative risk (RR), mean difference (MD), or standard mean difference (SMD) with 95% confidence interval (CI) were calculated and we also assessed heterogeneity by using Cochrane Q and I2 statistic combined with corresponding P-value. We included 9 eligible studies which included 785 patients eventually. The meta-analysis results shown that EIN increased level of IgA (MD, 0.31; 95% CI, 0.12–0.51), IgG (MD, 1.5; 95% CI, 0.73–2.28), IgM (MD, 0.22; 95% CI, 0.06–0.39), CD4+ (SMD, 0.81; 95% CI, 0.53–1.09), CD3+ (SMD, 0.68; 95% CI, 0.21–1.15), CD4+/CD8+ ratio (MD, 0.56; 95% CI, 0.12–1.01), and NK cell (MD, 2.35; 95% CI, 0.66–4.05); decreased IL-6 (MD, −98.22; 95% CI, −156.16 to −40.28) and TNF-α (MD, −118.29; 95% CI, −162.00 to −74.58), but not improve remained outcomes of interest involving postoperative complications, length of hospitalization, serum total protein, and CD8+. Descriptive analysis suggested that EIN also increased the concentration of IL-2 but not CRP. Impact on lymphocytes remains inconsistent. EIN is effective for enhancing host immunity and relieving the inflammatory response in GC patients undergoing gastrectomy, but clinical outcomes cannot be benefit from it. Heterogeneity caused by different

  8. Enhancing tumor apparent diffusion coefficient histogram skewness stratifies the postoperative survival in recurrent glioblastoma multiforme patients undergoing salvage surgery.

    PubMed

    Zolal, Amir; Juratli, Tareq A; Linn, Jennifer; Podlesek, Dino; Sitoci Ficici, Kerim Hakan; Kitzler, Hagen H; Schackert, Gabriele; Sobottka, Stephan B; Rieger, Bernhard; Krex, Dietmar

    2016-05-01

    Objective To determine the value of apparent diffusion coefficient (ADC) histogram parameters for the prediction of individual survival in patients undergoing surgery for recurrent glioblastoma (GBM) in a retrospective cohort study. Methods Thirty-one patients who underwent surgery for first recurrence of a known GBM between 2008 and 2012 were included. The following parameters were collected: age, sex, enhancing tumor size, mean ADC, median ADC, ADC skewness, ADC kurtosis and fifth percentile of the ADC histogram, initial progression free survival (PFS), extent of second resection and further adjuvant treatment. The association of these parameters with survival and PFS after second surgery was analyzed using log-rank test and Cox regression. Results Using log-rank test, ADC histogram skewness of the enhancing tumor was significantly associated with both survival (p = 0.001) and PFS after second surgery (p = 0.005). Further parameters associated with prolonged survival after second surgery were: gross total resection at second surgery (p = 0.026), tumor size (0.040) and third surgery (p = 0.003). In the multivariate Cox analysis, ADC histogram skewness was shown to be an independent prognostic factor for survival after second surgery. Conclusion ADC histogram skewness of the enhancing lesion, enhancing lesion size, third surgery, as well as gross total resection have been shown to be associated with survival following the second surgery. ADC histogram skewness was an independent prognostic factor for survival in the multivariate analysis.

  9. Pathogenic conjunctival bacteria associated with systemic co-morbidities of patients undergoing cataract surgery

    PubMed Central

    Fernández-Rubio, M-E; Cuesta-Rodríguez, T; Urcelay-Segura, J-L; Cortés-Valdés, C

    2013-01-01

    Purpose To identify the risk of patients undergoing cataract surgery of having pathogenic conjunctival bacteria associated with their systemic co-morbidities. Methods Retrospective study of consecutive patients undergoing their first cataract operation from July 2005 to April 2010. Their preoperative conjunctival bacteria were cultured, identified, and classified in bacterial groups. Their co-morbidities were defined from their clinical data and the answers to systematic questions asked in the anaesthetic evaluation. The Microsoft Access databases of the two data sets were merged for carrying out the statistical analysis. Univariate association of each bacterial group with each co-morbidity was studied by using χ2-test for categorical data and Student's t-test for continuous variables. Also, logistic regression models were used adjusting for age and sex. SPSS statistic programme, version 18 was used for all these analyses. Endophthalmitis cases in this surgical series were searched. Results In the 8333 selected patients, age was associated with increased conjunctival bacteria in all groups except for Streptococcus pneumoniae and Propionibacteriae. However, male sex was associated with these two groups and also with coagulase-negative Staphylococci, Corynebacterium xerosis, Staphylococcus aureus, and Gram-negative rods. After adjusting for age and sex, S. aureus was associated with diabetes, lung diseases, and renal and heart insufficiency; Gram-negative rods with smoking habit; Enterococci with diabetes; Streptococcus pneumoniae with kyphoscoliosis; and other Streptococci with diabetes and handicapped patients. Conclusion The more pathogenic conjunctival bacteria were more likely associated with patients' co-morbidities, such as diabetes, lung diseases, renal and heart insufficiency, kyphoscoliosis, and smoking habit, than the less pathogenic ones. PMID:23703631

  10. The immunocompromised adult patient and surgery.

    PubMed

    Littlewood, Keith E

    2008-09-01

    The perioperative management of immunosuppressed patients remains relatively unsophisticated. Rational management involves understanding the normal immune response to injury as modified by the preexisting or imposed abnormalities that immunosuppressed patients manifest on the basis of their disease and/or treatment. Patients with cancer, infected with human immunodeficiency virus, and having had an organ transplant are extreme examples of disordered immunity and it is important to understand the effects of their diseases and treatments. In the future, however, more appropriate management will require anticipation and appreciation of frequent preoperative immunotherapy, a more complete understanding of the immunological response to anesthesia and surgery, the ability to assess immune reserve and stratify risk within the context of that profile, and a better knowledge of the immunological effect of anesthetic agents.

  11. Circulating microRNAs indicate cardioprotection by sevoflurane inhalation in patients undergoing off-pump coronary artery bypass surgery

    PubMed Central

    LIU, XIAO; LIU, XIAOPENG; WANG, RUIKE; LUO, HUI; QIN, GANG; WANG, LU; YE, ZHI; GUO, QULIAN; WANG, E

    2016-01-01

    In patients undergoing off-pump coronary artery bypass surgery (OPCAB), it is important to attenuate myocardium injury during the surgery. The present study aimed to observe the cardioprotection induced by sevoflurane induction and maintenance compared with propofol intravenous anesthesia, and to detect its potential protection against acute myocardial injury with sensitive biomarkers. In total, 36 patients undergoing OPCAB were randomly assigned into two groups, receiving sevoflurane (n=18) or propofol (n=18) as the induction and maintenance anesthetic agent. The depth of anesthesia in the two groups was kept at a bispectral index value of 40–50. Physiological and hemodynamic parameters were recorded during the surgery. Cardiac troponin-I (cTnI), creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH) and two microRNAs (miR-499 and miR-208b) were also measured during and subsequent to surgery. Nno statistically significant differences were observed in the physiological and hemodynamic parameters between the two groups prior to surgery. Following surgery, the cardiac output and stroke volume improved significantly in the sevoflurane group (P<0.05). In addition, patients in the sevoflurane group had lower miR-499 (P<0.05) and miR-208b (P<0.01) levels at 12 h after surgery when compared with the propofol group. However, no significant differences in cTnI, CK-MB and LDH levels were observed following surgery between the two groups. In conclusion, volatile induction and maintenance with sevoflurane resulted in some extent of cardiac function improvement in patients undergoing OPCAB. Cardioprotection by sevoflurane is suggested by reduced cardiac injury compared with propofol, and indicated by the sensitive biomarkers, circulating miR-499 and miR-208b. PMID:27284310

  12. Circulating microRNAs indicate cardioprotection by sevoflurane inhalation in patients undergoing off-pump coronary artery bypass surgery.

    PubMed

    Liu, Xiao; Liu, Xiaopeng; Wang, Ruike; Luo, Hui; Qin, Gang; Wang, L U; Ye, Zhi; Guo, Qulian; Wang, E

    2016-06-01

    In patients undergoing off-pump coronary artery bypass surgery (OPCAB), it is important to attenuate myocardium injury during the surgery. The present study aimed to observe the cardioprotection induced by sevoflurane induction and maintenance compared with propofol intravenous anesthesia, and to detect its potential protection against acute myocardial injury with sensitive biomarkers. In total, 36 patients undergoing OPCAB were randomly assigned into two groups, receiving sevoflurane (n=18) or propofol (n=18) as the induction and maintenance anesthetic agent. The depth of anesthesia in the two groups was kept at a bispectral index value of 40-50. Physiological and hemodynamic parameters were recorded during the surgery. Cardiac troponin-I (cTnI), creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH) and two microRNAs (miR-499 and miR-208b) were also measured during and subsequent to surgery. Nno statistically significant differences were observed in the physiological and hemodynamic parameters between the two groups prior to surgery. Following surgery, the cardiac output and stroke volume improved significantly in the sevoflurane group (P<0.05). In addition, patients in the sevoflurane group had lower miR-499 (P<0.05) and miR-208b (P<0.01) levels at 12 h after surgery when compared with the propofol group. However, no significant differences in cTnI, CK-MB and LDH levels were observed following surgery between the two groups. In conclusion, volatile induction and maintenance with sevoflurane resulted in some extent of cardiac function improvement in patients undergoing OPCAB. Cardioprotection by sevoflurane is suggested by reduced cardiac injury compared with propofol, and indicated by the sensitive biomarkers, circulating miR-499 and miR-208b.

  13. Risk Assessment of Obstructive Sleep Apnea in a Population of Patients Undergoing Ambulatory Surgery

    PubMed Central

    Stierer, Tracey L.; Wright, Christopher; George, Anu; Thompson, Richard E.; Wu, Christopher L.; Collop, Nancy

    2010-01-01

    population of patients undergoing ambulatory surgery. J Clin Sleep Med 2010;6(5):467-472. PMID:20957847

  14. Physiotherapy Practice Patterns for Management of Patients Undergoing Thoracic Surgeries in India: A Survey

    PubMed Central

    Sultanpuram, Sagarika; Ottayil, Zulfeequer C. P.

    2016-01-01

    Aim. The aim of the current study is to determine the practice patterns of physiotherapists for patients undergoing thoracic surgeries in India. Materials and Methodology. A cross-sectional survey was conducted across India in which 600 questionnaires were sent in emails to physiotherapists. The questionnaire addressed assessment and treatment techniques of thoracic surgery. Results. A total of 234 completed questionnaires were returned with a response rate of 39%, with the majority of responses received from Telangana, Karnataka, and Andhra Pradesh. More than 90% of the responders practiced physical examination, chest expansion, chest X-ray, ABG analysis, pulmonary function test, and SpO2 (oxygen saturation) as the assessment measures in both the pre- and the postoperative phase. Breathing exercises, incentive spirometry, thoracic expansion exercises, coughing and huffing, positioning, and modified postural drainage are found to be commonly used physiotherapy interventions, both pre- and postoperatively, with a response rate of more than 90%. A response rate of more than 84.6% indicated that patients are made to dangle their lower limbs over the edge of the bed on the 1st postoperative day. Mobilization, such as walking up to a chair, sit to stand exercises, and perambulation within the patient's room, was started on the 2nd postoperative day, as stated by more than 65% of the physiotherapists. Staircase climbing was started on the 5th postoperative day. The most commonly used functional evaluation prior to discharge was 6-minute walk test. This was, in fact, practiced by 77.4% of the physiotherapists in their clinical settings. Conclusion. The most predominantly employed assessment measures included were physical examination, chest expansion, ABG analysis, pulmonary function test, chest X-ray, SpO2 (oxygen saturation), peripheral muscle strength, and cardiopulmonary exercise. The physiotherapy interventions most commonly used were breathing exercises, thoracic

  15. Influence of the location of nonischemic diabetic forefoot osteomyelitis on time to healing after undergoing surgery.

    PubMed

    Cecilia-Matilla, Almudena; Lázaro-Martínez, José Luis; Aragón-Sánchez, Javier; García-Álvarez, Yolanda; Chana-Valero, Pedro; Beneit-Montesinos, Juan Vicente

    2013-09-01

    The forefoot has been reported as the most frequent location of osteomyelitis in the feet of patients with diabetes. The forefoot includes toes and metatarsal heads as common locations of bone infections, but the anatomy of these bones is quite different. As a result, such differences in anatomy may have an impact on the outcomes. The aim of the present study was to determine whether different locations of osteomyelitis in the forefoot have any influence on time to healing after undergoing surgery in a prospective series including 195 patients without peripheral arterial disease and osteomyelitis confirmed by histopathology. Location of the lesion was classified into 4 groups: hallux, first metatarsal head, lesser metatarsal heads, and lesser toes. The time required to achieve healing and the cumulative rate of wounds healed and likelihood of healing were analyzed at 4, 8, and 12 weeks after surgery. Time of healing (mean ± SD) in the whole series was 10.7 ± 8.4 weeks. Osteomyelitis located in the lesser toes has a higher probability of healing by the fourth week (odds ratio [OR] = 5.7, 95% confidence interval [CI] = 2.8-11.6, P < .001), eighth week (OR = 3.2, 95% CI = 1.6-6.4, P < .001), or twelfth week (OR = 3.1, 95% CI = 1.3-7.0, P = .008) than other osteomyelitis locations. Osteomyelitis located in the first metatarsal joint was less likely to heal by the eighth week (OR = 0.4, 95% CI = 0.2-0.9, P = .037) and 12th week (OR = 0.4, 95% CI = 0.2-1.0, P = .040). In conclusion, time to healing is significantly different according to the location of the bone infection in the forefoot.

  16. Role of calf muscle stimulation in the prevention of DVT in Indian patients undergoing surgeries for fractures around the hip

    PubMed Central

    Goyal, Aman; Arora, Sumit; Batra, Sumit; Sharma, Rohit; Mittal, Mahesh Kumar; Sharma, Vinod K

    2012-01-01

    Background: The venous stasis of soleal vein during surgery may be an important factor in the development of deep vein thrombosis (DVT). The stimulation of calf muscle during surgery may help in preventing DVT. The present study is conducted to evaluate the role of peroperative calf muscle electrostimulation in prevention of DVT in patients undergoing surgeries around the hip joint. Materials and Methods: The study comprised 200 patients undergoing surgeries around the hip joint. The patients having risk factors (such as previous myocardial infarction, malignancies, paraplegia or lower limb monoplegia, previous history of DVT or varicose veins, etc.) for the development of DVT were excluded. They were randomized into two groups: 100 cases were given peroperative calf muscle electrostimulation for DVT prophylaxis (Group A) and the remaining 100 patients were taken as controls without any prophylaxis (Group B). The color Doppler ultrasound was performed to exclude pre-existing DVT and on 7th day postoperative to find out the incidence of DVT in both the groups. Results: Two patients among Group A and six patients among Group B demonstrated DVT on ultrasonography, but the difference was not found to be statistically significant (P=0.279). None of the patients had any clinical evidence of DVT. Conclusion: The role of peroperative calf muscle electrostimulation for DVT prophylaxis remains controversial. The risk of developing DVT in patients undergoing surgeries around the hip joint is very less in patients analysed in our series. PMID:23162147

  17. Should patients with asymptomatic significant carotid stenosis undergo simultaneous carotid and cardiac surgery?

    PubMed Central

    Ogutu, Peter; Werner, Raphael; Oertel, Frank; Beyer, Michael

    2014-01-01

    A best evidence topic in cardiovascular surgery was written according to a structured protocol. The question addressed was whether patients with severe asymptomatic carotid and coronary artery diseases should undergo simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG). A total of 624 papers were found using the reported search, of which 20 represent the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study results of these papers are tabulated. Previous cohort studies showed mixed results, while advocating for the necessity of a randomized controlled trial (RCT). A recent RCT showed that patients undergoing prophylactic or simultaneous CEA + CABG had lower rates of stroke (0%) compared with delayed CEA 1–3 months after CABG (7.7%), without significant perioperative mortality difference. This study included patients with unilateral severe (>70%) asymptomatic carotid stenosis requiring CABG. An earlier partly randomized trial also showed better outcomes for patients undergoing simultaneous procedures (P = 0.045). Interestingly, systematic reviews previously failed to show compelling evidence supporting prophylactic CEA. This could be partly due to the fact that these reviews collectively analyse different cohort qualities. Neurological studies have, however, shown reduced cognitive and phonetic quality and function in patients with unilateral and bilateral asymptomatic carotid artery stenosis. Twenty-one RCTs comparing lone carotid artery stenting (CAS) and CEA informed the American Heart Association guidelines, which declared CAS comparable with CEA for symptomatic and asymptomatic carotid stenosis (CS). However, the risk of death/stroke for CAS alone is double that for CEA alone in the acute phase following onset of symptoms, while CEA alone is associated with a doubled risk of myocardial infarction. There is

  18. Systematic Review: Audiovisual Interventions for Reducing Preoperative Anxiety in Children Undergoing Elective Surgery

    PubMed Central

    Van Lieshout, Ryan J.; Schmidt, Louis A.; Dobson, Kathleen G.; Buckley, Norman

    2016-01-01

    Objective To examine the effectiveness of Audiovisual (AV) interventions at reducing preoperative anxiety and its associated outcomes in children undergoing elective surgery. Methods A systematic review of randomized controlled trials (RCTs) and nonrandomized studies where the primary outcome was children’s preoperative anxiety was conducted. Secondary outcomes included postoperative pain, behavioral changes, recovery, induction compliance, satisfaction, and cost-effectiveness. The risk of bias of each study was assessed. Results In all, 18 studies were identified. A meta-analytic approach and narrative synthesis of findings were used to summarize the results of the studies. Conclusions This systematic review suggests that AV interventions can be effective in reducing children’s preoperative anxiety. Videos, multi-faceted programs, and interactive games appear to be most effective, whereas music therapy and Internet programs are less effective. While AV interventions appear potentially useful, adequately powered RCTs are required to conclusively pinpoint the components and mechanisms of the most effective AV interventions and guide practice. PMID:26476281

  19. An evidence summary of the management of patients taking direct oral anticoagulants (DOACs) undergoing dental surgery.

    PubMed

    Johnston, S

    2016-05-01

    Direct oral anticoagulant (DOAC) drugs (dabigatran, rivaroxaban, and apixaban) have emerged in the last decade to overcome some of the drawbacks of existing medications. To date, little is known about the dental management of patients taking these drugs. This study was undertaken to establish the evidence for the management of patients undergoing dental procedures while taking these medications. A rapid review approach was used to identify clinical and scientific research related to dental surgery performed in patients taking DOACs in order to produce an evidence summary. The rapid review did not identify any systematic reviews or original clinical trials and the overall quality of evidence found was poor. Most of the literature consisted of non-structured review articles and guidance documents based on assumptions from non-dental data and expert opinion, and recommendations on best practice varied throughout. The findings from the review of the literature varied considerably. Currently, recommendations are based on poor quality scientific data and clinical trials are required to establish best evidence-based practice guidance.

  20. Anaesthetic management of a child with Freeman-sheldon syndrome undergoing spinal surgery.

    PubMed

    Richa, F C; Yazbeck, P H

    2008-03-01

    Freeman-Sheldon syndrome, or distal arthrogryposis type 2A, is a rare congenital myopathy and dysplasia characterised by multiple contractures, abnormalities of the head and face, defective development of the hands and feet and skeletal malformations. The facial muscle contracture produces the typical 'whistling face' appearance. Anaesthetic issues include difficult intravenous access, difficult airway and postoperative pulmonary complications. Although an association with malignant hyperthermia has been suggested, this has not been confirmed. We report the management of a seven-year-old girl with Freeman-Sheldon syndrome undergoing anterior and posterior spinal surgery and describe a successful anaesthetic regimen based on a total intravenous anaesthesia technique with remifentanil and propofol without neuromuscular blocking agents. The child had an uneventful anaesthetic and postoperative course. We believe the presence of the myopathy warranted the use of a 'non-triggering' anaesthetic, as suxamethonium and volatile agents may be associated with significant complications such as muscle rigidity and rhabdomyolysis in myopathic patients, even in the absence of malignant hyperthermia.

  1. Evaluation of peripheral muscle strength of patients undergoing elective cardiac surgery: a longitudinal study

    PubMed Central

    Santos, Kelli Maria Souza; de Cerqueira Neto, Manoel Luiz; Carvalho, Vitor Oliveira; de Santana Filho, Valter Joviniano; da Silva Junior, Walderi Monteiro; Araújo Filho, Amaro Afrânio; Cerqueira, Telma Cristina Fontes; Cacau, Lucas de Assis Pereira

    2014-01-01

    Introduction Peripheral muscle strength has been little explored in the literature in the context of cardiac rehabilitation. Objective To evaluate the peripheral muscle strength of patients undergoing elective cardiac surgery. Methods This was a longitudinal observational study. The peripheral muscle strength was measured using isometric dynamometry lower limb (knee extensors and flexors) at three different times: preoperatively (M1), the day of discharge (M2) and hospital discharge (M3). Participants received physiotherapy pre and postoperatively during the days of hospitalization during the morning and afternoon. Results Twenty-two patients were evaluated. The values of peripheral muscle strength of knee extensors preoperative found were about 50% lower than those predicted for the healthy population. When comparing muscle strength prior (M1), with the remaining evaluation, found himself in a fall of 29% for the movement of knee extension and 25% for knee flexion in M2 and a decrease of 10% movement for knee extension and 13% for knee flexion in M3 when comparing with M1. Conclusion The values of peripheral muscle strength prior of the study patients were lower than predicted for the healthy population of the same age. After the surgical event this reduction is even more remarkable, being reestablished until the time of discharge, to values close to baseline. PMID:25372909

  2. The role of magnesium sulfate in tracheal intubation without muscle relaxation in patients undergoing ophthalmic surgery

    PubMed Central

    Soltani, Hassan-Ali; Hashemi, Seyed Jalal; Montazeri, Kamran; Dehghani, Alireza; Nematbakhsh, Mehdi

    2016-01-01

    Background: Muscle relaxant agents usually use to facilitate tracheal intubation; however, sometimes limitations exist. Magnesium (Mg) sulfate is a candidate for muscle relaxant substitute. This study was designed to determine the effect of Mg sulfate accompanied with propofol and fentanyl in patients undergoing ophthalmic surgery. Materials and Methods: In a double-blind randomized protocol and before tracheal intubation, Mg sulfate 40, 45, or 50 mg/kg in 100 ml of saline (Groups 1–3, respectively) or saline alone (Group 4) were administrated intravenously in 100 patients (n = 25 in each group) with the American Society of Anesthesiologist (ASA) physical Status I, II, or III. The patients' intubation condition in all subjects were determined and described. Results: The patients' demographic data including age, ASA, systolic and diastolic blood pressures, intraocular pressure, and body mass index were not significantly different between the groups. A better mask ventilation feasibility in Mg sulfate 45 group (Group 2) was observed when compared with Mg sulfate 50 (Group 3) (P = 0.022) and saline group (Group 4) (P = 0.021). In addition, the vocal cord movement and muscle relaxant requirement in saline group were significantly different from others groups (P < 0.05). The laryngoscopic time in saline group was greater than other groups significantly (P < 0.0001). Conclusion: Intravenous administration of Mg sulfate accompanied with propofol and fentanyl facilitates the tracheal intubation without neuromuscular blocking agents. To avoid Mg level increasing in plasma; however, the low dose of Mg sulfate is suggested. PMID:28163742

  3. Comparison of epidural morphine, hydromorphone and fentanyl for postoperative pain control in children undergoing orthopaedic surgery.

    PubMed

    Goodarzi, M

    1999-01-01

    The safety and side-effects profile of epidural administration of a hydrophilic (morphine), highly lipophilic (fentanyl) and a drug with intermediate hydrophilic and lipophilic activity (hydromorphone) were compared in 90 children undergoing orthopaedic procedures. Ninety patients were randomly assigned (30 in each group) to receive epidural morphine, hydromorphone, or fentanyl for postoperative analgesia. Respiratory effects, nausea, somnolence, urinary retention, pruritus and visual pain scales were evaluated and compared during a 30-h period following surgery. In the morphine group, 25% showed respiratory depression with oxygen saturation below 90% but there was no incidence of respiratory depression in the fentanyl or hydromorphone groups. Somnolence was prominent in some of the patients in all the groups, but was more prolonged in the morphine group. Statistically, there was no significant difference in nausea between the groups, but pruritus was more severe and frequent in the morphine group. The incidence of urinary retention in the morphine group was higher compared with the fentanyl and hydromorphone groups. In conclusion, epidural hydromorphone, demonstrating less side-effects, is preferable to morphine and fentanyl for epidural analgesia in children.

  4. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery.

    PubMed

    Duceppe, Emmanuelle; Parlow, Joel; MacDonald, Paul; Lyons, Kristin; McMullen, Michael; Srinathan, Sadeesh; Graham, Michelle; Tandon, Vikas; Styles, Kim; Bessissow, Amal; Sessler, Daniel I; Bryson, Gregory; Devereaux, P J

    2017-01-01

    The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of evidence assessment for patients who undergo noncardiac surgery. Strong recommendations included: 1) measuring brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery to enhance perioperative cardiac risk estimation in patients who are 65 years of age or older, are 45-64 years of age with significant cardiovascular disease, or have a Revised Cardiac Risk Index score ≥ 1; 2) against performing preoperative resting echocardiography, coronary computed tomography angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging to enhance perioperative cardiac risk estimation; 3) against the initiation or continuation of acetylsalicylic acid for the prevention of perioperative cardiac events, except in patients with a recent coronary artery stent or who will undergo carotid endarterectomy; 4) against α2 agonist or β-blocker initiation within 24 hours before surgery; 5) withholding angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker starting 24 hours before surgery; 6) facilitating smoking cessation before surgery; 7) measuring daily troponin for 48 to 72 hours after surgery in patients with an elevated NT-proBNP/BNP measurement before surgery or if there is no NT-proBNP/BNP measurement before surgery, in those who have a Revised Cardiac Risk Index score ≥1, age 45-64 years with significant cardiovascular disease, or age 65 years or older; and 8) initiating of long-term acetylsalicylic acid and statin therapy in patients who suffer myocardial injury/infarction after surgery.

  5. Refractive Changes Induced by Strabismus Corrective Surgery in Adults

    PubMed Central

    Leshno, Ari; Ziv-Baran, Tomer; Stolovitch, Chaim

    2017-01-01

    Purpose. To investigate refractive changes after strabismus correction procedures among adults. Methods. Retrospective chart review of adult patients who had horizontal recti muscles surgery with preoperative and postoperative cycloplegic refraction measurements. The preoperative refraction was mathematically subtracted from the postoperative refraction, and the induced refractive changes were statistically analyzed. Vector analysis was used to examine the magnitude of the toric change. The proportion of clinically significant refractive change was evaluated as well. Results. Thirty-one eyes from 22 subjects met the criteria and were included in the final analysis. A significant postoperative refractive change of the spherical equivalent towards myopia and a change of the astigmatism in the with-the-rule direction were observed. In a subset of 9 cases a third cycloplegic refraction measurement demonstrated stable refraction compared to the 1-month postoperative measurement. In 10 cases of single eye surgery, significant refractive changes were observed only in the operated side when compared to the sound eye. The induced surgical refractive change was of clinical significance (≥0.5 D) in 11 eyes of 9 patients (40.9% of patients). Conclusions. Refractive changes are a significant side effect of horizontal strabismus corrective surgery among adults. Therefore, patients should be informed about it prior to surgery and should be rerefracted in the postoperative period. PMID:28191347

  6. Decentralization of Care for Adults with Congenital Heart Disease in the United States: A Geographic Analysis of Outpatient Surgery

    PubMed Central

    Maxwell, Bryan G.; Maxwell, Thane G.; Wong, Jim K.

    2014-01-01

    Background Guidelines recommend that adults with congenital heart disease (CHD) undergo noncardiac surgery in regionalized centers of expertise, but no studies have assessed whether this occurs in the United States. We hypothesized that adults with CHD are less likely than children to receive care at specialized CHD centers. Methods Using a comprehensive state ambulatory surgical registry (California Ambulatory Surgery Database, 2005–2011), we calculated the proportion of adult and pediatric patients with CHD who had surgery at a CHD center, distance to the nearest CHD center, and distance to the facility where surgery was performed. Results Patients with CHD accounted for a larger proportion of the pediatric population (n = 11,254, 1.0%) than the adult population (n = 10,547, 0.07%). Only 2,741 (26.0%) adults with CHD had surgery in a CHD center compared to 6,403 (56.9%) children (p<0.0001). Adult CHD patients who had surgery at a non-specialty center (11.9±15.4 miles away) lived farther from the nearest CHD center (37.9±43.0 miles) than adult CHD patients who had surgery at a CHD center (23.2±28.4 miles; p<0.0001). Pediatric CHD patients who had surgery at a non-specialty center (18.0±20.7 miles away) lived farther from the nearest CHD center (35.7±45.2 miles) than pediatric CHD patients who had surgery at a CHD center (22.4±26.0 miles; p<0.0001). Conclusions Unlike children with CHD, most adults with CHD (74%) do not have outpatient surgery at a CHD center. For both adults and children with CHD, greater distance from a CHD center is associated with having surgery at a non-specialty center. These results have significant public health implications in that they suggest a failing to achieve adequate regional access to specialized ACHD care. Further studies will be required to evaluate potential strategies to more reliably direct this vulnerable population to centers of expertise. PMID:25247694

  7. Preliminary evaluation of a microtransesophageal probe in neonates and young infants undergoing surgery for congenital heart disease

    PubMed Central

    Pavithran, Sreeja; Natarajan, Kanagarajan; Vishwambaran, Bijesh; Arke, Avinash Dayalal; Sivakumar, Kothandam

    2014-01-01

    Background: The larger size of the currently available transesophageal echocardiography (TEE) probes limits their use to relatively older infants undergoing cardiac surgery. In very young neonates and infants, epicardial echocardiogram is used to assess postoperative residual defects. Recently, a miniaturized microTEE probe compatible in neonates has been introduced for clinical use. We evaluated the use of this probe in small infants undergoing cardiac surgery. Materials and Methods: Thirty-three consecutive neonates and infants undergoing cardiac surgery at our institution were included in the study. Intraoperative echocardiography with Philips s8-3t microTEE probe done using IE33 platform was utilized to study the preoperative anatomy and assess postoperative results. Results: Thirty-three patients aged 3 days-2 years (mean 5.1 months) and weighing 2.5-11 kg (mean 4.4 kg) underwent perioperative evaluation using the microTEE probe. Good quality two-dimensional and color Doppler images were obtained in all patients. There were no complications related to the probe insertion or manipulation. The findings on microTEE led to revision of surgery in five patients. Certain echocardiographic parameters that could never be recorded with epicardial echocardiogram could be easily seen in microTEE. Conclusion: On preliminary evaluation, the microTEE probe provided good quality images in very small infants who were not amenable for transesophageal echocardiographic evaluation so far. The probe could be used safely in small infants without complications. It appears to be a promising imaging modality in the perioperative assessment of young infants undergoing cardiac surgery, in whom intraoperative epicardial echocardiography is currently the only tool. PMID:25298691

  8. Impact of different intravenous fluids on blood glucose levels in nondiabetic patients undergoing elective major noncardiac surgeries

    PubMed Central

    Khetarpal, Ranjana; Chatrath, Veena; Kaur, Jagjit; Bala, Anju; Singh, Harjeet

    2016-01-01

    Background: Intravenous (IV) fluids are an integral part of perioperative management. Intraoperative hyperglycemia is associated with poor clinical outcomes in patients undergoing major surgeries even in nondiabetics. Aim: This study was conducted to observe the effect of different maintenance fluid regimens on intraoperative blood glucose levels in nondiabetic patients undergoing major surgeries under general anesthesia. Settings and Design: Randomized double-blind study. Materials and Methods: One hundred nondiabetic patients of either sex were divided randomly into two Groups I and II of 50 each undergoing elective major surgeries of more than 90 min duration under general anesthesia. Both groups were given calculated dosage of IV fluids accordingly 4-2-1 formula while Group I was given Ringer lactate (RL) and Group II was given 0.45% dextrose normal saline and potassium chloride 20 mmol/L. Changes in vital parameters, % oxygen saturation, and urine output were monitored at regular intervals. Capillary blood glucose (CBG) was measured half-hourly until end of surgery. If CBG level was more than 150 mg%, then calculated dose of human insulin (CBG/100) was given as IV bolus dose. Statistical Analysis: Statistical analysis was done using SPSS 22.0 software (IBM Corporation, Armonk, New York, USA), paired t-test and Chi-square test. Results: A significant increase of CBG level and was observed during intraoperative and immediate postoperative period (P < 0.001) in Group II. Conclusion: RL solution is probably the alternative choice of IV fluid for perioperative maintenance and can be used as replacement fluid in nondiabetic patients undergoing major surgeries. PMID:27746527

  9. The effect of remote ischaemic preconditioning on myocardial injury in patients undergoing off-pump coronary artery bypass graft surgery.

    PubMed

    Hong, D M; Mint, J J; Kim, J H; Sohn, I S; Lim, T W; Lim, Y J; Bahk, J H; Jeon, Y

    2010-09-01

    In several recent clinical trials on cardiac surgery patients, remote ischaemic preconditioning (RIPC) showed a powerful myocardial protective effect. However the effect of RIPC has not been studied in patients undergoing off-pump coronary artery bypass graft surgery. We evaluated whether RIPC could induce myocardial protection in off-pump coronary artery bypass graft surgery patients. Patients undergoing elective off-pump coronary artery bypass graft surgery were randomly allocated to the RIPC (n = 65) or control group (n = 65). After induction of anaesthesia, RIPC was induced by four cycles of five-minute ischaemia and reperfusion on the upper limb using a pneumatic cuff. Anaesthesia was maintained with sevoflurane, remifentanil and vecuronium. Myocardial injury was assessed by troponin I before surgery and 1, 6, 12, 24, 48 and 72 hours after surgery. There were no statistical differences in troponin I levels between RIPC and control groups (P = 0.172). Although RIPC reduced the total amount of troponin I (area under the curve of troponin increase) by 26%, it did not reach statistical significance (RIPC group 53.2 +/- 72.9 hours x ng/ml vs control group 67.4 +/- 97.7 hours x ng/ml, P = 0.281). In this study, RIPC by upper limb ischaemia reduced the postoperative myocardial enzyme elevation in off-pump coronary artery bypass graft surgery patients, but this did not reach statistical significance. Further study with a larger number of patients may be needed to fully evaluate the clinical effect of RIPC in off-pump coronary artery bypass graft surgery patients.

  10. Determinants of distance walked during the six-minute walk test in patients undergoing cardiac surgery at hospital discharge

    PubMed Central

    2014-01-01

    Introduction The aim of this study was to identify the determinants of distance walked in six-minute walk test (6MWD) in patients undergoing cardiac surgery at hospital discharge. Methods The assessment was performed preoperatively and at discharge. Data from patient records were collected and measurement of the Functional Independence Measure (FIM) and the Nottingham Health Profile (NHP) were performed. The six-minute walk test (6MWT) was performed at discharge. Patients undergoing elective cardiac surgery, coronary artery bypass grafting or valve replacement were eligible. Patients older than 75 years who presented arrhythmia during the protocol, with psychiatric disorders, muscular or neurological disorders were excluded from the study. Results Sixty patients (44.26% male, mean age 51.53 ± 13 years) were assessed. In multivariate analysis the following variables were selected: type of surgery (P = 0.001), duration of cardiopulmonary bypass (CPB) (P = 0.001), Functional Independence Measure - FIM (0.004) and body mass index - BMI (0.007) with r = 0.91 and r2 = 0.83 with P < 0.001. The equation derived from multivariate analysis: 6MWD = Surgery (89.42) + CPB (1.60) + MIF (2.79 ) - BMI (7.53) - 127.90. Conclusion In this study, the determinants of 6MWD in patients undergoing cardiac surgery were: the type of surgery, CPB time, functional capacity and body mass index. PMID:24885130

  11. Rifampin blood and tissue levels in patients undergoing cardiac valve surgery.

    PubMed Central

    Archer, G L; Armstrong, B C; Kline, B J

    1982-01-01

    Single 600-mg capsules of rifampin were given orally to 26 patients as prophylaxis during cardiac valve replacement. Antibiotic concentrations were measured in blood (serum or plasma) and tissue (excised cardiac valve). The serum or plasma levels of rifampin in 18 patients who ingested this drug 2 h before they received preoperative opiates and anticholinergics intramuscularly were not significantly different from the levels in four normal volunteers who received the drug. These levels were 15.9 +/- 6.5 micrograms/ml (mean +/- standard deviation) 2 h after drug administration, 7.1 +/- 4.3 micrograms/ml 8 h after drug administration and 2 h after a mean of 1.4 h on cardiopulmonary bypass, and 1.6 +/- 1.6 micrograms/ml 24 h after drug ingestion. The valve tissue level was 3.8 +/- 2.7 micrograms/g (mean +/- standard deviation; n = 10). This value was 65% of the simultaneous serum and plasma levels and 31% of the peak serum and plasma levels. Eight patients who were given rifampin at the same time that they received other preoperative medications had significantly lower blood levels than the 18 patients who received rifampin 2 h earlier (P less than 0.001). No rifampin was detected in valves from seven of these patients. Decreased rifampin absorption due to simultaneous administration with opiates and anticholinergics was the probable reason for the low plasma and serum levels observed. These data suggest that, if properly dosed, rifampin administered orally gives high blood and valve tissue levels, which are affected minimally by cardiopulmonary bypass in patients undergoing cardiac valve surgery. PMID:7103459

  12. Perioperative physical exercise interventions for patients undergoing lung cancer surgery: What is the evidence?

    PubMed

    Mainini, Carlotta; Rebelo, Patrícia Fs; Bardelli, Roberta; Kopliku, Besa; Tenconi, Sara; Costi, Stefania; Tedeschi, Claudio; Fugazzaro, Stefania

    2016-01-01

    Surgical resection appears to be the most effective treatment for early-stage non-small cell lung cancer. Recent studies suggest that perioperative pulmonary rehabilitation improves functional capacity, reduces mortality and postoperative complications and enhances recovery and quality of life in operated patients. Our aim is to analyse and identify the most recent evidence-based physical exercise interventions, performed before or after surgery. We searched in MEDLINE, EMBASE, CINAHL, Cochrane Library and PsycINFO. We included randomised controlled trials aimed at assessing efficacy of exercise-training programmes; physical therapy interventions had to be described in detail in order to be reproducible. Characteristics of studies and programmes, results and outcome data were extracted. Six studies were included, one describing preoperative rehabilitation and three assessing postoperative intervention. It seems that the best preoperative physical therapy training should include aerobic and strength training with a duration of 2-4 weeks. Although results showed improvement in exercise performance after preoperative pulmonary rehabilitation, it was not possible to identify the best preoperative intervention due to paucity of clinical trials in this area. Physical training programmes differed in every postoperative study with conflicting results, so comparison is difficult. Current literature shows inconsistent results regarding preoperative or postoperative physical exercise in patients undergoing lung resection. Even though few randomised trials were retrieved, treatment protocols were difficult to compare due to variability in design and implementation. Further studies with larger samples and better methodological quality are urgently needed to assess efficacy of both preoperative and postoperative exercise programmes.

  13. Perioperative physical exercise interventions for patients undergoing lung cancer surgery: What is the evidence?

    PubMed Central

    Mainini, Carlotta; Rebelo, Patrícia FS; Bardelli, Roberta; Kopliku, Besa; Tenconi, Sara; Costi, Stefania; Tedeschi, Claudio; Fugazzaro, Stefania

    2016-01-01

    Surgical resection appears to be the most effective treatment for early-stage non-small cell lung cancer. Recent studies suggest that perioperative pulmonary rehabilitation improves functional capacity, reduces mortality and postoperative complications and enhances recovery and quality of life in operated patients. Our aim is to analyse and identify the most recent evidence-based physical exercise interventions, performed before or after surgery. We searched in MEDLINE, EMBASE, CINAHL, Cochrane Library and PsycINFO. We included randomised controlled trials aimed at assessing efficacy of exercise-training programmes; physical therapy interventions had to be described in detail in order to be reproducible. Characteristics of studies and programmes, results and outcome data were extracted. Six studies were included, one describing preoperative rehabilitation and three assessing postoperative intervention. It seems that the best preoperative physical therapy training should include aerobic and strength training with a duration of 2–4 weeks. Although results showed improvement in exercise performance after preoperative pulmonary rehabilitation, it was not possible to identify the best preoperative intervention due to paucity of clinical trials in this area. Physical training programmes differed in every postoperative study with conflicting results, so comparison is difficult. Current literature shows inconsistent results regarding preoperative or postoperative physical exercise in patients undergoing lung resection. Even though few randomised trials were retrieved, treatment protocols were difficult to compare due to variability in design and implementation. Further studies with larger samples and better methodological quality are urgently needed to assess efficacy of both preoperative and postoperative exercise programmes. PMID:27803808

  14. Peri-operative dexamethasone therapy and post-operative psychosis in patients undergoing major oral and maxillofacial surgery.

    PubMed

    Koteswara, Chethan Manohara; Patnaik, Pritish

    2014-01-01

    A broad array of behavioral symptoms, including psychosis, can transpire post-operatively following a variety of surgeries. It is difficult to diagnose the exact cause of post-operative psychosis. We report three cases, which developed psychosis post-operatively after undergoing major oral and maxillofacial surgeries. All the three patients were administered dexamethasone peri-operatively. Dexamethasone is used to prevent or reduce post-operative edema. The exact dose of dexamethasone, which can cause psychosis, is unknown. It is important to raise awareness about this potential complication so that measures for management can be put in place in anticipation of such an event.

  15. Metabolic and clinical traits in horses undergoing feed deprivation for elective orthopaedic surgery.

    PubMed

    Reinprecht, Birgit; Hackl, Sigrun; Reisinger, Renate; Zickl, Michaela; Spona, Jürgen; Stanek, Christian; Zentek, Jürgen

    2007-01-01

    The objective of this study was to investigate some metabolic and clinical effects of feed deprivation in horses that were submitted for orthopaedic surgery. The effects of preoperative feed restriction were investigated in 20 horses submitted for elective orthopaedic surgery. The patients were fasted from 12 hours before until 4 hours after surgery. Serum free amino acids, glucose,free fatty acids (FFA), white blood cell counts, creatine kinase (CK) and aspartate aminotransferase (AST) were determined 24 hours before surgery, 2 hours after the end of anaesthesia and 24 and 72 hours after surgery. Besides, abdominal sounds, appetite, faecal quality and body temperature were examined. Serum free amino acids did not react homogenously, concentrations were partly increasing or decreasing. Plasma glucose and FFA increased after surgery and returned to their preoperative levels 72 hours after surgery. A significant rise of the segmented granulocytes occurred 24 hours after surgery, all other parameters of the leukogram did not exceed the physiological range. AST reached its highest activity 24 hours after surgery, whereas CK activities were highest at 2 hours after surgery. Abdominal sounds were significantly reduced until 24 hours after surgery, however, appetite was not depressed. Faecal quality was physiological after surgery. Mean body temperature stayed within the physiological range. In conclusion, a relatively short perioperative fasting period had significant effects on the metabolic traits in horses, however the effects on physiological functions were minor. The consequences of major surgical procedures need to be addressed in future studies.

  16. Safety of serotonin (5-HT3) receptor antagonists in patients undergoing surgery and chemotherapy: protocol for a systematic review and network meta-analysis

    PubMed Central

    2013-01-01

    Background Serotonin (5-HT3) receptor antagonists are a class of antiemetic medications often used to prevent nausea and vomiting among patients undergoing chemotherapy, radiotherapy or surgery. However, recent studies suggest that these agents might be associated with increased cardiac harm. To examine this further, we are proposing to conduct a systematic review and network meta-analysis on the comparative safety of 5-HT3 receptor antagonists among patients undergoing chemotherapy or surgery. Methods/Design Studies reporting one or more safety outcomes of interest for 5-HT3 receptor antagonists compared with each other, placebo, and/or other anti-emetic agents (for example, benzamides, phenothiazines, butyrophenones, antihistamines, and anticholinergics) among children and adult patients undergoing surgery or chemotherapy will be included. Our primary outcome of interest is arrhythmia. Our secondary outcomes include cardiac death, QT prolongation, PR prolongation, all-cause mortality, nausea, and vomiting. We will include experimental studies, quasi-experimental studies (namely controlled before-after and interrupted time series), and observational studies (namely cohort studies). We will not limit inclusion by publication status, time period, duration of follow-up or language of dissemination. Electronic databases (for example, MEDLINE, EMBASE) will be searched from inception onwards. These main searches will be supplemented by searching for difficult to locate and unpublished studies, such as dissertations, and governmental reports. The eligibility criteria will be pilot-tested and subsequently used to screen the literature search results by two reviewers in duplicate. A similar process will be followed for full-text screening, data abstraction, and risk of bias/methodological quality appraisal. The Cochrane Risk of Bias tool will be used to appraise experimental and quasi-experimental studies, and cohort studies will be assessed using the Newcastle Ottawa

  17. Construction of a Clinical Decision Support System for Undergoing Surgery Based on Domain Ontology and Rules Reasoning

    PubMed Central

    Bau, Cho-Tsan; Huang, Chung-Yi

    2014-01-01

    Abstract Objective: To construct a clinical decision support system (CDSS) for undergoing surgery based on domain ontology and rules reasoning in the setting of hospitalized diabetic patients. Materials and Methods: The ontology was created with a modified ontology development method, including specification and conceptualization, formalization, implementation, and evaluation and maintenance. The Protégé–Web Ontology Language editor was used to implement the ontology. Embedded clinical knowledge was elicited to complement the domain ontology with formal concept analysis. The decision rules were translated into JENA format, which JENA can use to infer recommendations based on patient clinical situations. Results: The ontology includes 31 classes and 13 properties, plus 38 JENA rules that were built to generate recommendations. The evaluation studies confirmed the correctness of the ontology, acceptance of recommendations, satisfaction with the system, and usefulness of the ontology for glycemic management of diabetic patients undergoing surgery, especially for domain experts. Conclusions: The contribution of this research is to set up an evidence-based hybrid ontology and an evaluation method for CDSS. The system can help clinicians to achieve inpatient glycemic control in diabetic patients undergoing surgery while avoiding hypoglycemia. PMID:24730353

  18. The effect of July admission on inpatient morbidity and mortality after adult spinal deformity surgery

    PubMed Central

    De la Garza-Ramos, Rafael; Passias, Peter G.; Schwab, Frank J.; Lafage, Virginie

    2016-01-01

    Background Some studies have suggested patients who undergo surgery in July have worse outcomes compared to patients treated during other months. The purpose of this study is to compare inpatient morbidity and mortality among patients who underwent adult spinal deformity (ASD) surgery in July with those who underwent surgery in other months. Methods Admission data for patients who underwent ASD surgery were extracted from the Nationwide Inpatient Sample for the years 2002 to 2011. Only adult patients (over 21 years of age) and elective admissions to teaching hospitals were included. A multivariable regression analysis was performed to examine the independent effect of July admissions on overall complications, major complications, and inpatient mortality. Results A total of 27,794 patients were identified, with 2,023 (7.8%) admitted in July and 25,771 (92.2%) in other months. Overall complication rates in July (43.1%) were not different from rates in other months (44.9%, p=0.468). Similarly, major complication rates were similar; 12.9% in July and 12.4% in other months (p=0.764). Mortality was not different between groups (p=0.807). After multivariable analysis, July admissions were not found to increase the odds of developing any complication (OR 0.94; 95% CI, 0.77 - 1.12; p=0.403), major complications (OR 1.04; 95% CI, 0.76 - 1.41; p=0.788) or inpatient mortality (OR 1.35; 95% CI, 0.31 - 5.84; p=0.684). Conclusion In this study of a nationwide database, patients who underwent ASD surgery in July did not have increased odds of developing a complication or inpatient mortality compared to patients admitted in other months. PMID:26913223

  19. Frequency of homologous blood transfusion in patients undergoing cleft lip and palate surgery

    PubMed Central

    Adeyemo, Wasiu L.; Ogunlewe, Mobolanle O.; Desalu, Ibironke; Ladeinde, Akinola L.; Adeyemo, Titilope A.; Mofikoya, Bolaji O.; Hassan, Olakunle O.; Akanmu, Alani S.

    2010-01-01

    Aim: The study aims to determine the frequency of homologous blood transfusion in patientsundergoing cleft lip and palate surgery at the Lagos University Teaching Hospital, Nigeria. Setting and Design: A prospective study of transfusion rate in cleft surgery conducted at the Lagos University Teaching Hospital, Nigeria. Material and Methods: One hundred consecutive patients who required cleft lip and palate surgery were recruited into the study. Data collected included age, sex and weight of patients, type of cleft defects, type of surgery done, preoperative haematocrit, duration of surgery, amount of blood loss during surgery, the number of units of blood cross-matched and those used. Each patient was made to donate a unit of homologous blood prior to surgery. Results: There were 52 females and 48 males with a mean age of 64.4 ± 101.1 months (range, 3-420 months). The most common cleft defect was isolated cleft palate (45%) followed by unilateral cleft lip (28%). Cleft palate repair was the most common procedure (45%) followed by unilateral cleft lip repair (41%). The mean estimated blood loss was 95.8 ± 144.9 ml (range, 2-800ml). Ten (10%) patients (CL=2; CP=5, BCL=1; CLP=2) were transfused but only two of these were deemed appropriate based on percentage blood volume loss. The mean blood transfused was 131.5 ± 135.4ml (range, 35-500ml). Six (60%) of those transfused had a preoperative PCV of < 30%. Only 4.9% of patients who had unilateral cleft lip surgery were transfused as compared with 50% for CLP surgery, 11% for CP surgery, and 10% for bilateral cleft lip surgery. Conclusions: The frequency of blood transfusion in cleft lip and palate surgery was 10% with a cross-match: transfusion ratio of 10 and transfusion index of 0.1. A "type and screen" policy is advocated for cleft lip and palate surgery. PMID:20924451

  20. Response to low-dose intrathecal clonidine in septuagenarians undergoing sub-umbilical surgeries: A study

    PubMed Central

    Sen, Jayashree; Sen, Bitan

    2015-01-01

    Clonidine, an alpha-2-adrenergic agonist, may have a clinically relevant analgesic action but also a hypotensive action, when administered spinally. Aim: To evaluate the analgesic and circulatory effects of low-dose intrathecal clonidine co-administered with hyperbaric bupivacaine in septuagenarian patients undergoing sub-umbilical surgeries. Materials and Methods: A total of 20 patients within the age group of 70-80 years of either sex, enrolled in this study, were randomly divided into groups of 10 each. Group I received clonidine 7.5 μg as an adjuvant to 15 mg of hyperbaric bupivacaine and Group II (control group) received 15 mg of bupivacaine with saline to make volume in the two solutions equal. Result: The level of subarachnoid block was comparable in the two groups. Duration of motor blockade was longer in the clonidine group (221.4 ± 35.92 min) compared with the control group (112.3 ± 12.45 min). Request for 1st dose of analgesic was earlier in the control group (135.5 ± 28.52 min) than the clonidine group (295 ± 18.85 min). Mean arterial pressure (clonidine 77.67 ± 6.47 vs. control 93.87 ± 3.03, P = 0.0002) and heart rate (clonidine 65.2 ± 5.20 vs. control 77.4 ± 6.06, P = 0.003) were significantly lower (P < 0.05) in the clonidine group compared with the control group from 20 mins after the block to the end of 3 h. In the clonidine group, 3 patients had postoperative headache, 4 had intra-operative shivering. 2 patients in the clonidine group also developed hypotension and 1 bradycardia and 1 of them developed bradyapnea along with acute hypotension 5 min after shifting to the postoperative ward and later recovered on resuscitation. In the control group 2 patients had bradycardia, 6 had intra-operative shivering and 3 had postoperative headache. Conclusion: We conclude that addition of clonidine in the dose of 7.5 μg to bupivacaine significantly increases the duration of spinal analgesia with clinically insignificant influence on hemodynamic

  1. Management of patients with recently implanted coronary stents on dual antiplatelet therapy who need to undergo major surgery.

    PubMed

    Savonitto, S; Caracciolo, M; Cattaneo, M; DE Servi, S

    2011-11-01

    About 5% of patients undergoing coronary stenting need to undergo surgery within the next year. The risk of perioperative cardiac ischemic events, particularly stent thrombosis (ST), is high in these patients, because surgery has a prothrombotic effect and antiplatelet therapy is often withdrawn in order to avoid bleeding. The clinical and angiographic predictors of ST are well known, and the proximity to an acute coronary syndrome adds to the risk. The current guidelines recommend delaying non-urgent surgery for at least 6 weeks after the placement of a bare metal stent and for 6-12 months after the placement of a drug-eluting stent, when the risk of ST is reduced. However, in the absence of formal evidence, these recommendations provide little support with regard to managing urgent operations. When surgery cannot be postponed, stratifying the risk of surgical bleeding and cardiac ischemic events is crucial in order to manage perioperative antiplatelet therapy in individual cases. Dual antiplatelet therapy should not be withdrawn for minor surgery or most gastrointestinal endoscopic procedures. Aspirin can be safely continued perioperatively in the case of most major surgery, and provides coronary protection. In the case of interventions at high risk for both bleeding and ischemic events, when clopidogrel withdrawal is required in order to reduce perioperative bleeding, perioperative treatment with the short-acting intravenous glycoprotein IIb-IIIa inhibitor tirofiban is safe in terms of bleeding, and provides strong antithrombotic protection. Such surgical interventions should be performed at hospitals capable of performing an immediate percutaneous coronary intervention at any time in the case of acute myocardial ischemia.

  2. Factors related to sinus rhythm at discharge after radiofrequency ablation of permanent atrial fibrillation in patients undergoing mitral valve surgery.

    PubMed

    Rostagno, Carlo; Gelsomino, Sandro; Capecchi, Irene; Rossi, Alessandra; Montesi, Gian Franco; Stefàno, Pier Luigi

    2016-04-01

    Late recovery of sinus rhythm is unusual in patients with permanent AF treated by (radiofrequency) RF maze procedure during mitral valve surgery. Identification of clinical and instrumental preoperative factors predictive of early success of RF ablation in patients with permanent AF undergoing mitral valve surgery may improve selection of subjects to obtain long-term results. Hundred and thirty consecutive patients with permanent AF and mitral valve disease underwent modified RF maze procedure during concomitant mitral valve surgery. Rheumatic valve disease (61 pts) and mitral valve prolapse (41 pts) were the more common aetiology of valve abnormalities. Mitral valve replacement was performed in 54 % of patients and mitral valve repair in the remaining 46 %. Four patients died after surgery. At discharge, 87 patients (69 %) were in sinus rhythm (group 1) and 43 patients in AF persisted (group 2). At an average 24-month follow-up, sinus rhythm was present in 67 % of patients, and 33 % were in atrial fibrillation. In this period, late recovery of sinus rhythm was observed only in five patients, while eight discharged in sinus rhythm developed again atrial fibrillation. Among preoperative parameters at univariate analysis female sex, atrial fibrillation >24 months, left atrial diameter >54 mm, left atrial area >24 cm(2), rheumatic valve disease and NYHA class were associated with persistence of AF. At Cox regression multivariate analysis, increased left atrial area (OR 1.07 per unit increase-95 % CI 1.01-1.131) and rheumatic aetiology of valve disease (OR 4.52, 95 % CI 1.65-12.4) were associated with persistence of AF at hospital discharge. Persistence of AF after RF ablation in patients undergoing mitral valve surgery is related to aetiology, e.g. rheumatic valve disease, and to increasing left atrial diameter. Due to low rate of late recovery of sinus rhythm, indication to RF ablation associated with MV surgery should be carefully considered in patients with large

  3. A Posterior TAP Block Provides More Effective Analgesia Than a Lateral TAP Block in Patients Undergoing Laparoscopic Gynecologic Surgery: A Retrospective Study

    PubMed Central

    Yoshiyama, Sakatoshi; Ueshima, Hironobu; Sakai, Ryomi; Otake, Hiroshi

    2016-01-01

    Background. There are a few papers that compared the lateral transversus abdominis plane (TAP) block with the posterior TAP block. Our study aimed to compare retrospectively the quality of analgesia after laparoscopic gynecologic surgery using the lateral TAP block with general anesthesia versus the posterior TAP block with general anesthesia. Method. Sixty-seven adult female patients were included in this retrospective study. Of these patients, thirty-four patients received the lateral TAP block with general anesthesia (lat. TAP group), and the rest of thirty-three patients received the posterior TAP block with general anesthesia (pos. TAP group). Pain scores both at rest and at movement and the use of additional analgesic drugs were recorded in the postoperative care unit within twenty-four hours after the operation. Postoperative complications were noted. Results. Patients who received pos. TAP reported lower visual analog scale (VAS) pain scores in all points, within twenty-four hours after the operation, than patients who received lat. TAP. Moreover, with the use of additional analgesic drugs, the incidence of nausea and vomiting during the first twenty-four hours after surgery was lower in the pos. TAP group than in the lat. TAP group. Conclusion. The posterior TAP block provided more effective analgesia than the lateral TAP block in patients undergoing laparoscopic gynecologic surgery. PMID:26941794

  4. Frequency of Hepatitis-B and C in patients undergoing cataract surgery in a tertiary care Centre

    PubMed Central

    Tahir, Muhammad Ali; Cheema, Alyscia; Tareen, Saifullah

    2015-01-01

    Objective: To analyze the frequency of hepatitis B and C in patients undergoing cataract surgery. Methods: This descriptive study was conducted at department of Ophthalmology Jinnah Post Graduate Medical Centre. The duration of study was seven months from May 2013 to November 2013. After taking informed consent from the patient and hospital ethical committee all patients presenting with cataract and undergoing cataract surgery were evaluated for the existence of hepatitis C and B. Diagnosis of hepatitis C or B was made on the criteria that a patient must be positive for either Anti-HCV or HBsAg or both. Proformas were filled and data was collected and analysis was done. Pearson’s correlation coefficients were calculated to calculate the occurrence of hepatitis C and B in general population undergoing cataract surgery. Results: Six hundred and forty-eight patients were operated on for cataract surgery at Jinnah Post Graduate Medical Centre during the study period. Mean age of patients was 63 years, 300 (46.29%) were male and 348 (53.70%) female. Out of them 57 (8.79%) patients were carriers of either Hepatitis C or B. Hepatitis B accounted for 17 cases (2.62%) however Hepatitis C positive were 40 cases (6.17%). Nobody was simultaneously affected by both hepatitis C and B. Conclusion: Significant number of asymptomatic carriers of hepatitis C and B were found in preoperative cataract patients. It is recommended that preoperative screening of all cataract patients should be done so that asymptomatic carriers might not become a threat for spread of disease. PMID:26430425

  5. Anaesthesia for a patient with Leigh's syndrome undergoing surgery for scoliosis.

    PubMed

    Jacobs, T F; Plasschaert, F S; Bossuyt, G P; Szegedi, L L; Herregods, L L

    2004-01-01

    Anaesthesia for patients with Leigh's syndrome has rarely been reported. Leigh's syndrome or subacute necrotizing encephalomyelopathy is a neurodegenerative disorder of infancy or childhood. Acute exacerbation with respiratory failure may accompany surgery and general anaesthesia. In this case report we describe the anaesthetic management of a 17 year old patient scheduled for spine surgery.

  6. Effect of lung-protective ventilation with lower tidal volumes on clinical outcomes among patients undergoing surgery: a meta-analysis of randomized controlled trials

    PubMed Central

    Gu, Wan-Jie; Wang, Fei; Liu, Jing-Chen

    2015-01-01

    Background: In anesthetized patients undergoing surgery, the role of lung-protective ventilation with lower tidal volumes is unclear. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of this ventilation strategy on postoperative outcomes. Methods: We searched electronic databases from inception through September 2014. We included RCTs that compared protective ventilation with lower tidal volumes and conventional ventilation with higher tidal volumes in anesthetized adults undergoing surgery. We pooled outcomes using a random-effects model. The primary outcome measures were lung injury and pulmonary infection. Results: We included 19 trials (n = 1348). Compared with patients in the control group, those who received lung-protective ventilation had a decreased risk of lung injury (risk ratio [RR] 0.36, 95% confidence interval [CI] 0.17 to 0.78; I2 = 0%) and pulmonary infection (RR 0.46, 95% CI 0.26 to 0.83; I2 = 8%), and higher levels of arterial partial pressure of carbon dioxide (standardized mean difference 0.47, 95% CI 0.18 to 0.75; I2 = 65%). No significant differences were observed between the patient groups in atelectasis, mortality, length of hospital stay, length of stay in the intensive care unit or the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen. Interpretation: Anesthetized patients who received ventilation with lower tidal volumes during surgery had a lower risk of lung injury and pulmonary infection than those given conventional ventilation with higher tidal volumes. Implementation of a lung-protective ventilation strategy with lower tidal volumes may lower the incidence of these outcomes. PMID:25512653

  7. The effects of discharge training and counseling on post-discharge problems in patients undergoing coronary artery bypass graft surgery

    PubMed Central

    Akbari, Masoumeh; Celik, Sevilay Senol

    2015-01-01

    Background: Advances in coronary artery surgery have reduced morbidity, mortality, and rates of graft occlusion. Discharge programs are important services for the continuity of treatment and must encompass physical, psychological, and social aspects of individual patient care. This study aimed at investigating the effect of planned discharge training and counseling on the problems experienced by patients undergoing coronary artery bypass graft (CABG) surgery. Materials and Methods: A semi-experimental study was performed on 100 patients undergoing CABG surgery in the surgery department. During a period of 9 months from January to September 2013, the patients in the intervention group were provided with adequate discharge training and counseling with a booklet before surgery and counseling until 6 weeks after discharge, while the control group patients received only routine clinical procedures, i.e. prescribing medicine, controlling vital signs, and wound dressing. The data were analyzed using Statistical Package for the Social Sciences (SPSS) 23. Frequency and distribution were used to describe the data, and paired sample t-test, variance analysis, Fisher's exact test, and Chi-squared tests were also used. Results: The reported problems for both groups had a descending pattern during the three follow-ups. However, this pattern had a greater slope in the intervention group compared to the control one. As a result of these education programs, problems were fewer in the intervention group than in the control group (P < 0.05). Conclusions: Discharge training and counseling given to the intervention group had a positive impact on decreasing the problems that the patients had. Therefore, the institutions may be recommended to support multidisciplinary patient training and counseling activities using the methods described in this study. PMID:26257798

  8. Classification and discrimination of pediatric patients undergoing open heart surgery with and without methylprednisolone treatment by cytomics

    NASA Astrophysics Data System (ADS)

    Bocsi, Jozsef; Mittag, Anja; Pierzchalski, Arkadiusz; Osmancik, Pavel; Dähnert, Ingo; Tárnok, Attila

    2011-02-01

    Introduction: Methylprednisolone (MP) is frequently preoperatively administered in children undergoing open heart surgery. The aim of this medication is to inhibit overshooting immune responses. Earlier studies demonstrated cellular and humoral immunological changes in pediatric patients undergoing heart surgeries with and without MP administration. Here in a retrospective study we investigated the modulation of the cellular immune response by MP. The aim was to identify suitable parameters characterizing MP effects by cluster analysis. Methods: Blood samples were analysed from two aged matched groups with surgical correction of septum defects. Group without MP treatment consisted of 10 patients; MP was administered on 21 patients (median dose: 11mg/kg) before cardiopulmonary bypass (CPB). EDTA anticoagulated blood was obtained 24 h preoperatively, after anesthesia, at CPB begin and end (CPB2), 4h, 24h, 48h after surgery, at discharge and at out-patient followup (8.2; 3.3-12.2 month after surgery; median and IQR). Flow cytometry showed the biggest MP relevant changes at CPB2 and 4h postoperatively. They were used for clustering analysis. Classification was made by discriminant analysis and cluster analysis by means of Genes@work software. Results & conclusion: 146 parameters were obtained from analysis. Cross-validation revealed several parameters being able to discriminate between MP groups and to identify immune modulation. MP administration resulted in a delayed activation of monocytes, increased ratio of neutrophils, reduced T-lymphocytes counts. Cluster analysis demonstrated that classification of patients is possible based on the identified cytomics parameters. Further investigation of these parameters might help to understand the MP effects in pediatric open heart surgery.

  9. The coronary CT angiography vision protocol: a prospective observational imaging cohort study in patients undergoing non-cardiac surgery

    PubMed Central

    Sheth, Tej; Butler, Craig; Chow, Benjamin; Chan, M T V; Mitha, Ayesha; Nagele, Peter; Tandon, Vikas; Stewart, Lori; Graham, Michelle; Choi, G Y S; Kisten, T; Woodard, P K; Crean, Andrew; Abdul Aziz, Y F; Karthikeyan, G; Chow, C K; Szczeklik, W; Markobrada, M; Mastracci, T.; Devereaux, P J

    2012-01-01

    Introduction At present, physicians have a limited ability to predict major cardiovascular complications after non-cardiac surgery and little is known about the anatomy of coronary arteries associated with perioperative myocardial infarction. We have initiated the Coronary CT Angiography (CTA) VISION Study to (1) establish the predictive value of coronary CTA for perioperative myocardial infarction and death and (2) describe the coronary anatomy of patients that have a perioperative myocardial infarction. Methods and analysis The Coronary CTA VISION Study is prospective observational study. Preoperative coronary CTA will be performed in 1000–1500 patients with a history of vascular disease or at least three cardiovascular risk factors who are undergoing major elective non-cardiac surgery. Serial troponin will be measured 6–12 h after surgery and daily for the first 3 days after surgery. Major vascular outcomes at 30 days and 1 year after surgery will be independently adjudicated. Ethics and dissemination Coronary CTA results in a measurable radiation exposure that is similar to a nuclear perfusion scan (10–12 mSV). Treating physicians will be blinded to the CTA results until 30 days after surgery in order to provide the most unbiased assessment of its prognostic capabilities. The only exception will be the presence of a left main stenosis >50%. This approach is supported by best available current evidence that, excluding left main disease, prophylatic revascularisation prior to non-cardiac surgery does not improve outcomes. An external safety and monitoring committee is overseeing the study and will review outcome data at regular intervals. Publications describing the results of the study will be submitted to major peer-reviewed journals and presented at international medical conferences. PMID:22855630

  10. Analyses of balance and flexibility of obese patients undergoing bariatric surgery

    PubMed Central

    Benetti, Fernanda Antico; Bacha, Ivan Leo; Junior, Arthur Belarmino Garrido; Greve, Júlia Maria D'Andréa

    2016-01-01

    OBJECTIVE: To assess the postural control and flexibility of obese subjects before and both six and 12 months after bariatric surgery. To verify whether postural control is related to flexibility following weight reductions resulting from bariatric surgery. METHODS: The sample consisted of 16 subjects who had undergone bariatric surgery. All assessments were performed before and six and 12 months after bariatric surgery. Postural balance was assessed using an Accusuway® portable force platform, and flexibility was assessed using a standard chair sit and reach test (Wells' chair). RESULTS: With the force platform, no differences were observed in the displacement area or velocity from the center of pressure in the mediolateral and anteroposterior directions. The displacement speed from the center of pressure was decreased at the six month after the surgery; however, unchanged from baseline at 12 months post-surgery. Flexibility increased over time according to the three measurements tested. CONCLUSIONS: Static postural balance did not change. The velocity of postural adjustment responses were increased at six months after surgery. Therefore, weight loss promotes increased flexibility. Yet, improvements in flexibility are not related to improvements in balance. PMID:26934236

  11. Incidence of Deep Vein Thrombosis in Patients Undergoing Degenerative Spine Surgery onProphylactic Dalteparin; A Single Center Report

    PubMed Central

    Moayer, AlirezaFarid; Mohebali, Navideh; Razmkon, Ali

    2016-01-01

    Objective: To determine the incidence of deep vein thrombosis (DVT)in patients undergoing spinal surgeries receiving prophylactic doses of Deltaparin in a single center in central Iran. Method: This cross-sectional study was conducted in Shariatee hospital of Isfahan during a 12-month period. We included all the patients undergoing elective spinal surgeries in our center during the study period who received prophylactic dosages of subcutaneous Dalteparin (5000unit daily) thefirst postoperative day. Those with absolute contraindications of anticoagulation therapy were not included in the study. Patients were followed for 3 months clinically and the incidence of DVT was recorded. DVT was suspected clinically and was confirmed by color Doppler sonography. Results: Overall we included 120 patients with mean age of 44.8 ± 12.6years among whom there were 54 (45%) men and 66 (55%) women. Lumbar discectomy (32.9%)and laminectomy (20.2%)were the most common performed procedures. DVT was detected in 1 (0.83%) patient in postoperative period. None of the patients developed pulmonary embolism and none hemorrhagic adverse event was recorded. The patient was treated with therapeutic unfractionated heparin and was discharged with warfarin.  Conclusion: Our results shows the efficacy of LMWH (Dalteparin) in reducing the incidence of DVT to 0.83%. These results also show the safety of Dalteparin in spine surgery because of lack of bleeding complication. PMID:27162925

  12. A randomized multicenter study of remifentanil compared with alfentanil, isoflurane, or propofol in anesthetized pediatric patients undergoing elective strabismus surgery.

    PubMed

    Davis, P J; Lerman, J; Suresh, S; McGowan, F X; Coté, C J; Landsman, I; Henson, L G

    1997-05-01

    Remifentanil hydrochloride is a new, ultrashort-acting opioid metabolized by nonspecific plasma and tissue esterases. We conducted this multicenter study to examine the hemodynamic response and recovery profile of premedicated children undergoing strabismus repair who were randomly assigned to receive one of four treatment drugs (remifentanil, alfentanil, isoflurane, or propofol) along with nitrous oxide and oxygen for maintenance of anesthesia. Induction of anesthesia was by nitrous oxide, oxygen, and halothane or nitrous oxide, oxygen, and propofol. Anesthesia was then maintained with remifentanil 1.0 microgram/kg over 30-60 s, followed by a constant infusion of 1.0 microgram.kg-1.min-1, alfentanil 100 micrograms/kg bolus followed by a constant infusion of 2.5 micrograms.kg-1.min-1, propofol 2.5 mg/kg bolus followed by a constant infusion of 200 micrograms.kg-1.min-1, or isoflurane 1.0 minimum alveolar anesthetic concentration. The infusions of the anesthetics and the administration of the inhaled gases were adjusted clinically by predetermined protocols. Elapsed time intervals from the end of surgery to the time the patients were tracheally extubated and displayed purposeful movement, as well as the time the patients met the postanesthesia care unit (PACU) and hospital discharge times, were recorded. Heart rate and systolic and diastolic blood pressure were measured at fixed intervals. In addition, cardiovascular side effects (bradycardia, hypotension, and hypertension) as well as vomiting, pruritus, agitation, and postoperative hypoxemia were also noted. There were no significant differences in patient demographics among the treatment groups. There was no difference in the early recovery variables (times to extubation and purposeful movement) or the times to PACU and hospital discharge among groups. There were significant differences in side effects among the groups. Patients who received remifentanil had higher PACU objective pain-discomfort scores than those

  13. [Internal medicine and cardiovascular evaluation of preoperative and perioperative patients undergoing ophthalmic surgery].

    PubMed

    Soldini, M

    2013-01-01

    Ophthalmic surgery would a surgical practice with fewer complications compared to other types of surgery. This is only true in part, because of the elderly population of reference. So, in cataract surgery we are faced with a patient with heart disease which carries the signs of aging and degenerative consequences linked to it. The interventions performed in patients with heart disease are still potentially have a greater risk, although site preparation and monitoring during and after surgery in recent years have allowed greater safety for patients and an overall reduction in morbidity and mortality. It is stressed so the importance of a correct clinical diagnosis of the general patient for a better stratification of cardiovascular risk for ophthalmic surgery. It must therefore avoid the most frequent sequelae, such as the ICC, arrhythmias and hypertensive crises. One purpose of a Service of Internal Medicine, like ours, totally dedicated to the functional requirements of the assistance of ophthalmologic patients, both during hospitalization, and in prehospitalization, and especially in Day Hospital and in Day Service, for the cardiac risk stratification in ophthalmic surgery, is to ensure firstly to the patient and then to colleagues ophthalmologist and surgeons and anesthetists the greater security on the plane predictive for reducing perioperative and postoperative morbidity and mortality.

  14. Comparison between sevoflurane and desflurane on emergence and recovery characteristics of children undergoing surgery for spinal dysraphism

    PubMed Central

    Gupta, Priyanka; Rath, Girija Prasad; Prabhakar, Hemanshu; Bithal, Parmod Kumar

    2015-01-01

    Background and Aims: Rapid recovery is desirable after neurosurgery as it enables early post-operative neurological evaluation and prompt management of complications. Studies have been rare comparing the recovery characteristics in paediatric neurosurgical patients. Hence, this study was carried out to compare the effect of sevoflurane and desflurane anaesthesia on emergence and extubation in children undergoing spinal surgery. Methods: Sixty children, aged 1–12 years, undergoing elective surgery for lumbo-sacral spinal dysraphism were enrolled. Anaesthesia was induced with sevoflurane using a face mask. The children were then randomised to receive either sevoflurane or desflurane with oxygen and nitrous oxide, fentanyl (1 μg/kg/h) and rocuronium. The anaesthetic depth was guided by bispectral index (BIS®) monitoring with a target BIS® between 45 and 55. Perioperative data with regard to demographic profile, haemodynamics, emergence and extubation times, modified Aldrete score (MAS), pain (objective pain score), agitation (Cole's agitation score), time to first analgesic and complications, thereof, were recorded. Statistical analysis was done using STATA 11.2 (StataCorp., College Station, TX, USA) and data are presented as median (range) or mean ± standard deviation. Results: The demographic profile, haemodynamics, MAS, pain and agitation scores and time to first analgesic were comparable in between the two groups (P > 0.05). The emergence time was shorter in desflurane group (2.75 [0.85–12] min) as compared to sevoflurane (8 [2.5–14] min) (P < 0.0001). The extubation time was also shorter in desflurane group (3 [0.8–10] min) as compared to the sevoflurane group (5.5 [1.2–14] min) (P = 0.0003). Conclusion: Desflurane provided earlier tracheal extubation and emergence as compared to sevoflurane in children undergoing surgery for lumbo-sacral spinal dysraphism. PMID:26379291

  15. Effects of different types of hydroxyethyl starch (HES) on microcirculation perfusion and tissue oxygenation in patients undergoing liver surgery.

    PubMed

    Cui, Yinghua; Sun, Bo; Wang, Changsong; Liu, Shujuan; Li, Peng; Shi, Jinghui; Li, Enyou

    2014-01-01

    To compare the effects of hydroxyethyl starch (HES) 130/0.4 and HES 200/0.5, which have different molecular weights and degrees of substitution, on microcirculation perfusion and tissue oxygenation in patients undergoing liver surgery. Thirty patients with an American Society of Anesthesiologists status I/II who were scheduled for liver surgery were randomly divided into two groups: one received an intraoperative HES 130/0.4 infusion equal to the amount of blood loss (HES 130/0.4 group, n=15), and the other received HES 200/0.5 equal to the amount of blood loss (HES 200/0.5 group, n=15). Gastric mucosal perfusion and tissue oxygenation were monitored by measuring the gastric mucosal pH (pHi), which was determined using a carbon dioxide tonometer inserted through a nasogastric tube. Gastric mucosal pHi , hemodynamic parameters, body temperature, and blood gas parameters were recorded upon entering the operating room, before skin incision, one hour and two hours after skin incision, and at the end of surgery. The intraoperative pHi decreased in both groups of patients, but the decline in the HES 130/0.4 group was smaller than that of the HES 200/0.5 group. The pHi of the HES 130/0.4 group was significantly higher than that of the HES 200/0.5 group two hours after skin incision and at the end of surgery (P<0.05). A multivariate analysis showed that the type of colloid used intraoperatively was the only variant that affected pHi (F=0.626, P<0.05). Moreover, there were good correlation between pHi at the end of surgery and the length of postoperative hospital stay (r=-0.536, P<0.05) and the time intervals from surgery to the passage of flatus (r=-0.547, P<0.05). Compared with HES 200/0.5, the use of HES 130/0.4 (with a relatively lower molecular weight and lower degree of substitution) could significantly improve internal organ perfusion and tissue oxygenation in patients undergoing liver surgery with a relatively large amount of blood loss.

  16. Perioperative lung-protective ventilation strategy reduces postoperative pulmonary complications in patients undergoing thoracic and major abdominal surgery

    PubMed Central

    2016-01-01

    The occurrence of postoperative pulmonary complications is strongly associated with increased hospital mortality and prolonged postoperative hospital stays. Although protective lung ventilation is commonly used in the intensive care unit, low tidal volume ventilation in the operating room is not a routine strategy. Low tidal volume ventilation, moderate positive end-expiratory pressure, and repeated recruitment maneuvers, particularly for high-risk patients undergoing major abdominal surgery, can reduce postoperative pulmonary complications. Facilitating perioperative bundle care by combining prophylactic and postoperative positive-pressure ventilation with intraoperative lung-protective ventilation may be helpful to reduce postoperative pulmonary complications. PMID:26885294

  17. Perioperative management of oral antiplatelet therapy and clinical outcomes in coronary stent patients undergoing surgery. Results of a multicentre registry.

    PubMed

    Rossini, Roberta; Musumeci, Giuseppe; Capodanno, Davide; Lettieri, Corrado; Limbruno, Ugo; Tarantini, Giuseppe; Russo, Nicolina; Calabria, Paolo; Romano, Michele; Inashvili, Ana; Sirbu, Vasile; Guagliumi, Giulio; Valsecchi, Orazio; Senni, Michele; Gavazzi, Antonello; Angiolillo, Dominick J

    2015-02-01

    The aim was to investigate the perioperative risk of ischaemic and bleeding events in patients with coronary stents undergoing cardiac and non-cardiac surgery and how these outcomes are affected by the perioperative use of oral antiplatelet therapy. This was a multicentre, retrospective, observational study conducted in patients with coronary stent(s) undergoing cardiac or non-cardiac surgery. The primary efficacy endpoint was the 30-day incidence of major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction (MI) or stroke. The primary safety endpoint was the 30-day incidence of Bleeding Academic Research Consortium (BARC) bleeding ≥ 2. A total of 666 patients were included. Of these, 371 (55.7 %) discontinued their antiplatelet medication(s) (all or partly) before undergoing surgery. At 30 days, patients with perioperative discontinuation of antiplatelet therapy experienced a significantly higher incidence of MACE (7.5 % vs 0.3 %, p< 0.001), cardiac death (2.7 % vs 0.3 %, p=0.027), and MI (4.0 % vs 0 %, p< 0.001). After adjustment, peri-operative antiplatelet discontinuation was the strongest independent predictor of 30-day MACE (odds ratio [OR]=25.8, confidence interval [CI]=3.37-198, p=0.002). Perioperative aspirin (adjusted OR 0.27, 95 % CI 0.11-0.71, p=0.008) was significantly associated with a lower risk of MACE. The overall incidence of BARC ≥ 2 bleeding events at 30-days was significantly higher in patients who discontinued oral antiplatelet therapy (25.6 % vs 13.9 %, p< 0.001). However, after adjustment, antiplatelet discontinuation was not independently associated with BARC ≥ 2 bleeding. In conclusion antiplatelet discontinuation increases the 30-day risk of MACE, in patients with coronary stents undergoing cardiac and non-cardiac surgery, while not offering significant protection from BARC≥ 2 bleeding.

  18. Ocular risk management in patients undergoing general anesthesia: an analysis of 39,431 surgeries

    PubMed Central

    Kara-Junior, Newton; de Espindola, Rodrigo França; Filho, Joao Valverde; Rosa, Christiane Pellegrino; Ottoboni, Andre; Silva, Enis Donizete

    2015-01-01

    OBJECTIVE: This study sought to describe and analyze ocular findings associated with nonocular surgery in patients who underwent general anesthesia. METHODS: The authors retrospectively collected a series of 39,431 surgeries using standardized data forms. RESULTS: Ocular findings were reported in 9 cases (2.3:10,000), which involved patients with a mean age of 58.9±19.5 years. These cases involved patients classified as ASA I (33%), ASA II (55%) or ASA III (11%). General anesthesia with propofol and remifentanil was used in 4 cases, balanced general anesthesia was used in 4 cases, and regional block was used in combination with balanced general anesthesia in one case. Five patients (55%) underwent surgery in the supine position, one patient (11%) underwent surgery in the lithotomy position, two patients (22%) underwent surgery in the prone position, and one patient (11%) underwent surgery in the lateral position. Ocular hyperemia was detected in most (77%) of the 9 cases with ocular findings; pain/burning of the eyes, visual impairment, eye discharge and photophobia were observed in 55%, 11%, 11% and 11%, respectively, of these 9 cases. No cases involved permanent ocular injury or vision loss. CONCLUSION: Ophthalmological findings after surgeries were uncommon, and most of the included patients were relatively healthy. Minor complications, such as dehydration or superficial ocular trauma, should be prevented by following systematic protocols that provide appropriate ocular occlusion with a lubricating ointment and protect the eye with an acrylic occluder. These procedures will refine the quality of anesthesia services and avoid discomfort among patients, surgeons and anesthesia staff. PMID:26247665

  19. Aetiology of preoperative anaemia in patients undergoing elective cardiac surgery-the challenge of pillar one of Patient Blood Management.

    PubMed

    Abraham, J; Sinha, R; Robinson, K; Scotland, V; Cardone, D

    2017-01-01

    Preoperative anaemia is common in patients undergoing cardiac surgery. Whilst there is a strong association with increased morbidity and mortality, it is currently unclear whether treatment of anaemia leads to patient benefit. This retrospective study aimed to determine the aetiology of preoperative anaemia in a cohort of patients undergoing elective cardiac surgery over two years at a tertiary hospital. Laboratory data obtained at the preoperative assessment clinic visit were assessed to stratify patients into four groups-iron deficiency anaemia (IDA), possible IDA, anaemia of chronic disease (ACD) and non-anaemic patients with low ferritin according to the 'Preoperative haemoglobin assessment and optimisation template' of the Australian Patient Blood Management (PBM) Guidelines. Of patients with preoperative anaemia, 23.1% had IDA, 6.6% had possible IDA and 70.3% had possible ACD. Of the patients with possible ACD, 30% had a ferritin <100 µg/l, representing limited iron stores or coexisting absolute iron deficiency in the setting of chronic disease. In addition, 46.2% of those with possible ACD had iron studies indicative of functional iron deficiency. Time between assessment and surgery was as little as one day in a third of patients and in only 7% was it more than seven days. Our findings indicate that about one-third of our patients with preoperative anaemia had evidence of iron deficiency, a potentially reversible cause of anaemia. In addition, a significant number had either limited iron stores that may render them iron deficient by surgery, or a functional iron deficiency.

  20. Chemoradiation Therapy for Potentially Resectable Gastric Cancer: Clinical Outcomes Among Patients Who Do Not Undergo Planned Surgery

    SciTech Connect

    Kim, Michelle M.; Mansfield, Paul F.; Das, Prajnan; Janjan, Nora A.; Badgwell, Brian D.; Phan, Alexandria T.; Delclos, Marc E.; Maru, Dipen; Ajani, Jaffer A.; Crane, Christopher H.; Krishnan, Sunil

    2008-05-01

    Purpose: We retrospectively analyzed treatment outcomes among resectable gastric cancer patients treated preoperatively with chemoradiation therapy (CRT) but rendered ineligible for planned surgery because of clinical deterioration or development of overt metastatic disease. Methods and Materials: Between 1996 and 2004, 39 patients with potentially resectable gastric cancer received preoperative CRT but failed to undergo surgery. At baseline clinical staging, 33 (85%) patients had T3-T4 disease, and 27 (69%) patients had nodal involvement. Most patients received 45 Gy of radiotherapy with concurrent 5-fluorouracil-based chemotherapy. Twenty-one patients underwent induction chemotherapy before CRT. Actuarial times to local control (LC), distant control (DC), and overall survival (OS) were calculated by the Kaplan-Meier method. Results: The cause for surgical ineligibility was development of metastatic disease (28 patients, 72%; predominantly peritoneal, 18 patients), poor performance status (5 patients, 13%), patient/physician preference (4 patients, 10%), and treatment-related death (2 patients, 5%). With a median follow-up of 8 months (range, 1-95 months), actuarial 1-year LC, DC, and OS were 46%, 12%, and 36%, respectively. Median LC and OS were 11.0 and 10.1 months, respectively. Conclusions: Patients with potentially resectable gastric cancer treated with preoperative CRT are found to be ineligible for surgery principally because of peritoneal progression. Patients who are unable to undergo planned surgery have outcomes comparable to that of patients with advanced gastric cancer treated with chemotherapy alone. CRT provides durable LC for the majority of the remaining life of these patients.

  1. Cardiovascular effects of total intravenous anesthesia using ketamine-medetomidine-propofol (KMP-TIVA) in horses undergoing surgery

    PubMed Central

    UMAR, Mohammed Ahmed; FUKUI, Sho; KAWASE, Kodai; ITAMI, Takaharu; YAMASHITA, Kazuto

    2014-01-01

    Cardiovascular effects of total intravenous anesthesia using ketamine-medetomidine-propofol drug combination (KMP-TIVA) were determined in 5 Thoroughbred horses undergoing surgery. The horses were anesthetized with intravenous administration (IV) of ketamine (2.5 mg/kg) and midazolam (0.04 mg/kg) following premedication with medetomidne (5 µg/kg, IV) and artificially ventilated. Surgical anesthesia was maintained by controlling propofol infusion rate (initially 0.20 mg/kg/min following an IV loading dose of 0.5 mg/kg) and constant rate infusions of ketamine (1 mg/kg/hr) and medetomidine (1.25 µg/kg/hr). The horses were anesthetized for 175 ± 14 min (range from 160 to 197 min). Propofol infusion rates ranged from 0.13 to 0.17 mg/kg/min, and plasma concentration (Cpl) of propofol ranged from 11.4 to 13.3 µg/ml during surgery. Cardiovascular measurements during surgery remained within clinically acceptable ranges in the horses (heart rate: 33 to 37 beats/min, mean arterial blood pressure: 111 to 119 mmHg, cardiac index: 48 to 53 ml/kg/min, stroke volume: 650 to 800 ml/beat and systemic vascular resistance: 311 to 398 dynes/sec/cm5). The propofol Cpl declined rapidly after the cessation of propofol infusion and was significantly lower at 10 min (4.5 ± 1.5 µg/ml), extubation (4.0 ± 1.2 µg/ml) and standing (2.4 ± 0.9 µg/ml) compared with the Cpl at the end of propofol administration (11.4 ± 2.7 µg/ml). All the horses recovered uneventfully and stood at 74 ± 28 min after the cessation of anesthesia. KMP-TIVA provided satisfactory quality and control of anesthesia with minimum cardiovascular depression in horses undergoing surgery. PMID:25409552

  2. Examination of a CRP first approach for the detection of postoperative complications in patients undergoing surgery for colorectal cancer

    PubMed Central

    McSorley, Stephen T.; Khor, Bo Y.; MacKay, Graham J.; Horgan, Paul G.; McMillan, Donald C.

    2017-01-01

    Abstract The aim of the present study was to examine whether a C-reactive protein (CRP) first approach would improve the detection rate of postoperative complications by CT. CRP is a useful biomarker to identify major complications following surgery for colorectal cancer. Patients with histologically confirmed colorectal cancer, who underwent elective surgery between 2008 and 2015 at a single centre were included. Exceeding the established CRP threshold of 150 mg/L on postoperative day (POD) 4 was recorded. Results of CT performed between postoperative days 4 and 14 were recorded. Four hundred ninety-five patients were included. The majority were male (58%), over 65 (68%), with node-negative disease (66%) and underwent open surgery (70%). Those patients who underwent a CT scan (n = 93), versus those who did not (n = 402), were more likely to have a postoperative complication (84% vs 35%, P < 0.001), infective complication (67% vs 21%, P < 0.001), and anastomotic leak (17% vs 2%, P < 0.001). In patients who did not undergo a CT scan (n = 402) exceeding the CRP threshold (n = 117) on POD 4 was associated with a higher rate of postoperative complication (50% vs 29%, P < 0.001), infective complications (36% vs 15%, P < 0.001), and anastomotic leak (4% vs 0.5%, P = 0.009). In patients who did undergo a CT scan (n = 93) exceeding the CRP threshold (n = 53) on POD 4 was associated with earlier CT (median POD 6 vs 8, P = 0.001) but not postoperative complications. A CRP first approach resulted in earlier and improved detection of complications by CT following surgery for colorectal cancer. PMID:28207541

  3. IMPACT OF VITAMIN D AND CALCIUM DEFICIENCY IN THE BONES OF PATIENTS UNDERGOING BARIATRIC SURGERY: A SYSTEMATIC REVIEW

    PubMed Central

    CABRAL, Jefry Alberto Vargas; de SOUZA, Gabriela Pereira; NASCIMENTO, Juliana de Almeida; SIMONETI, Luis Fernando; MARCHESE, Carolina; SALES-PERES, Silvia Helena de Carvalho

    2016-01-01

    ABSTRACT Introduction: Bariatric surgery is considered the most effective tool in the control and treatment of severe obesity, but patients undergoing this procedure are at increased risk of developing nutritional deficiencies by limiting the intake and absorption of many nutrients. Objective: To assess the impact of vitamin D deficiency and calcium in bone in patients after gastric bypass in Roux-en-Y, pointing directly at the type of administration, doses and effects after surgery. Method: Was conducted a systematic review with articles related to the topic of the last 10 years searched in PubMed (US National Library of Medicine National Institutes of Health, Medline, Lilacs, Scielo and Cochrane using the headings "bariatric surgery", "bone", "obesity", "vitamin D '', "calcium" AND "absorption". Exclusion criteria to research on animals, smokers, pregnant women and patient treated with bisphosphonates. Results: Five articles were included in this review. All refer that bariatric surgery can lead to nutritional deficiencies and poor absorption of fats and fat-soluble vitamins and other micronutrients such as calcium. Conclusion: Patients submitted to RYGB should make use of multivitamins and minerals especially vitamin D and calcium to prevent bone fractures. Monitoring, treatment and control of risk factors are essential to prevent complications after this operation. PMID:27683792

  4. Providing Preoperative Information for Children Undergoing Surgery: A Randomized Study Testing Different Types of Educational Material to Reduce Children's Preoperative Worries

    ERIC Educational Resources Information Center

    Fernandes, S. C.; Arriaga, P.; Esteves, F.

    2014-01-01

    This study developed three types of educational preoperative materials and examined their efficacy in preparing children for surgery by analysing children's preoperative worries and parental anxiety. The sample was recruited from three hospitals in Lisbon and consisted of 125 children, aged 8-12 years, scheduled to undergo outpatient surgery. The…

  5. The Prevalence of Body Dysmorphic Disorder in Patients Undergoing Cosmetic Surgery: a Systematic Review.

    PubMed

    Panayi, Andreana

    2015-09-01

    Body dysmorphic disorder (BDD) is a somatoform disorder characterised by a distressing obsession with an imagined or slight appearance defect, which can significantly impair normal day-to-day functioning. Patients with BDD often first present, and are hence diagnosed, in cosmetic surgery settings. Several studies have investigated the prevalence rate of BDD in the general population or have done so for patients referring to cosmetic medical centers. To date, however, no review has been undertaken to compare the prevalence in the general community versus in a cosmetic surgery setting. Despite the lack of such a review it is a commonly held belief that BDD is more common in patients seeking cosmetic surgery. The current study aims to review the available literature in order to investigate whether BDD is indeed more prevalent in patients requesting cosmetic surgery, and if that is the case, to provide possible reasons for the difference in prevalence. In addition this review provides evidence on the effectiveness of cosmetic surgery as a treatment of BDD.

  6. Inpatient cardiac rehabilitation programs’ exercise therapy for patients undergoing cardiac surgery: National Korean Questionnaire Survey

    PubMed Central

    Seo, Yong Gon; Jang, Mi Ja; Park, Won Hah; Hong, Kyung Pyo; Sung, Jidong

    2017-01-01

    Inpatient cardiac rehabilitation (ICR) has been commonly conducted after cardiac surgery in many countries, and has been reported a lots of results. However, until now, there is inadequacy of data on the status of ICR in Korea. This study described the current status of exercise therapy in ICR that is performed after cardiac surgery in Korean hospitals. Questionnaires modified by previous studies were sent to the departments of thoracic surgery of 10 hospitals in Korea. Nine replies (response rate 90%) were received. Eight nurses and one physiotherapist completed the questionnaire. Most of the education on wards after cardiac surgery was conducted by nurses. On postoperative day 1, four sites performed sitting on the edge of bed, sit to stand, up to chair, and walking in the ward. Only one site performed that exercise on postoperative day 2. One activity (stairs up and down) was performed on different days at only two sites. Patients received education preoperatively and predischarge for preventing complications and reducing muscle weakness through physical inactivity. The results of the study demonstrate that there are small variations in the general care provided by nurses after cardiac surgery. Based on the results of this research, we recommended that exercise therapy programs have to conduct by exercise specialists like exercise physiologists or physiotherapists for patients in hospitalization period. PMID:28349037

  7. Inpatient cardiac rehabilitation programs' exercise therapy for patients undergoing cardiac surgery: National Korean Questionnaire Survey.

    PubMed

    Seo, Yong Gon; Jang, Mi Ja; Park, Won Hah; Hong, Kyung Pyo; Sung, Jidong

    2017-02-01

    Inpatient cardiac rehabilitation (ICR) has been commonly conducted after cardiac surgery in many countries, and has been reported a lots of results. However, until now, there is inadequacy of data on the status of ICR in Korea. This study described the current status of exercise therapy in ICR that is performed after cardiac surgery in Korean hospitals. Questionnaires modified by previous studies were sent to the departments of thoracic surgery of 10 hospitals in Korea. Nine replies (response rate 90%) were received. Eight nurses and one physiotherapist completed the questionnaire. Most of the education on wards after cardiac surgery was conducted by nurses. On postoperative day 1, four sites performed sitting on the edge of bed, sit to stand, up to chair, and walking in the ward. Only one site performed that exercise on postoperative day 2. One activity (stairs up and down) was performed on different days at only two sites. Patients received education preoperatively and predischarge for preventing complications and reducing muscle weakness through physical inactivity. The results of the study demonstrate that there are small variations in the general care provided by nurses after cardiac surgery. Based on the results of this research, we recommended that exercise therapy programs have to conduct by exercise specialists like exercise physiologists or physiotherapists for patients in hospitalization period.

  8. The quantitative and qualitative responses of platelets in pediatric patients undergoing cardiopulmonary bypass surgery.

    PubMed

    Ignjatovic, Vera; Than, Jenny; Summerhayes, Robyn; Newall, Fiona; Horton, Steve; Cochrane, Andrew; Monagle, Paul

    2012-01-01

    This prospective, single-center study aimed to evaluate the platelet response during cardiopulmonary bypass (CPB) surgery in a large cohort of children up to 6 years of age. Blood samples were drawn at four time points: after induction of anesthesia, after initiation of the CPB, before protamine, and immediately after chest closure. The study recruited 60 children requiring CPB for surgical repair of congenital heart defects. The platelet count decreased throughout CPB surgery, but during the same period, platelet activity increased. The more pronounced decrease in platelet count observed in children younger than 1 year compared with that of children 1 to 6 years of age was not associated with an age-specific change in platelet activity. The overall increase in platelet function observed in this study could provide a mechanism that compensates for the decrease in platelet count. This study provides a new foundation for future studies investigating requirements of platelet supplementation in the setting of pediatric CPB surgery.

  9. Incidence, Predictors, and Clinical Outcomes of Postoperative Cardiac Tamponade in Patients Undergoing Heart Valve Surgery.

    PubMed

    You, Seng Chan; Shim, Chi Young; Hong, Geu-Ru; Kim, Darae; Cho, In Jeong; Lee, Sak; Chang, Hyuck-Jae; Ha, Jong-Won; Chang, Byung-Chul; Chung, Namsik

    2016-01-01

    This study aimed to investigate the incidence, predictors, and clinical outcomes of cardiac tamponade after heart valve surgery. A total of 556 patients who underwent heart valve surgery in a single tertiary center between January 2010 and March 2012 were studied. All patients underwent transthoracic echocardiography (TTE) about 5 days after surgery and TTE was repeated regularly. Patients with suspected acute pericardial hemorrhage were excluded. Cardiac tamponade occurred in twenty-four (4.3%) patients and all underwent surgical or percutaneous pericardial drainage. The median time of pericardial drainage after surgery was 17 (interquartile range, IQR, 13-30) days. Infective endocarditis, mechanical valve replacement of aortic or mitral valve, and any amount of pericardial effusion (PE) on the first postoperative TTE were related to the occurrence of cardiac tamponade (all p<0.05). After multivariate adjustment, occurrence of cardiac tamponade was associated with any amount of PE on the first postoperative TTE (hazard ratio, HR, 14.00, p<0.001) and mechanical valve replacement (HR 2.69, p = 0.025). The mean hospital days in patients with cardiac tamponade was higher than those without (34.9 vs. 13.5, p = 0.031). After pericardial drainage, there was no echocardiographic recurrence of significant PE during a median of 34.8 (IQR 14.9-43.7) months after surgery. Cardiac tamponade after heart valve surgery is not uncommon. Patients with any amount of PE at the first postoperative TTE or mechanical valve replacement should receive higher attention with regard to the occurrence of cardiac tamponade. Although it prolongs hospital stay, cardiac tamponade exhibits a benign clinical course without recurrence after timely intervention.

  10. Incidence, Predictors, and Clinical Outcomes of Postoperative Cardiac Tamponade in Patients Undergoing Heart Valve Surgery

    PubMed Central

    You, Seng Chan; Shim, Chi Young; Hong, Geu-Ru; Kim, Darae; Cho, In Jeong; Lee, Sak; Chang, Hyuck-Jae; Ha, Jong-Won; Chang, Byung-Chul; Chung, Namsik

    2016-01-01

    This study aimed to investigate the incidence, predictors, and clinical outcomes of cardiac tamponade after heart valve surgery. A total of 556 patients who underwent heart valve surgery in a single tertiary center between January 2010 and March 2012 were studied. All patients underwent transthoracic echocardiography (TTE) about 5 days after surgery and TTE was repeated regularly. Patients with suspected acute pericardial hemorrhage were excluded. Cardiac tamponade occurred in twenty-four (4.3%) patients and all underwent surgical or percutaneous pericardial drainage. The median time of pericardial drainage after surgery was 17 (interquartile range, IQR, 13–30) days. Infective endocarditis, mechanical valve replacement of aortic or mitral valve, and any amount of pericardial effusion (PE) on the first postoperative TTE were related to the occurrence of cardiac tamponade (all p<0.05). After multivariate adjustment, occurrence of cardiac tamponade was associated with any amount of PE on the first postoperative TTE (hazard ratio, HR, 14.00, p<0.001) and mechanical valve replacement (HR 2.69, p = 0.025). The mean hospital days in patients with cardiac tamponade was higher than those without (34.9 vs. 13.5, p = 0.031). After pericardial drainage, there was no echocardiographic recurrence of significant PE during a median of 34.8 (IQR 14.9–43.7) months after surgery. Cardiac tamponade after heart valve surgery is not uncommon. Patients with any amount of PE at the first postoperative TTE or mechanical valve replacement should receive higher attention with regard to the occurrence of cardiac tamponade. Although it prolongs hospital stay, cardiac tamponade exhibits a benign clinical course without recurrence after timely intervention. PMID:27855225

  11. An international prospective cohort study evaluating major vascular complications among patients undergoing noncardiac surgery: the VISION Pilot Study

    PubMed Central

    2011-01-01

    Objectives Among patients undergoing noncardiac surgery, our objectives were to: (1) determine the feasibility of undertaking a large international cohort study; (2) estimate the current incidence of major perioperative vascular events; (3) compare the observed event rates to the expected event rates according to the Revised Cardiac Risk Index (RCRI); and (4) provide an estimate of the proportion of myocardial infarctions without ischemic symptoms that may go undetected without perioperative troponin monitoring. Design An international prospective cohort pilot study. Participants Patients undergoing noncardiac surgery who were > 45 years of age, receiving a general or regional anesthetic, and requiring hospital admission. Measurements Patients had a Roche fourth-generation Elecsys troponin T measurement collected 6 to 12 hours postoperatively and on the first, second, and third days after surgery. Our primary outcome was major vascular events (a composite of vascular death [i.e., death from vascular causes], nonfatal myocardial infarction, nonfatal cardiac arrest, and nonfatal stroke) at 30 days after surgery. Our definition for perioperative myocardial infarction included: (1) an elevated troponin T measurement with at least one of the following defining features: ischemic symptoms, development of pathologic Q waves, ischemic electrocardiogram changes, coronary artery intervention, or cardiac imaging evidence of myocardial infarction; or (2) autopsy findings of acute or healing myocardial infarction. Results We recruited 432 patients across 5 hospitals in Canada, China, Italy, Colombia, and Brazil. During the first 30 days after surgery, 6.3% (99% confidence interval 3.9–10.0) of the patients suffered a major vascular event (10 vascular deaths, 16 nonfatal myocardial infarctions, and 1 nonfatal stroke). The observed event rate was increased 6-fold compared with the event rate expected from the RCRI. Of the 18 patients who suffered a myocardial infarction

  12. Information and behavioural instruction along the health‐care pathway: the perspective of people undergoing hernia repair surgery and the role of formal and informal information sources

    PubMed Central

    Powell, Rachael; McKee, Lorna; Bruce, Julie

    2009-01-01

    Abstract Background  Provision of information and behavioural instruction has been demonstrated to improve recovery after surgery. However, patients draw on a range of information sources and it is important to establish which sources patients use and how this influences perceptions and behaviour as they progress along the surgical pathway. In this qualitative, exploratory and longitudinal study, the use of information and instruction were explored from the perspective of people undergoing inguinal hernia repair surgery. Methods  Seven participants undergoing inguinal hernia repair surgery were interviewed using semi‐structured interviews 2 weeks before surgery and 2 weeks and 4 months post‐surgery. Nineteen interviews were conducted in total. Topic guides included sources of knowledge, reasons for help‐seeking and opting for surgery and factors influencing return to activity. Data were analysed thematically according to Interpretative Phenomenological Analysis. Findings and conclusions  Participants sought information from a range of sources, focusing on informal information sources before surgery and using information and instruction from health‐care professionals post‐surgery. This information influenced behaviours including deciding to undergo surgery, use of pain medication and returning to usual activity. Anxiety and help‐seeking resulted when unexpected post‐surgical events occurred such as extensive bruising. Findings were consistent with psychological and sociological theories. Overall, participants were positive about the information and instruction they received but expressed a desire for more timely information on post‐operative adverse events. PMID:19236631

  13. Ratio of C-Reactive Protein to Albumin Predicts Muscle Mass in Adult Patients Undergoing Hemodialysis

    PubMed Central

    Chen, Yu-Tong; Wu, Pei-Yu; Chen, Hsi-Hsien; Chen, Tso-Hsiao; Hsu, Yung-Ho

    2016-01-01

    Recent studies have indicated that the ratio of C-reactive protein to albumin (CRP–Alb ratio) is associated with clinical outcomes in patients with disease. We examined the predictive value of this ratio in patients undergoing hemodialysis (HD). In this cross-sectional study, 91 eligible adult HD patients were analyzed, and the correlation between the CRP–Alb ratio and skeletal muscle mass normalized for body weight (SMM/wt; estimated using a bioelectrical impedance analyzer) was investigated. The mean age of the study participants was 54.9 ± 6.6 years (ranging from 27 to 64 years); 43 (47.2%) were men. The mean values for the SMM/wt were 39.1% ± 5.4%. The CRP–Alb ratio was found to be negatively correlated with SMM/wt (r = −0.33, P = 0.002) and creatinine (r = −0.20, P = 0.056). All the univariate significant and nonsignificant relevant covariates were selected for multivariable stepwise regression analysis. We determined that the homeostasis model assessment-estimated insulin resistance and CRP–Alb ratio were independent risk determinants for SMM/wt (βHOMA-IR = −0.18 and βCRP–Alb ratio = −3.84, adjusted R2 = 0.32). This study indicated that the CRP–Alb ratio may help clinicians in predicting muscle mass in adult patients undergoing HD. PMID:27768746

  14. Changes in quality of life associated with surgical risk in elderly patients undergoing cardiac surgery.

    PubMed

    Romero, Paola Severo; de Souza, Emiliane Nogueira; Rodrigues, Juliane; Moraes, Maria Antonieta

    2015-10-01

    The study aims to verify quality of life of elderly patients submitted to cardiac surgery, and correlating surgical risk to health-related quality of life instrument domains. Prospective cohort study, performed at a cardiology hospital. It included elderly patients who had undergone elective cardiac surgery. Pre- and postoperative quality of life was evaluated by applying the World Health Organization Quality of Life-Old (WHOQOL-OLD) scale and the Short-Form Health Survey (SF-36) questionnaire. Surgical risk was stratified using the European System for Cardiac Operative Risk Evaluation (EuroSCORE). Fifty-four patients, mostly men (64.8%), were included, with a mean age of 69.3 ± 5.7 years. The eight domains of the SF-36 questionnaire, and the four facets presented for the WHOQOL-OLD scale showed improved quality of life 6 months after surgery (P < 0.001). No difference was found in the association of EuroSCORE with the domains of the health-related quality of life instruments. The data showed improved quality of life of elderly people submitted to cardiac surgery, unrelated to surgical risk.

  15. Congenital intrathoracic kidney in a patient undergoing coronary artery bypass surgery.

    PubMed

    Darwazah, Ahmad K; Yosri, Ahmad

    2011-03-01

    Intrathoracic kidney is a rare congenital anomaly. It appears as a posterior mediastinal mass on chest X-ray. Most cases are asymptomatic and are discovered accidentally. We present a 48-year-old male patient with intrathoracic kidney discovered during routine investigation for coronary artery bypass surgery.

  16. The Physiologic and Anesthetic Considerations in Elderly Patients Undergoing Robotic Renal Surgery

    PubMed Central

    Vasdev, Nikhil; Poon, Anna Sau Kuk; Gowrie-Mohan, S; Lane, Tim; Boustead, Gregory; Hanbury, Damian; Adshead, James M

    2014-01-01

    A number of patients are diagnosed with renal malignancies incidentally worldwide. Once a diagnosis of a renal malignancy is established, after a careful evaluation, patients can be offered a robotic nephrectomy or partial nephrectomy. We present a review of the physiologic and anesthetic considerations in elderly patients who are being considered for robotic renal surgery. PMID:24791150

  17. A Preoperative Personalized Risk Assessment Calculator for Elderly Ovarian Cancer Patients undergoing Primary Cytoreductive Surgery

    PubMed Central

    Barber, Emma L; Rutstein, Sarah; Miller, William C; Gehrig, Paola A

    2015-01-01

    Objective Cytoreductive surgery for ovarian cancer has higher rates of postoperative complication than neoadjuvant chemotherapy followed by surgery. If patients at high risk of postoperative complication were identified preoperatively, primary therapy could be tailored. Our objective was to develop a predictive model to estimate the risk of major postoperative complication after primary cytoreductive surgery among elderly ovarian cancer patients. Methods Patients who underwent primary surgery for ovarian cancer between 2005-2013 were identified from the National Surgical Quality Improvement Project. Patients were selected using primary procedure CPT codes. Major complications were defined as grade 3 or higher complications on the validated Claviden-Dindo scale. Using logistic regression, we identified demographic and clinical characteristics predictive of postoperative complication. Results We identified 2,101 ovarian cancer patients of whom 35.9% were older than 65. Among women older than 65, the rate of major postoperative complication was 16.4%. Complications were directly associated with preoperative laboratory values (serum creatinine, platelets, white blood cell count, hematocrit), ascites, white race, and smoking status, and indirectly associated with albumin. Our predictive model had an area under receiver operating characteristic curve of 0.725. In order to not deny patients necessary surgery, we chose a 50% population rate of postoperative complication which produced model sensitivity of 9.8% and specificity of 98%. Discussion Our predictive model uses easily and routinely obtained objective preoperative factors to estimate the risk of postoperative complication among elderly ovarian cancer patients. This information can be used to assess risk, manage postoperative expectations, and make decisions regarding initial treatment. PMID:26432038

  18. Effect of dexmedetomidine-etomidate-fentanyl combined anesthesia on somatosensory- and motor-evoked potentials in patients undergoing spinal surgery.

    PubMed

    Lin, Sheng; Dai, Na; Cheng, Zhengyan; Shao, Wei; Fu, Zhijian

    2014-05-01

    This aim of the present study was to evaluate the effects of dexmedetomidine (DEX) on the intraoperative monitoring of somatosensory-evoked potentials (SEPs) and motor-evoked potentials (MEPs) in patients undergoing spinal surgery. A total of 36 patients who received spinal surgery under general anesthesia were randomly divided into two groups (n=18 per group), group C, the test group and group D, the control group, and these groups were subjected to a matching anesthesia induction. In brief, the anesthesia was administered via injection of etomidate and fentanyl; once the patients were unconscious, a laryngeal mask airway (LMA) was inserted, SEPs and MEPs were monitored and the collected data were considered to be basic data. Cisatracurium was subsequently injected and an endotracheal tube (7#) was inserted to replace the LMA. The following procedures were conducted for anesthesia maintenance: Group C, the anesthesia was maintained via target-controlled infusion of etomidate and intermittent injection of fentanyl; and group D, DEX (0.5 μg/kg) was injected over a duration of 10 min and then pumped at a rate of 0.5 μg/kg/h. In the two groups, all of the other drugs used were the same and a muscle relaxant was not administered. The bispectral index was maintained between 45 and 55 during surgery, and the SEPs and MEPs were monitored continuously until the surgery was completed. No significant difference in duration and amplitude of the SEPs (P15-N20) was identified between group C and D (P>0.05). Furthermore, the MEPs were monitored in the two groups at specific durations and no significant difference was observed between the two groups (P>0.05). The SEPs and MEPs were maintained in the patients who were administered with the DEX-etomidate-fentanyl combined anesthesia during spinal surgery.

  19. Administration of tranexamic acid to patients undergoing surgery for adolescent idiopathic scoliosis evokes pain and increases the infusion rate of remifentanil during the surgery

    PubMed Central

    Ohashi, Nobuko; Ohashi, Masayuki; Endo, Naoto; Kohno, Tatsuro

    2017-01-01

    Background We recently reported that tranexamic acid (TXA) evokes pain in rats by inhibiting γ-aminobutyric acid and glycine receptors on neurons in the spinal dorsal horn. Although TXA is commonly used to reduce perioperative blood loss during various surgeries, its potential to induce intraoperative nociception, thereby increasing the need for more analgesics during surgery, has not been investigated. Therefore, this study aimed to investigate whether TXA evokes pain and increases the need for a higher infusion rate of remifentanil in patients undergoing surgery for adolescent idiopathic scoliosis (AIS). Methods Data were collected from patients with AIS who underwent posterior spinal fusion surgery from January 2008 to December 2015. All surgical procedures were performed under total intravenous anesthesia with propofol and remifentanil, by the same team of orthopedic surgeons and anesthesiologists at a single institution. Patients in the TXA group were administered TXA (loading and maintenance doses, 1000 mg and 100 mg/h) whereas those in the control group were not. Our primary outcome was the infusion rate of the intraoperative opioid analgesic remifentanil. Results The final analysis was based on data collected from 33 and 30 patients in the control and TXA groups, respectively. No differences were observed in the demographic data or the hemodynamic parameters between the two groups of patients. In the TXA group, the durations of surgery and anesthesia were shorter, intravascular fluid volume and total blood loss were lower, and the doses of fentanyl and ketamine administered were higher than they were in the control group (P < 0.05 for all). The mean infusion rate of intraoperative remifentanil was significantly higher in the TXA group than in the control group (control group: 0.23 ± 0.04 μg/kg/min; TXA group: 0.28 ± 0.12 μg/kg/min; P = 0.014). Conclusions Patients who received TXA during the AIS surgery required a higher infusion rate of remifentanil

  20. I-gel as an alternative to endotracheal tube in adult laparoscopic surgeries: A comparative study

    PubMed Central

    Badheka, Jigisha Prahladrai; Jadliwala, Rashida Mohammedi; Chhaya, Vrajeshchandra Amrishbhi; Parmar, Vandana Surendrabhai; Vasani, Amit; Rajyaguru, Ajay Maganlal

    2015-01-01

    BACKGROUND: The tracheal tube is always considered to be the gold standard for laparoscopic surgeries. As conventional laryngoscopy guided endotracheal intubation evokes significant hypertension and tachycardia, we have used I-gel, second generation extraglottic airway device, in an attempt to overcome these drawbacks. We conducted this study to compare haemodynamic changes during insertion, efficacy of ventilation, and complications with the use of I-gel when compared with endotracheal tube (ETT) in laparoscopic surgeries. MATERIALS AND METHODS: A total of 60 American Society of Anaesthesiologists physical status I and II adult patients undergoing elective laparoscopic surgeries were randomly allocated to one of the two groups of 30 patients each: Group-A (I-gel) in which patients airway was secured with appropriate sized I-gel, and Group-B (ETT) in which patients airway was secured with laryngoscopy - guided endotracheal intubation. Ease, attempts and time for insertion of airway device, haemodynamic and ventilatory parameters at different time intervals, and attempts for gastric tube insertion, and perioperative complications were recorded. RESULTS: There was significant rise in pulse rate and mean blood pressure during insertion with use of ETT when compared to I-gel. Furthermore, time required for I-gel insertion was significantly less when compared with ETT. However ease and attempts for airway device insertion, attempts for gastric tube insertion and efficacy of ventilation were comparable between two groups. CONCLUSION: We concluded that I-gel requires less time for insertion with minimal haemodynamic changes when compared to ETT. I-gel also provides adequate positive-pressure ventilation, comparable with ETT. Hence I-gel can be a safe and suitable alternative to ETT for laparoscopic surgeries. PMID:26622115

  1. Analysis of Intraoperative and Postoperative Complications in Pseudoexfoliation Eyes Undergoing Cataract Surgery

    PubMed Central

    Shetty, Sathyendranath B

    2016-01-01

    Introduction Pseudoexfoliation (PXE) is a genetically inherited condition affecting usually seen in those aged over 50 years. Surgical management of cataract in patients with PXE pose a challenge due to associated changes in ocular structures. Aim To study the challenges in the management of cataract in patients with PXE. Materials and Methods This was an interventional study conducted in the Ophthalmology Department of MS Ramaiah Medical College and Memorial Hospital, Bangalore from June 2012 to September 2014. All patients admitted for cataract surgery during this period who were diagnosed as cataract associated with PXE above 50 years of age belonging to either sex were included in the study. All patients underwent cataract surgery with intraocular lens implantation. Depending on type of cataract both small incision and phacoemulsification operations were conducted. Intraoperative and postoperative complications were studied. The patients were reviewed up to 6 weeks postoperatively. Results A total of 50 eyes of 50 patients diagnosed as cataract with PXE underwent cataract surgery. Of which 40 eyes (80%) underwent small incision cataract surgery whereas, 10 (20%) underwent phacoemusification. Corneal thinning (<535 microns) was noted in majority of the cases (41 cases). Preoperatively there were 3 cases of zonular weakness. Pseudo exfoliation with glaucoma was seen in 5 cases. Intraoperative complications encountered during surgery were; zonular dialysis in 3 cases, posterior capsular tear in 2 cases, out of these 5 cases vitreous loss was seen in 3 cases. Postoperative complications were corneal odema in 17 cases, of which endothelium de-compensated in one case, while early posterior capsular opacification was seen in 6 cases. Final best corrected visual acuity was between 6/6-6/12 in 39(78%) eyes, 6/18 -6/36 in 6(12%) cases; 6/60 to less in 5(10%) cases. Conclusion Cataract surgery in eyes with PXE has higher incidence of intraoperative and postoperative

  2. Cryopreservation of in vitro matured oocytes after ex vivo oocyte retrieval from gynecologic cancer patients undergoing radical surgery

    PubMed Central

    Park, Chan Woo; Lee, Sun Hee; Yang, Kwang Moon; Lee, In Ho; Lim, Kyung Teak; Lee, Ki Heon

    2016-01-01

    Objective The aim of this study was to report a case series of in vitro matured (IVM) oocyte freezing in gynecologic cancer patients undergoing radical surgery under time constraints as an option for fertility preservation (FP). Methods Case series report. University-based in vitro fertilization center. Six gynecologic cancer patients who were scheduled to undergo radical surgery the next day were referred for FP. The patients had endometrial (n=2), ovarian (n=3), and double primary endometrial and ovarian (n=1) cancer. Ex vivo retrieval of immature oocytes from macroscopically normal ovarian tissue was followed by mature oocyte freezing after IVM or embryo freezing with intracytoplasmic sperm injection. Results A total of 53 oocytes were retrieved from five patients, with a mean of 10.6 oocytes per patient. After IVM, a total of 36 mature oocytes were obtained, demonstrating a 67.9% maturation rate. With regard to the ovarian cancer patients, seven IVM oocytes were frozen from patient 3, who had stage IC cancer, whereas one IVM oocyte was frozen from patient 4, who had stage IV cancer despite being of a similar age. With regard to the endometrial cancer patients, 15 IVM oocytes from patient 1 were frozen. Five embryos were frozen after the fertilization of IVM oocytes from patient 6. Conclusion Immature oocytes can be successfully retrieved ex vivo from macroscopically normal ovarian tissue before radical surgery. IVM oocyte freezing provides a possible FP option in patients with advanced-stage endometrial or ovarian cancer without the risk of cancer cell spillage or time delays. PMID:27358831

  3. Does ambroxol confer a protective effect on the lungs in patients undergoing cardiac surgery or having lung resection?

    PubMed

    Wang, Shaohua; Huang, Dayu; Ma, Qinyun; Chen, Xiaofeng

    2014-06-01

    A best evidence topic in perioperative care was written according to a structured protocol. The question addressed was 'Does ambroxol confer a protective effect on the lung in patients undergoing cardiac surgery or having lung resection?' A total of 247 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. Several studies indicate that for patients with chronic obstructive pulmonary disease (COPD) who undergo cardiac surgery or upper abdominal surgery, perioperative ambroxol administration is associated with improved pulmonary function and reduced postoperative pulmonary complications (PPCs). In patients with pulmonary lobectomy, large-dose ambroxol treatment (1000 mg/day for 3 days) is correlated with reduced PPCs (6 vs 19%, P = 0.02), decreased postoperative hospital stay (5.6 vs 8.1 days, P = 0.02) and lower postoperative cost (2499 vs 5254 €, P = 0.04) compared with low-dose ambroxol treatment. Ambroxol also has a protective effect on the lungs during extracorporeal bypass, ameliorating inflammatory reaction and oxygen stress and preserving pulmonary surfactant. However, there is no evidence for any advantage of reducing PPCs after extracorporeal circulation. We conclude that perioperative application of ambroxol, a versatile mucoactive drug, particularly in high doses, is associated with lower PPCs, especially in high-risk patients with fundamental lung disease such as COPD. Large doses of ambroxol are correlated with even lower PPCs after lung resection. We recommend that routine intravenous ambroxol should be used in large doses in high-risk patients in the perioperative period to reduce the risk of PPCs.

  4. Preventing bleeding and thromboembolic complications in atrial fibrillation patients undergoing surgery.

    PubMed

    André, Charles

    2015-08-01

    Neurologists feel uneasy when asked about temporary anticoagulant interruption for surgery in patients with atrial fibrillation (AF). Rational decisions can be made based on current scientific evidence. Method Critical review of international guidelines and selected references pertaining to bleeding and thromboembolism during periods of oral anticoagulant interruption. Results Withholding oral anticoagulants leads to an increased risk of perioperative thromboembolism, depending on factors such as age, renal and liver function, previous ischemic events, heart failure etc. Surgeries are associated with a variable risk of bleeding - from minimal to very high. Individualized decisions about preoperative drug suspension, bridging therapy with heparin and time to restart oral anticoagulants after hemostasis can significantly reduce these opposing risks. Conclusion Rational decisions can be made after discussion with all Health care team professionals involved and consideration of patient fears and expectations. Formal written protocols should help managing antithrombotic treatment during this delicate period.

  5. The effect of spinal versus general anesthesia on postoperative pain and analgesic requirements in patients undergoing peripheral vascular surgery.

    PubMed

    Nesek-Adam, Visnja; Rasić, Zarko; Schwarz, Dragan; Grizelj-Stojcić, Elvira; Rasić, Domagoj; Krstonijević, Zoran; Markić, Ana; Kovacević, Marko

    2012-12-01

    The optimal anesthetic technique for peripheral vascular surgery remains controversial. The purpose of this study was to evaluate the effect of spinal versus general anesthesia on postoperative pain, analgesic requirements and postoperative comfort in patients undergoing peripheral vascular surgery. A total of 40 patients scheduled for peripheral vascular surgery were randomly assigned to two groups of 20 patients each to receive general anesthesia (GA) or spinal anesthesia (SA). In GA group, anesthesia was induced using thiopental and fentanyl. Vecuronium was used for muscle relaxation. Anaesthesia was maintained with isoflurane and nitrous oxide. In the SA group, hyperbaric 0.5% bupivacaine was injected into the subarachnoid space. Postoperative pain was assessed for 24 hours by a visual analog scale during three assessment periods: 0-4, 4-12 and 12-24 h as well as analgesic requirements. Patients were also asked to assess their postoperative state as satisfactory or unsatisfactory with regard to the pain, side effects and postoperative nausea and vomiting. Visual analogue scale (VAS) pain score was significantly lower in the group SA compared with group GA. This effect was mainly due to the lower pain score during the first study period. The patients received general anesthesia also reported a significantly higher rate of unsatisfactory postoperative comfort than those receiving spinal anesthesia. We conclude that spinal anesthesia is superior to general anesthesia when considering patients' satisfaction, side effects and early postoperative analgesic management.

  6. A randomized comparative study of patients undergoing myocardial revascularization with or without cardiopulmonary bypass surgery: The MASS III Trial

    PubMed Central

    Hueb, Whady; Lopes, Neuza HM; Gersh, Bernard J; Castro, Cláudio C; Paulitsch, Felipe S; Oliveira, Sergio A; Dallan, Luis A; Hueb, Alexandre C; Stolf, Noedir A; Ramires, José AF

    2008-01-01

    The MASS III Trial is a large project from a single institution, The Heart Institute of the University of Sao Paulo, Brazil (InCor), enrolling patients with coronary artery disease and preserved ventricular function. The aim of the MASS III Trial is to compare medical effectiveness, cerebral injury, quality of life, and the cost-effectiveness of coronary surgery with and without of cardiopulmonary bypass in patients with multivessel coronary disease referred for both strategies. The primary endpoint should be a composite of cardiovascular mortality, cerebrovascular accident, nonfatal myocardial infarction, and refractory angina requiring revascularization. The secondary end points in this trial include noncardiac mortality, presence and severity of angina, quality of life based on the SF-36 Questionnaire, and cost-effectiveness at discharge and at 5-year follow-up. In this scenario, we will analyze the cost of the initial procedure, hospital length of stay, resource utilization, repeat hospitalization, and repeat revascularization events during the follow-up. Exercise capacity will be assessed at 6-months, 12-months, and the end of follow-up. A neurocognitive evaluation will be assessed in a subset of subjects using the Brain Resource Center computerized neurocognitive battery. Furthermore, magnetic resonance imaging will be made to detect any cerebral injury before and after procedures in patients who undergo coronary artery surgery with and without cardiopulmonary bypass. Clinical Trial registration information ISRCTN59539154 Off-pump vs. on-pump surgery in patients with Stable CAD MASS III PMID:18755039

  7. The impact of human rhinovirus infection in pediatric patients undergoing heart surgery.

    PubMed

    Delgado-Corcoran, Claudia; Witte, Madolin K; Ampofo, Krow; Castillo, Ramon; Bodily, Stephanie; Bratton, Susan L

    2014-12-01

    Human rhinovirus (HRV), the most common cause of upper respiratory infection in children, can present as bronchiolitis, pneumonia, or asthma exacerbations. The impact of HRV in infants and toddlers with congenital heart disease is poorly defined. A case-control study was performed to compare the clinical course for 19 young children with respiratory symptoms who tested positive for rhinovirus after heart surgery with that of 56 matched control subjects. The control subjects were matched by surgical repair, age, weight, and time of the year. Patients with known HRVs before surgery and control subjects with respiratory symptoms or positive test results for viruses were excluded from the study. Human rhinovirus infection was associated with more than a tenfold increase in the odds of noninvasive ventilation after extubation (odds ratio [OR] 11.45; 95 % confidence interval [CI] 3.97-38.67), a 12-fold increase in the probability of extubation failure (OR 12.84; 95 % CI 2.93-56.29), and increased use of pulmonary medications including bronchodilator and nitric oxide (p < 0.001). As a result, the hospital length of stay (HLOS) was two times longer than for the control subjects (p < 0.001), and the cardiac intensive care unit (CICU) length of stay (CICU LOS) was three times longer (p < 0.0001). The intubation time was significantly longer (p < 0.001), and the CICU respiratory charges were significantly greater (p = 0.001) for the infected patients. Human rhinovirus increases resource use and prolongs postoperative recovery after pediatric heart surgery. Surgery timing should be delayed for patients with rhinovirus if possible.

  8. Preoperative and surveillance MR imaging of patients undergoing cytoreductive surgery and heated intraperitoneal chemotherapy

    PubMed Central

    2016-01-01

    MR imaging provides considerable advantages for imaging patients with peritoneal tumor. Its inherently superior contrast resolution compared to CT allows MRI to more accurately depict small peritoneal tumors that are often missed on other imaging tests. Combining different contrast mechanisms including diffusion-weighted (DW) MRI and gadolinium-enhanced MRI provides a powerful tool for preoperative and surveillance imaging in patients being considered for cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC). PMID:26941984

  9. Low-molecular-weight heparin prophylaxis: preoperative versus postoperative initiation in patients undergoing elective hip surgery.

    PubMed

    Hull, R D; Pineo, G F; MacIsaac, S

    2001-01-01

    Administration of low-molecular-weight heparin prophylaxis in elective hip implant patients commonly begins 12 h preoperatively in European practices to optimize effectiveness, and 12 to 24 h postoperatively in North American practices to optimize safety. A meta-analysis comparing these two treatment regimes revealed that preoperative initiation demonstrated greater efficacy and superior safety for patients (10.0% rate of total deep-vein thrombosis vs. 15.3%, P = .023). In addition to the pre/postsurgical debate, proximity of initiation of low-molecular-weight heparin in relation to surgery is an issue of critical importance. Recent studies revealed that beginning therapy immediately within 2 h preoperatively or 6 h postoperatively dramatically decreased the risk of venous thrombosis. An investigation of low-molecular-weight heparin prophylaxis initiated 2 h before elective hip surgery or approximately 6 h after surgery compared with warfarin sodium revealed that total and proximal deep-vein thrombosis rates were reduced in patients receiving low-molecular-weight heparin compared with warfarin. The frequencies of deep-vein thrombosis for patients receiving preoperative and postoperative dalteparin vs. warfarin for all deep-vein thrombosis were 36 of 337 (10.7%, P < .001) and 44 of 336 (13.1%, P < .001) vs. 81 of 338 (24.0%); and for proximal deep-vein thrombosis were 3 of 354 (0.8%, P = .035) and 3 of 358 (0.8%, P = .033) vs. 11 of 363 (3.0%). Relative risk reductions for the dalteparin groups vs. warfarin ranged from 45% to 72%. In this case, low-molecular-weight heparin administered in close proximity to surgery provided superior efficacy over warfarin. Major bleeding was significantly increased with the preoperative regimen but not the postoperative regimen.

  10. Monitoring cerebral oxygenation in a pediatric patient undergoing surgery for vascular ring.

    PubMed

    Joshi, Reena K; Motta, Pablo; Horibe, Mayumi; Mossad, Emad

    2006-02-01

    Regional cerebral oxygenation can be monitored using near-infrared spectroscopy (NIRS). Inadequacy of collateral cerebral circulation and regional cerebral ischemia during cardiac and vascular surgery may be detected by the use of NIRS monitoring. We report a 2-year-old child who underwent surgical repair of vascular ring and subclavian reimplantation, where use of NIRS helped in early detection and timely intervention to prevent prolonged cerebral ischemia.

  11. Use of Guideline-Based Antibiotic Prophylaxis in Women Undergoing Gynecologic Surgery

    PubMed Central

    Wright, Jason D.; Hassan, Khalid; Ananth, Cande V.; Herzog, Thomas J.; Lewin, Sharyn N.; Burke, William M.; Lu, Yu-Shiang; Neugut, Alfred I.; Hershman, Dawn L.

    2014-01-01

    Objective To examine guideline-based use of prophylactic antibiotics in patients who underwent gynecologic surgery. Methods We identified women who underwent gynecologic surgery between 2003–2010. Procedures were stratified as antibiotic-appropriate (abdominal, vaginal, or laparoscopically assisted vaginal hysterectomy) or antibiotic-inappropriate (oophorectomy, cystectomy, tubal ligation, dilation and curettage, myomectomy, and tubal ligation). Antibiotic use was examined using hierarchical regression models. Results Among 545,332 women who underwent procedures for which antibiotics were recommended, 87.1% received appropriate antibiotic prophylaxis, 2.3% received non-guideline recommended antibiotics, and 10.6% received no prophylaxis. Use of antibiotics increased from 88.0% in 2003 to 90.7% in 2010 (P<0.001). After excluding patients with infectious complications, 26.7% of women received antibiotics more than 24 hours after surgery. Among 491,071, who had operations in which antibiotics were not recommended, antibiotics were administered to 197,226 (40.2%) women. Use of nonguideline based antibiotics also increased over time from 33.4% in 2003 to 43.7% in 2010 (P<0.001). Year of diagnosis, surgeon and hospital procedural volume, and area of residence were the strongest predictors of guideline-based and non-guideline-based antibiotic use. Conclusion Although use of antibiotics is high for women who should receive antibiotics, antibiotics are increasingly being administered to women for whom the drugs are of unproven benefit. PMID:24201674

  12. Relaxation Training and Postoperative Music Therapy for Adolescents Undergoing Spinal Fusion Surgery.

    PubMed

    Nelson, Kirsten; Adamek, Mary; Kleiber, Charmaine

    2017-02-01

    Spinal fusion for idiopathic scoliosis is one of the most painful surgeries experienced by adolescents. Music therapy, utilizing music-assisted relaxation with controlled breathing and imagery, is a promising intervention for reducing pain and anxiety for these patients. It can be challenging to teach new coping strategies to post-operative patients who are already in pain. This study evaluated the effects of introducing music-assisted relaxation training to adolescents before surgery. Outcome measures were self-reported pain and anxiety, recorded on 0-10 numeric rating scale, and observed behavioral indicators of pain and relaxation. The training intervention was a 12-minute video about music-assisted relaxation with opportunities to practice before surgery. Forty-four participants between the ages of 10 and 19 were enrolled. Participants were randomly assigned to the experimental group that watched the video at the preoperative visit or to the control group that did not watch the video. All subjects received a music therapy session with a board certified music therapist on post-operative day 2 while out of bed for the first time. Pain and anxiety were significantly reduced from immediately pre-therapy to post-therapy (paired t-test; p).

  13. Cardiovascular evaluation and management of severely obese patients undergoing surgery: a science advisory from the American Heart Association.

    PubMed

    Poirier, Paul; Alpert, Martin A; Fleisher, Lee A; Thompson, Paul D; Sugerman, Harvey J; Burke, Lora E; Marceau, Picard; Franklin, Barry A

    2009-07-07

    Obesity is associated with comorbidities that may lead to disability and death. During the past 20 years, the number of individuals with a body mass index >30, 40, and 50 kg/m(2), respectively, has doubled, quadrupled, and quintupled in the United States. The risk of developing comorbid conditions rises with increasing body mass index. Possible cardiac symptoms such as exertional dyspnea and lower-extremity edema occur commonly and are nonspecific in obesity. The physical examination and electrocardiogram often underestimate cardiac dysfunction in obese patients. The risk of an adverse perioperative cardiac event in obese patients is related to the nature and severity of their underlying heart disease, associated comorbidities, and the type of surgery. Severe obesity has not been associated with increased mortality in patients undergoing cardiac surgery but has been associated with an increased length of hospital stay and with a greater likelihood of renal failure and prolonged assisted ventilation. Comorbidities that influence the preoperative cardiac risk assessment of severely obese patients include the presence of atherosclerotic cardiovascular disease, heart failure, systemic hypertension, pulmonary hypertension related to sleep apnea and hypoventilation, cardiac arrhythmias (primarily atrial fibrillation), and deep vein thrombosis. When preoperatively evaluating risk for surgery, the clinician should consider age, gender, cardiorespiratory fitness, electrolyte disorders, and heart failure as independent predictors for surgical morbidity and mortality. An obesity surgery mortality score for gastric bypass has also been proposed. Given the high prevalence of severely obese patients, this scientific advisory was developed to provide cardiologists, surgeons, anesthesiologists, and other healthcare professionals with recommendations for the preoperative cardiovascular evaluation, intraoperative and perioperative management, and postoperative cardiovascular care of

  14. Effect of Oral Pregabalin as Preemptive Analgesic in Patients Undergoing Lower Limb Orthopedic Surgeries under Spinal Anaesthesia

    PubMed Central

    Sebastian, Bon; Nelamangala, Kiran; Krishnamurthy, Dinesh

    2016-01-01

    Introduction Conquering postoperative pain which has significant impact on the surgery outcome can be challenging for the clinicians. Pregabalin is a GABA analogue used for various neuropathic pain syndromes. Very few studies are there with the use of pregabalin as a preemptive analgesic for orthopedic surgeries. Aim To compare pregabalin 150 mg with placebo for postoperative pain control in patients undergoing elective lower limb orthopedic surgeries under spinal anaesthesia and to assess any side effects. Materials and Methods A randomized double blinded prospective study was undertaken. Ninety patients with ASA physical status I, II, aged between 18–50 years were enrolled in the study. One hour prior to spinal anaesthesia Group C - received colour matched empty capsules, Group P – received 150mg of oral pregabalin. Spinal anaesthesia was administered in sitting position in L3-L4 space with Inj. Bupivacaine heavy (0.5%) at a dose of 0.3mg/kg body weight with 20 mg being the maximum dose using 25 gauge spinal needle. Rescue analgesia was provided with using Inj. Diclofenac 1.5 mg/kg intramuscular. Results Time for rescue analgesia (VAS score >3) was significantly increased in Group P than in Group C. The total dose of diclofenac required in the 24 hour postoperative period was significantly lower in Group P than in Group C. The sedation scores and patient satisfaction scores were also more in Group P than in Group C. Conclusion Preemptive pregabalin in an oral dose of 150 mg offers good postoperative analgesia in lower limb orthopedic surgeries under spinal anaesthesia. PMID:27630927

  15. Intraoperative Dexmedetomidine Improves the Quality of Recovery and Postoperative Pulmonary Function in Patients Undergoing Video-assisted Thoracoscopic Surgery

    PubMed Central

    Lee, Su Hyun; Lee, Chang Yeong; Lee, Jin Gu; Kim, Namo; Lee, Hye Mi; Oh, Young Jun

    2016-01-01

    Abstract Video-assisted thoracoscopic surgery (VATS) has been known to be a stressful event for patients, and dexmedetomidine is known to attenuate surgery-induced sympathetic responses and potentiate analgesia in perioperative periods. The present was designed to evaluate the effects of intraoperative dexmedetomidine administration on the quality of recovery (QoR) and pulmonary function after VATS. Patients with lung cancer undergoing VATS were randomized to Dex group (loading of 1.0 μg/kg for 20 minutes before the termination of surgery, n = 50) or Control group (comparable volume of normal saline, n = 50). The QoR-40 questionnaire assesses postoperative recovery and validates the overall surgical and general anesthesia outcomes. The QoR-40 scores, forced expiratory volume for 1 second (FEV1) on postoperative day (POD) 1 and 2, and emergence agitation were evaluated.The global QoR-40 score (162.3 ± 17.8 vs 153.3 ± 18.7, P = 0.016 on POD 1; 174.3 ± 16.0 vs 166.8 ± 16.7, P = 0.028 on POD 2) and FEV1 (2.1 ± 0.4 vs 1.9 ± 0.5 L, P = 0.034 on POD 1; 2.2 ± 0.5 vs 2.0 ± 0.4 L, P = 0.030 on POD 2) were significantly higher in the Dex group compared with the Control group on POD1 and POD 2. The score of emergence agitation was lower in the Dex group compared with the Control group (3 [2–5] vs 5 [3–7], P < 0.001). The number of patients indicating severe emergence agitation was shorter in the Dex group than Control group (0 [0%] vs 7 [14%], P = 0.048). The length of hospital stay was significantly shorter (6.7 [3–9] vs 8.4 [4–9] days, P = 0.045) in the Dex group compared with the Control group. Intraoperative dexmedetomidine administration improved QoR, postoperative pulmonary function, and emergence agitation in patients undergoing VATS. Consequently, intraoperative dexmedetomidine administration could improve postoperative outcomes and reduced the length of hospital stay in

  16. The cardiovascular effects of sevoflurane and isoflurane after premedication of healthy dogs undergoing elective surgery.

    PubMed

    Abed, Janan M; Pike, Fred S; Clare, Monica C; Brainard, Benjamin M

    2014-01-01

    Sevoflurane and isoflurane are commonly used in veterinary anesthesia. The objective of this prospective, randomized, open-label clinical study was to compare the cardiovascular effects of sevoflurane and isoflurane via direct arterial blood pressure measurements and the lithium dilution cardiac output (LDCO) on premedicated healthy dogs undergoing elective tibial plateau leveling osteotomy (TPLO). Nineteen client-owned dogs were included. All dogs were premedicated with hydromorphone (0.05 mg/kg IV and glycopyrrolate 0.01 mg/kg subcutaneously). Ten dogs were anesthetized with sevoflurane and nine dogs were anesthetized with isoflurane. Eighteen dogs were instrumented with a dorsal pedal arterial catheter, and one dog had a femoral arterial catheter. All dogs had continuous, direct systolic (SAP), diastolic (DAP), and mean arterial (MAP) blood pressure readings as well as heart rate (HR), cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR), systemic vascular resistance index (SVRI), stroke volume variation (SVV), and pulse pressure variation (PPV) recorded q 5 min during the surgical procedure. There was no significant statistical difference in all parameters between the sevoflurane and isoflurane treatment groups. Both sevoflurane and isoflurane inhalant anesthetics appear to have similar hemodynamic effects when used as part of a multimodal anesthetic protocol in premedicated healthy dogs undergoing an elective surgical procedure.

  17. Effects of remote ischemic preconditioning in high-risk patients undergoing cardiac surgery (Remote IMPACT): a randomized controlled trial

    PubMed Central

    Walsh, Michael; Whitlock, Richard; Garg, Amit X.; Légaré, Jean-François; Duncan, Andra E.; Zimmerman, Robert; Miller, Scott; Fremes, Stephen; Kieser, Teresa; Karthikeyan, Ganesan; Chan, Matthew; Ho, Anthony; Nasr, Vivian; Vincent, Jessica; Ali, Imtiaz; Lavi, Ronit; Sessler, Daniel I.; Kramer, Robert; Gardner, Jeff; Syed, Summer; VanHelder, Tomas; Guyatt, Gordon; Rao-Melacini, Purnima; Thabane, Lehana; Devereaux, P.J.

    2016-01-01

    Background: Remote ischemic preconditioning is a simple therapy that may reduce cardiac and kidney injury. We undertook a randomized controlled trial to evaluate the effect of this therapy on markers of heart and kidney injury after cardiac surgery. Methods: Patients at high risk of death within 30 days after cardiac surgery were randomly assigned to undergo remote ischemic preconditioning or a sham procedure after induction of anesthesia. The preconditioning therapy was three 5-minute cycles of thigh ischemia, with 5 minutes of reperfusion between cycles. The sham procedure was identical except that ischemia was not induced. The primary outcome was peak creatine kinase–myocardial band (CK-MB) within 24 hours after surgery (expressed as multiples of the upper limit of normal, with log transformation). The secondary outcome was change in creatinine level within 4 days after surgery (expressed as log-transformed micromoles per litre). Patient-important outcomes were assessed up to 6 months after randomization. Results: We randomly assigned 128 patients to remote ischemic preconditioning and 130 to the sham therapy. There were no significant differences in postoperative CK-MB (absolute mean difference 0.15, 95% confidence interval [CI] −0.07 to 0.36) or creatinine (absolute mean difference 0.06, 95% CI −0.10 to 0.23). Other outcomes did not differ significantly for remote ischemic preconditioning relative to the sham therapy: for myocardial infarction, relative risk (RR) 1.35 (95% CI 0.85 to 2.17); for acute kidney injury, RR 1.10 (95% CI 0.68 to 1.78); for stroke, RR 1.02 (95% CI 0.34 to 3.07); and for death, RR 1.47 (95% CI 0.65 to 3.31). Interpretation: Remote ischemic precnditioning did not reduce myocardial or kidney injury during cardiac surgery. This type of therapy is unlikely to substantially improve patient-important outcomes in cardiac surgery. Trial registration: ClinicalTrials.gov, no. NCT01071265. PMID:26668200

  18. Efficacy of prophylactic intra-aortic balloon pump therapy in chronic heart failure patients undergoing cardiac surgery.

    PubMed

    Yildirim, Yalin; Pecha, Simon; Kubik, Mathias; Alassar, Yousuf; Deuse, Tobias; Hakmi, Samer; Reichenspurner, Hermann

    2014-11-01

    This study investigated the efficacy of prophylactic intraoperative intra-aortic balloon pump (IABP) usage in chronic heart failure patients with severely reduced left ventricular function undergoing elective cardiac surgery. Between January 2008 and December 2012, 107 patients with severely reduced left ventricular ejection fraction (LVEF <35%) received prophylactic intraoperative IABP implantation during open-heart surgery. Surgical procedures performed were isolated coronary artery bypass grafting (CABG) in 35 patients (32.7%), aortic valve replacement in 12 (11.2%), mitral valve repair or replacement in 15 (14.0%), combined valve and CABG procedures in 27 (25.2%), and other surgical procedures in 18 (16.8%). Results and outcomes were compared with those in a propensity score-matched cohort of 107 patients who underwent cardiac surgery without intraoperative IABP implantation. Matching criteria were age, gender, LVEF, and surgical procedure. Duration of intensive care unit (ICU) stay, duration of hospital stay, and 30-day mortality were markers of outcome. In the IABP group, mean patient age was 69.1 ± 13.7 years; 66.4% (70) were male. All IABPs were placed intraoperatively. Mean duration of IABP application time was 42.4 ± 8.7 h. IABP-related complications occurred in five patients (4.7%), including one case of inguinal bleeding, one case of mesenteric ischemia, and ischemia of the lower limb in three patients. No stroke or major bleeding occurred during IABP support. Mean durations of ICU and hospital stay were 3.38 ± 2.15 days and 7.69 ± 2.02 days, respectively, in the IABP group, and 4.20 ± 3.14 days and 8.57 ± 3.26 days in the control group, showing statistically significant reductions in duration of ICU and hospital stay in the IABP group (ICU stay, P = 0.036; hospital stay, P = 0.015). Thirty-day survival rates were 92.5 and 94.4% in the IABP and control group, respectively, showing no statistically significant difference (P = 0.75). IABP usage in

  19. Current techniques and strategies for anesthesia in patients undergoing peripheral bypass surgery.

    PubMed

    Bouman, E; Dortangs, E; Buhre, W; Gramke, H F

    2014-04-01

    Peripheral arterial disease is an illness with a high prevalence in Europe and North America. The disease is associated with a significant impact on quality of life. Despite advanced medical and endovascular treatments, surgery is often indicated to prevent the consequences of ischemic injury. Usually, these patients do have significant comorbidities resulting in an increased risk for anesthesia-related complications. While general anesthesia is commonly used for the majority of the patients, local and regional anesthesia (RA) offer several possible advantages such as stable cardiovascular hemodynamic perioperative course, improved postoperative pain relief and prevention of chronic postsurgical pain syndromes. This review will discuss perioperative management, available evidence regarding general anesthesia and various regional anesthetic techniques for peripheral vascular surgery, and the current advises regarding anticoagulants and RA. No definitive conclusions can be drawn from the existing literature with respect to superiority of general or neuraxial anesthesia or even RA. Maybe the profits lie in the combination of techniques, a strategy, to overcome the risks of one and use the benefits of the other technique. From circumstantial evidence, it is most likely that the experience of the anesthetic and surgical team is one of the major determinants of perioperative complications independent from the individual anesthesia technique.

  20. Professional oral health care reduces the duration of hospital stay in patients undergoing orthognathic surgery

    PubMed Central

    SHIGEISHI, HIDEO; RAHMAN, MOHAMMAD ZESHAAN; OHTA, KOUJI; ONO, SHIGEHIRO; SUGIYAMA, MASARU; TAKECHI, MASAAKI

    2016-01-01

    The present study reviewed the records of 58 patients who underwent orthognathic surgery [sagittal split ramus osteotomy (SSRO), Le Fort I osteotomy, genioplasty, anterior maxillary alveolar osteotomy] between 2010 and 2015. To investigate the influence of preoperative oral health care on postoperative inflammation, infection and length of hospital stay in those patients, white blood cell (WBC) count and C-reactive protein (CRP) levels were compared between patients who received and did not receive preoperative oral care. The mean CRP level throughout the postoperative term was lower in the oral care group as compared to the non-oral care group. By contrast, the oral care group had a lower occurrence of postoperative infectious complications (surgical site infection, anastomotic leak) (13.6 vs. 20.8%) and a shorter average length of hospital stay (16.2±3.8 vs. 21.2±7.4 days). These results suggest that preoperative professional oral health care decreases the duration of hospital stay following orthognathic surgery by inhibiting inflammation and infectious complications during the postoperative stage. PMID:26870334

  1. Peri-operative Levosimendan in Patients Undergoing Cardiac Surgery: An Overview of the Evidence.

    PubMed

    Shi, William Y; Li, Sheila; Collins, Nicholas; Cottee, David B; Bastian, Bruce C; James, Allen N; Mejia, Ross

    2015-07-01

    Levosimendan, a calcium sensitiser, has recently emerged as a valuable agent in the peri-operative management of cardiac surgery patients. Levosimendan is a calcium-sensitising ionodilator. By binding to cardiac troponin C and reducing its calcium-binding co-efficient, it enhances myofilament responsiveness to calcium and thus enhances myocardial contractility without increasing oxygen demand. Current evidence suggests that levosimendan enhances cardiac function after cardiopulmonary bypass in patients with both normal and reduced left ventricular function. In addition to being used as post-operative rescue therapy for low cardiac output syndrome, a pre-operative levosimendan infusion in high risk patients with poor cardiac function may reduce inotropic requirements, the need for mechanical support, the duration of intensive care admissions as well as post-operative mortality. Indeed, it is these higher-risk patients who may experience a greater degree of benefit. Larger, multicentre randomised trials in cardiac surgery will help to elucidate the full potential of this agent.

  2. Perioperative stroke in a patient undergoing surgery for oral cancer: A case report

    PubMed Central

    Sukegawa, Shintaro; Kanno, Takahiro; Kanai, Kengo; Mandai, Toshiko; Shibata, Akane; Takahashi, Yuka; Hirata, Yuji; Furuki, Yoshihiko

    2016-01-01

    Carotid artery stenosis is a significant risk factor for stroke. In elderly patients with carotid atherosclerosis and stenosis, it is not unusual for oral, head and neck cancer surgery to be performed. The present study describes a case of stroke that occurred during a neck dissection for the treatment of cervical lymph node metastasis of a left maxillary gingival carcinoma. The patient was an 84-year-old female who was considered to be at high risk of a stroke based on pre-operative head and neck computed tomography scans, which detected severe carotid atherosclerosis and stenosis. There was no possible stroke prophylaxis available during the performance of the neck dissection in the present case. However, if patients are evaluated to be high-risk pre-operatively, statin agents should be administered, the surgery should be carefully performed, adequate sedation should be maintained post-operatively and the patient should be followed up, aiming to achieve the early detection of a possible stroke. PMID:27698839

  3. Nosocomial Infection in Adult Patients Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation

    PubMed Central

    2017-01-01

    Data on the frequency of nosocomial infections during extracorporeal membrane oxygenation (ECMO) in adult populations remain scarce. We investigated the risk factors for nosocomial infections in adult patients undergoing venoarterial ECMO (VA-ECMO) support. From January 2011 to December 2015, a total of 259 patients underwent ECMO. Of these, patients aged 17 years or less and patients undergoing ECMO for less than 48 hours were excluded. Of these, 61 patients diagnosed with cardiogenic shock were evaluated. Mean patient age was 60.6 ± 14.3 years and 21 (34.4%) patients were female. The mean preoperative Sequential Organ Failure Assessment (SOFA) score was 8.6 ± 2.2. The mean duration of ECMO support was 6.8 ± 7.4 days. The rates of successful ECMO weaning and survival to discharge were 44.3% and 31.1%, respectively. There were 18 nosocomial infections in 14 (23.0%) patients. These included respiratory tract infections in 9 cases and bloodstream infections in a further 9. In multivariate analysis, independent predictors of infection during ECMO were the preoperative creatinine level (hazard ratio [HR], 2.176; 95% confidence interval [CI], 1.065–4.447; P = 0.033) and the duration of ECMO support (HR, 1.400; 95% CI, 1.081–1.815; P = 0.011). A higher preoperative creatinine level and an extended duration of ECMO support are risk factors for infection. Therefore, to avoid the development of nosocomial infections, strategies to shorten the length of ECMO support should be applied whenever possible. PMID:28244284

  4. Nosocomial Infection in Adult Patients Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation.

    PubMed

    Kim, Gwan Sic; Lee, Kyo Seon; Park, Choung Kyu; Kang, Seung Ku; Kim, Do Wan; Oh, Sang Gi; Oh, Bong Suk; Jung, Yochun; Kim, Seok; Yun, Ju Sik; Song, Sang Yun; Na, Kook Joo; Jeong, In Seok; Ahn, Byoung Hee

    2017-04-01

    Data on the frequency of nosocomial infections during extracorporeal membrane oxygenation (ECMO) in adult populations remain scarce. We investigated the risk factors for nosocomial infections in adult patients undergoing venoarterial ECMO (VA-ECMO) support. From January 2011 to December 2015, a total of 259 patients underwent ECMO. Of these, patients aged 17 years or less and patients undergoing ECMO for less than 48 hours were excluded. Of these, 61 patients diagnosed with cardiogenic shock were evaluated. Mean patient age was 60.6 ± 14.3 years and 21 (34.4%) patients were female. The mean preoperative Sequential Organ Failure Assessment (SOFA) score was 8.6 ± 2.2. The mean duration of ECMO support was 6.8 ± 7.4 days. The rates of successful ECMO weaning and survival to discharge were 44.3% and 31.1%, respectively. There were 18 nosocomial infections in 14 (23.0%) patients. These included respiratory tract infections in 9 cases and bloodstream infections in a further 9. In multivariate analysis, independent predictors of infection during ECMO were the preoperative creatinine level (hazard ratio [HR], 2.176; 95% confidence interval [CI], 1.065-4.447; P = 0.033) and the duration of ECMO support (HR, 1.400; 95% CI, 1.081-1.815; P = 0.011). A higher preoperative creatinine level and an extended duration of ECMO support are risk factors for infection. Therefore, to avoid the development of nosocomial infections, strategies to shorten the length of ECMO support should be applied whenever possible.

  5. Investigation of the relationship between heat loss and nitrogen excretion in elderly patients undergoing major abdominal surgery under general anaesthetic.

    PubMed

    Carli, F; Clark, M M; Woollen, J W

    1982-10-01

    An attempt was made to reduce heat loss in elderly patients undergoing major abdominal surgery. Two groups were studied. In one group, efforts were made to minimize heat loss by using a hot-water humidifier in the anaesthetic circuit, a hot-water circulating mattress under the patient and warming all i.v. fluids. Otherwise, the surgical and anaesthetic techniques were comparable. The same anaesthetic technique of nitrous oxide, oxygen, pancuronium and fentanyl with intermittent positive pressure ventilation was used in all cases. Nitrogen loss was measured in urine collected over 48 h from an indwelling urinary catheter inserted soon after induction of anaesthesia. Prevention of heat loss during anaesthesia and postoperative recovery caused a significant reduction in nitrogen loss.

  6. Ketamine in adult cardiac surgery and the cardiac surgery Intensive Care Unit: An evidence-based clinical review

    PubMed Central

    Mazzeffi, Michael; Johnson, Kyle; Paciullo, Christopher

    2015-01-01

    Ketamine is a unique anesthetic drug that provides analgesia, hypnosis, and amnesia with minimal respiratory and cardiovascular depression. Because of its sympathomimetic properties it would seem to be an excellent choice for patients with depressed ventricular function in cardiac surgery. However, its use has not gained widespread acceptance in adult cardiac surgery patients, perhaps due to its perceived negative psychotropic effects. Despite this limitation, it is receiving renewed interest in the United States as a sedative and analgesic drug for critically ill-patients. In this manuscript, the authors provide an evidence-based clinical review of ketamine use in cardiac surgery patients for intensive care physicians, cardio-thoracic anesthesiologists, and cardio-thoracic surgeons. All MEDLINE indexed clinical trials performed during the last 20 years in adult cardiac surgery patients were included in the review. PMID:25849690

  7. Impact of hypertonic saline on postoperative complications for patients undergoing upper gastrointestinal surgery

    PubMed Central

    Hong, Siqi; Shang, Qingjuan; Geng, Qiankun; Yang, Yang; Wang, Yan; Guo, Chunbao

    2017-01-01

    Abstract The aim of this study was to explore the impact of 3% hypertonic saline (HS) intragastric administration for patients who underwent upper gastrointestinal surgery. During the postoperative period, 3% HS has been suggested as a means to improve the intestinal edema and reduce gastrointestinal complications. The medical records of 111 patients with HS intragastric administration following upper gastrointestinal surgery and 268 patients, served as control, were reviewed retrospectively. Propensity score matching was performed to adjust for selected baseline variables. Clinical outcomes, including early gastrointestinal function recovery, postoperative complications, and length of hospital stay, were compared according to the HS intragastric administration or not. HS intragastric administration was associated with prompt postoperative gastrointestinal function recovery, including first flatus (risk ratio [RR], 1.32; 95% confidence interval [CI], 0.89–1.65; P = 0.048) and feeding within 3 postoperative days (RR (95% CI), 0.57 (0.49–0.77); P = 0.036). Early ileus occurred in 25 of 108 patients with HS treatment versus 36 of 108 patients without HS treatment (RR (95% CI), 1.43 (0.63–2.15); P = 0.065). The patients with HS experienced a lower overall postoperative complication (odds ratio [OD] 0.57; 95% CI, 0.33–1.09; P = 0.063), including trend toward a decrease for infectious complications (15[13.9] vs 23[21.3]; P = 0.11; OD, 0.59; 95% CI, 0.29–1.22). There was a decreased incidence of anastomotic leakage (1[0.9] vs 7[6.5]; P = 0.033) and postoperative ileuas (5[4.6%] vs 11[10.2%]; P = 0.096) in the HS administration patients. Our study demonstrated beneficial postoperative clinical effects of HS intragastric administration in patients who had undergone upper gastrointestinal surgery, such as prompt postoperative gastrointestinal function recovery and reduced overall postoperative complications, which may be attributed to a

  8. Comparison of harmonic blade versus traditional approach in canine patients undergoing spinal decompressive surgery for naturally occurring thoracolumbar disk extrusion

    PubMed Central

    Hettlich, Bianca F.; Cook, Laurie; London, Cheryl; Fosgate, Geoffrey T.

    2017-01-01

    Objectives To assess feasibility of the harmonic Osteovue blade (HOB) for use in the soft tissue approach for dogs undergoing hemilaminectomy and to compare outcomes between dogs undergoing HOB or traditional approach (TRAD). Methods A prospective randomized clinical trial was performed using 20 client-owned dogs with thoracolumbar intervertebral disk extrusion requiring hemilaminectomy. Dogs were randomly assigned to HOB or TRAD. Neurologic function and pain scores were assessed pre-operatively. Intraoperative blood loss and surgical approach time as well as postoperative pain and wound healing scores were recorded. Additionally, neurologic recovery and owner perceived quality of life were recorded at day 10 and 30 postoperative. Results There was no significant difference in sex distribution, weight, age, preoperative neurological grade and pain score, and perioperative outcome measures between groups. Intraoperative total blood loss was minimal for HOB and TRAD (median: 0 ml (range 0–9) and 2.2 ml (range 0–6.8), respectively; p = 0.165) and approach times were similar (median: 7 min (range 5–12) and 8 min (range 5–13), respectively; p = 0.315). While changes in wound healing scores were similar, changes in postoperative pain scores and neurological function were significantly improved in the HOB compared to the TRAD group. Postoperative complications in the HOB group consisted of automutilation of part of the incision and development of a small soft, non-painful subcutaneous swelling in 1 dog each. Conclusions The HOB is a safe and effective tool for the soft tissue approach for routine spinal surgery in dogs and is associated with decreased pain and increased neurological function post-surgery. PMID:28253289

  9. Effect of ischemic postconditioning on myocardial protection in patients undergoing coronary artery bypass grafting surgery with cardiopulmonary bypass

    PubMed Central

    Safaei, Nasser; Sheikhalizadeh, Mohammad Ali; Badalzadeh, Reza

    2016-01-01

    Introduction: Reperfusion injury is a well-known phenomenon following restoration of the coronary circulation after coronary artery bypass grafting (CABG) that impairs myocardial function. In order to control the severity of this injury, we aimed to investigate the effect of a new conditioning strategy namely ischemic postconditioning (IPOC) along with controlled aortic root reperfusion (CARR) on myocardial protection in CABG surgery with cardiopulmonary bypass. Methods: In a doubled blind clinical trial study, 51 patients undergoing first-time elective CABG were randomly divided in three groups: CARR, IPOC, and combination of IPOC and CARR. At the end of procedure and just before aortic cross-clamp removal, reperfusion was started as following: In CARR-receiving groups, the reperfusion was started with low perfusion pressures for 10 minutes, and in IPOC-receiving groups, three cycles of 1 minute episodes of ischemia separated by 1 minute episodes of reperfusion was applied as postconditioning protocol. Left ventricular ejection fraction (EF) (by echocardiography), inotrope requirement index, and myocardial arrhythmias were measured up to 72 hours after operation. Results: Echocardiography revealed that the recovery of EF after operation in IPOC group was significantly higher than those of two other groups (P < 0.05). Inotropic support requirement was significantly lower in IPOC groups. In addition, the incidence of atrial and ventricular arrhythmias after opening of aortic clamp and in intensive care unit (ICU) as well as recovery time of cardiac rhythm upon reperfusion were lowered by administration of IPOC, as compared with CARR group. Conclusion: The study suggests that IPOC may provide clinical benefits against reperfusion injury in patients undergoing CABG surgery and maintain the post ischemic left ventricular performance. PMID:27489599

  10. Nutrition Support for Children Undergoing Congenital Heart Surgeries: A Narrative Review.

    PubMed

    Wong, Judith J M; Cheifetz, Ira M; Ong, Chengsi; Nakao, Masakazu; Lee, Jan Hau

    2015-07-01

    Energy imbalance in infants and children with congenital heart disease (CHD) is common and influenced by age, underlying cardiac diagnoses, and presence or absence of congestive heart failure. During the surgical hospitalization period, these children are prone to nutritional deterioration due to stress of surgery, anesthetic/perfusion techniques, and postoperative care. Poor nutrition is associated with increased perioperative morbidity and mortality. This review aims to examine various aspects of nutrition in critically ill children with CHD, including (1) energy expenditure, (2) perioperative factors that contribute to energy metabolism, (3) bedside practices that are potentially able to optimize nutrient delivery, and (4) medium- to long-term impact of energy balance on clinical outcomes. We propose a nutrition algorithm to optimize nutrition of these children in the perioperative period where improvements in nutrition status will likely impact surgical outcomes.

  11. Clinical evolution of mediastinitis in patients undergoing adjuvant hyperbaric oxygen therapy after coronary artery bypass surgery

    PubMed Central

    do Egito, Julyana Galvão Tabosa; Abboud, Cely Saad; de Oliveira, Aline Pâmela Vieira; Máximo, Carlos Alberto Gonçalves; Montenegro, Carolina Moreira; Amato, Vivian Lerner; Bammann, Roberto; Farsky, Pedro Silvio

    2013-01-01

    ABSTRACT Objective: To evaluate the use of hyperbaric oxygen therapy as an adjunctive treatment in mediastinitis after coronary artery bypass surgery. Methods: This is a retrospective descriptive study, performed between October 2010 and February 2012. Hyperbaric oxygen therapy was indicated in difficult clinical management cases despite antibiotic therapy. Results: We identified 18 patients with mediastinitis during the study period. Thirty three microorganisms were isolated, and polymicrobial infection was present in 11 cases. Enterobacteriaceae were the most prevalent pathogens and six were multi-resistant agents. There was only 1 hospital death, 7 months after the oxygen therapy caused by sepsis, unrelated to hyperbaric oxygen therapy. This treatment was well-tolerated. Conclusion: The initial data showed favorable clinical outcomes. PMID:24136762

  12. Anesthetic considerations in the patients of chronic obstructive pulmonary disease undergoing laparoscopic surgeries.

    PubMed

    Khetarpal, Ranjana; Bali, Kusum; Chatrath, Veena; Bansal, Divya

    2016-01-01

    The aim of this study was to review the various anesthetic options which can be considered for laparoscopic surgeries in the patients with the chronic obstructive pulmonary disease. The literature search was performed in the Google, PubMed, and Medscape using key words "analgesia, anesthesia, general, laparoscopy, lung diseases, obstructive." More than thirty-five free full articles and books published from the year 1994 to 2014 were retrieved and studied. Retrospective data observed from various studies and case reports showed regional anesthesia (RA) to be valid and safer option in the patients who are not good candidates of general anesthesia like patients having obstructive pulmonary diseases. It showed better postoperative patient outcome with respect to safety, efficacy, postoperative pulmonary complications, and analgesia. So depending upon disease severity RA in various forms such as spinal anesthesia, paravertebral block, continuous epidural anesthesia, combined spinal epidural anesthesia (CSEA), and CSEA with bi-level positive airway pressure should be considered.

  13. Anterior motor strip displacement in a boy with right frontal gray matter heterotopia undergoing epilepsy surgery.

    PubMed

    Little, Andrew S; Ng, Yu-Tze; Kerrigan, John F; Treiman, David M; Fram, Evan; Rekate, Harold L

    2007-09-01

    The case of a 14-year-old boy with behavioral problems and medically refractory epilepsy related to symptomatic gray matter heterotopia in the right frontal lobe is reported. The patient underwent subdural cortical grid placement for seizure localization and functional mapping prior to lesionectomy. On the basis of the patient's MRI scan, it was predicted that the motor cortex was located adjacent to the abnormality, well anterior to its expected location. This prediction was confirmed by stimulation mapping. The patient underwent successful resection of the lesion under the guidance of the cortical map. Postoperatively, his seizures and behavior improved markedly. This case highlights how eloquent cortex can rarely be drawn toward a region of gray matter heterotopia. In addition, he is one of the few reported cases of focal cortical dysplasia resection with resultant improved behavior. These observations of unusual cortical representations have implications in epilepsy surgery planning.

  14. Factors Associated With Quality Of Life In Women Undergoing Surgery For Stress Urinary Incontinence

    PubMed Central

    Sirls, Larry T.; Tennstedt, Sharon; Albo, Mike; Chai, Toby; Kenton, Kim; Huang, Liyuan; Stoddard, Anne M; Arisco, Amy; Gormley, E. Ann

    2014-01-01

    Purpose To determine the association of clinicodemographic factors with urinary incontinence (UI) related quality of life (QoL) in women having surgery for stress urinary incontinence (SUI) and to compare the incontinence-specific IIQ (Incontinence Impact Questionnaire) and the ICIQ (International Consultation on Incontinence Questionnaire). Secondary objectives evaluated the contributions of incontinence severity and sexual function to QoL. Materials and Methods Baseline data from 597 women in the Trial of Mid Urethral Slings (TOMUS). Correlates of QoL tested included health status and history, type, severity and bother of UI, and sexual function. Results Lower QoL by both the IIQ and ICIQ included younger age, higher BMI, more SUI symptoms, and more severe and bothersome UI symptoms. Each measure identified factors associated with lower QoL not identified by the other (IIQ; Hispanic ethnicity, poor health status and more urge UI symptoms, and ICIQ; prior UI treatment and more UI episodes per day). Sexually active women had similar QoL but also increased incontinence episodes (IIQ and ICIQ) and more sexual dysfunction (IIQ only). Conclusion In women planning SUI surgery, QoL is associated with non-UI factors as well as with the type, severity and degree of bother from UI symptoms. Many factors are associated with QoL as measured by both IIQ and ICIQ. However more non-UI factors were associated with QoL when measured by the IIQ than by the ICIQ. More than one scale may be needed to evaluate QoL after SUI treatment. PMID:20952014

  15. Stacked Modalities' Thromboprophylactic Therapy for Patients Undergoing Total Knee Replacement Surgery.

    PubMed

    Jiang, Limin; Zhang, Shudong; Zhao, Yuchi

    2017-03-01

    Thromboprophylaxis is a controversial and challenging topic in joint replacement surgery. Mechanical prophylaxis in combination with the use of anticoagulants have been shown to have greater efficacy than single modalities. But the early use of anticoagulants has the potential to increases the risk of postoperative bleeding. The purpose of this study was to evaluate the thromboprophylactic effects of sequential combined method using early-mechanical compression with delayed rivaroxaban in total knee arthroplasty. A retrospective cohort study, including 369 patients receiving simultaneous combined mechanical and pharmacological thromboprophylactic modality and 385 patients receiving sequential combined modality with early-mechanical compression treatment followed by rivaroxaban 2 days later after primary total knee arthroplasty surgery was conducted. The incidence rates of proximal and distal deep vein thrombosis (DVT) on the 2nd day and the 5th week and the volume of wound drainage were compared postoperatively. On the 2nd postoperative day, the incidence rates of proximal and distal DVT in the sequential group (1.56, 4.16%) had no significant difference compared with those (1.08, 3.25%) in the simultaneous group (p = 0.569, 0.507, respectively). No difference was found in the incidence rate of proximal and distal DVT on the 5th week between groups. No pulmonary embolism occurred. The mean volume of wound drainage in the sequential group was 343 mL which was 98 mL lesser than in the simultaneous group (p < 0.001). The sequential combined method as called "stacked modalities" thromboprophylactic therapy following total knee arthroplasty was safe and effective. The use of the mechanical compression method alone during the early-postoperative 48 hours, then followed by rivaroxaban then until the 5th week had the same antithrombotic effects and reduced the postoperative wound drainage volume as compared with simultaneous combined modalities.

  16. Retrospective radiological outcome analysis following teriparatide use in elderly patients undergoing multilevel instrumented lumbar fusion surgery

    PubMed Central

    Kaliya-Perumal, Arun-Kumar; Lu, Meng-Ling; Luo, Chi-An; Tsai, Tsung-Ting; Lai, Po-Liang; Chen, Lih-Huei; Chen, Wen-Jer; Niu, Chi-Chien

    2017-01-01

    Abstract Elderly patients with chronic nonresolving symptoms due to degenerative spine pathologies are prone to have poor surgical outcomes and hardware-related complications, especially following multilevel instrumented lumbar fusion surgeries. With intention of analyzing if teriparatide can be an effective adjunct therapy to surgical management, radiological outcomes are studied. Sixty-two elderly patients were divided into 2 similar groups. Group 1 (n = 30; mean age = 69.83 years; fusion levels = 137; screws = 269) had taken teriparatide (20 mcg SC injection, once daily) for a duration of 7.4 ± 2.4 months following surgery and Group 2 (n = 32; mean age = 70.38 years; fusion levels = 144; screws = 283) did not take teriparatide. Radiological evaluation was done to determine the state of postero lateral fusion mass and to investigate the incidence of pedicle screw loosening at 1-year follow-up. Unilateral or bilateral bridging bone formation across the transverse process of adjacent vertebras showing continuous trabeculation suggestive of solid fusion was obtained in 66.7% patients in the teriparatide group and 50% patients in the control group (P = 0.20). 13.4% of the total no. of screws showed signs of loosening in the teriparatide group, compared to 24.4% in the control group (P = 0.001). Percentage of patients achieving solid fusion following teriparatide use was found to be more than that of the control group. This difference may have clinical importance but was not statistically significant. However, teriparatide use was more significantly influential in reducing the incidence of subsequent pedicle screw loosening. PMID:28151894

  17. Preoperative Antihypertensive Medication in Relation to Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery: A Meta-Analysis

    PubMed Central

    Zhou, Ai-Guo; Chen, An-ji; Zhang, Xiong-fei; Deng, Hui-wei

    2017-01-01

    Background. We undertake a systematic review and meta-analysis to evaluate the effect of preoperative hypertension and preoperative antihypertensive medication to postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery. Methods. We searched PubMed, Embase, and Cochrane Library (from inception to March 2016) for eligible studies. The outcomes were the effects of preoperative hypertension, preoperative calcium antagonists regimen, preoperative ACE inhibitors regimen, and preoperative beta blocking agents regimen with POAF. We calculated pooled risk ratios (OR) and 95% CIs using random- or fixed-effects models. Results. Twenty-five trials involving 130087 patients were listed. Meta-analysis showed that the number of preoperative hypertension patients in POAF group was significantly higher (P < 0.05), while we found that there are no significant differences between two groups in Asia patients by subgroup analysis, which is in contrast to other outcomes. Compared with the Non-POAF group, the number of patients who used calcium antagonists and ACE inhibitors preoperatively in POAF group was significantly higher (P < 0.05). And we found that there were no significant differences between two groups of preoperative beta blocking agents used (P = 0.08). Conclusions. Preoperative hypertension and preoperative antihypertensive medication in patients undergoing cardiac operations seem to be associated with higher risk of POAF. PMID:28286753

  18. Effects of pulsatile perfusion during cardiopulmonary bypass on biochemical markers and kidney function in patients undergoing cardiac surgeries.

    PubMed

    Mohammadzadeh, Alireza; Jafari, Naser; Hasanpour, Mohammad; Sahandifar, Soheil; Ghafari, Masoud; Alaei, Vahed

    2013-01-01

    For several years there is no conclusive guideline on the effectiveness of pulsatile or non-pulsatile perfusion during cardiopulmonary bypass (CPB) in patients undergoing cardiac surgeries. In this study, we evaluated the effect of pulsatile versus continuous perfusion on the myocardial release of the cardiac biochemical markers including, creatine phosphokinase (CPK), cardiac creatine kinase (CK-MB), and lactate dehydrogenase (LDH), and also kidney function tests including: blood urea nitrogen test (BUN) and creatinine test (Cr) in patients that underwent both pulsatile and non-pulsatile methods before and after heart surgeries. A total of 80 patients were enrolled in this study, 40 patients in each pulsatile and non-pulsatile group. Venous blood samples were drown from each patient in two groups before operation and after operation at, 24, 48, and 72 h and analyzed separately for CPK, its cardiac isoenzyme (CK-MB), LDH, BUN and Cr. There were no significant differences between the two groups with regard to preoperative parameters such as sex, age, and body surface area. Our study shows that the effect of pulsatile perfusion on cardiac and kidney function is better than the non-pulsatile method.

  19. The perioperative dental screening and management of patients undergoing cardiothoracic, vascular surgery and other cardiovascular invasive procedures: A systematic review.

    PubMed

    Cotti, Elisabetta; Arrica, Mariantonietta; Di Lenarda, Andrea; Serri, Sara B; Bassareo, Pierpaolo; Padeletti, Luigi; Mercuro, Giuseppe

    2017-03-01

    Background One controversial issue in the relationship between oral care and cardiovascular diseases is how and whether to manage oral infections prior to cardiovascular surgery or other cardiovascular invasive procedures. Design We designed a systematic review to assess the information available on three main questions. Is there an agreement on the need for dental evaluation and treatment before cardiovascular interventions? Are consistent clinical recommendations or protocols available? Is dental treatment prior to cardiovascular interventions effective? Methods A systematic electronic search of MEDLINE, Scopus and Web of Science was performed from the database inceptions up to 31 April 2016. Searches were performed using Boolean operators to combine medical subject headings and free text words. Because this review included a large, heterogeneous group of study designs and sources, the results were synthesised in a narrative approach. Results In total, 2447 studies were identified: 2099 (+241 duplicates) were excluded after screening; 107 were included for full-text assessment; 55 were excluded for not meeting the inclusion criteria; and 11 were not available. Thus, 44 studies meeting the inclusion criteria were analysed. We found that, for patients undergoing cardiovascular surgery, there is a general agreement on the need for screening and treatment of dental infections, but not on the protocols. We also found that there are conflicting indications on when and to what extent to perform the treatment and that the risk-to-benefit ratios for these treatments are controversial. Conclusion No satisfactory answers regarding dental care before cardiovascular invasive procedures are available.

  20. A Comparison of Third-Generation Semi-Invasive Arterial Waveform Analysis with Thermodilution in Patients Undergoing Coronary Surgery

    PubMed Central

    Broch, Ole; Renner, Jochen; Gruenewald, Matthias; Meybohm, Patrick; Schöttler, Jan; Steinfath, Markus; Malbrain, Manu; Bein, Berthold

    2012-01-01

    Uncalibrated semi-invasive continous monitoring of cardiac index (CI) has recently gained increasing interest. The aim of the present study was to compare the accuracy of CI determination based on arterial waveform analysis with transpulmonary thermodilution. Fifty patients scheduled for elective coronary surgery were studied after induction of anaesthesia and before and after cardiopulmonary bypass (CPB), respectively. Each patient was monitored with a central venous line, the PiCCO system, and the FloTrac/Vigileo-system. Measurements included CI derived by transpulmonary thermodilution and uncalibrated semi-invasive pulse contour analysis. Percentage changes of CI were calculated. There was a moderate, but significant correlation between pulse contour CI and thermodilution CI both before (r2 = 0.72, P < 0.0001) and after (r2 = 0.62, P < 0.0001) CPB, with a percentage error of 31% and 25%, respectively. Changes in pulse contour CI showed a significant correlation with changes in thermodilution CI both before (r2 = 0.52, P < 0.0001) and after (r2 = 0.67, P < 0.0001) CPB. Our findings demonstrated that uncalibrated semi-invasive monitoring system was able to reliably measure CI compared with transpulmonary thermodilution in patients undergoing elective coronary surgery. Furthermore, the semi-invasive monitoring device was able to track haemodynamic changes and trends. PMID:22919321

  1. A comparison of third-generation semi-invasive arterial waveform analysis with thermodilution in patients undergoing coronary surgery.

    PubMed

    Broch, Ole; Renner, Jochen; Gruenewald, Matthias; Meybohm, Patrick; Schöttler, Jan; Steinfath, Markus; Malbrain, Manu; Bein, Berthold

    2012-01-01

    Uncalibrated semi-invasive continous monitoring of cardiac index (CI) has recently gained increasing interest. The aim of the present study was to compare the accuracy of CI determination based on arterial waveform analysis with transpulmonary thermodilution. Fifty patients scheduled for elective coronary surgery were studied after induction of anaesthesia and before and after cardiopulmonary bypass (CPB), respectively. Each patient was monitored with a central venous line, the PiCCO system, and the FloTrac/Vigileo-system. Measurements included CI derived by transpulmonary thermodilution and uncalibrated semi-invasive pulse contour analysis. Percentage changes of CI were calculated. There was a moderate, but significant correlation between pulse contour CI and thermodilution CI both before (r(2) = 0.72, P < 0.0001) and after (r(2) = 0.62, P < 0.0001) CPB, with a percentage error of 31% and 25%, respectively. Changes in pulse contour CI showed a significant correlation with changes in thermodilution CI both before (r(2) = 0.52, P < 0.0001) and after (r(2) = 0.67, P < 0.0001) CPB. Our findings demonstrated that uncalibrated semi-invasive monitoring system was able to reliably measure CI compared with transpulmonary thermodilution in patients undergoing elective coronary surgery. Furthermore, the semi-invasive monitoring device was able to track haemodynamic changes and trends.

  2. Increased coronary artery disease severity in black women undergoing coronary bypass surgery.

    PubMed

    Efird, Jimmy T; O'Neal, Wesley T; Griffin, William F; Anderson, Ethan J; Davies, Stephen W; Landrine, Hope; O'Neal, Jason B; Shiue, Kristin Y; Kindell, Linda C; Bruce Ferguson, T; Randolph Chitwood, W; Kypson, Alan P

    2015-02-01

    Race and sex disparities are believed to play an important role in heart disease. The purpose of this study was to examine the association between race, sex, and number of diseased vessels at the time of coronary artery bypass grafting (CABG), and subsequent postoperative outcomes. The 13,774 patients undergoing first-time, isolated CABG between 1992 and 2011 were included. Trend in the number of diseased vessels between black and white patients, stratified by sex, were analyzed using a Cochran-Armitage trend test. Models were adjusted for age, procedural status (elective vs. nonelective), and payor type (private vs. nonprivate insurance). Black female CABG patients presented with an increasingly greater number of diseased vessels than white female CABG patients (adjusted P(trend) = 0.0021). A similar trend was not observed between black and white male CABG patients (adjusted P(trend) = 0.18). Black female CABG patients were also more likely to have longer intensive care unit and hospital lengths of stay than other race-sex groups.Our findings suggest that black female CABG patients have more advanced coronary artery disease than white female CABG patients. Further research is needed to determine the benefit of targeted preventive care and preoperative workup for this high-risk group.

  3. Anesthetic management of a patient with Sturge-Weber syndrome undergoing oral surgery.

    PubMed

    Yamashiro, Mikiko; Furuya, Hideki

    2006-01-01

    This case involves a possible complication of excessive bleeding or rupture of hemangiomas. Problems and anesthetic management of the patient are discussed. A 35-year-old man with Sturge-Weber syndrome was to undergo teeth extraction and gingivectomy. Hemangiomas covered his face and the inside of the oral cavity. We used intravenous conscious sedation with propofol and N2O-O2 to reduce the patient's emotional stress. It was previously determined that stress caused marked expansion of this patient's hemangiomas. Periodontal ligament injection was chosen as the local anesthesia technique. Teeth were extracted without excessive bleeding or rupture of hemangiomas, but the planned gingivectomies were cancelled. Deep sedation requiring airway manipulation should be avoided because there are possible difficulties in airway maintenance. Because this was an outpatient procedure, propofol was selected as the sedative agent primarily because of its rapid onset and equally rapid recovery. Periodontal ligament injection with 2% lidocaine containing 1: 80,000 epinephrine was chosen for local anesthesia. Gingivectomy was cancelled because hemostasis was challenging. As part of preoperative preparation, equipment for prompt intubation was available in case of rupture of the hemangiomas. The typically seen elevation of blood pressure was suppressed under propofol sedation so that expansion of the hemangiomas and significant intraoperative bleeding was prevented. Periodontal ligament injection as a local anesthetic also prevented bleeding from the injection site.

  4. Shikani Optical Stylet versus Macintosh Laryngoscope for Intubation in Patients Undergoing Surgery for Cervical Spondylosis: A Randomized Controlled Trial

    PubMed Central

    Xu, Mao; Li, Xiao-Xi; Guo, Xiang-Yang; Wang, Jun

    2017-01-01

    Background: Airway management is critical in patients with cervical spondylosis, a population with a high incidence of difficult airway. Intubation with Shikani Optical Stylet (SOS) has become increasingly popular in difficult airway. We compared the effects of intubation with SOS versus Macintosh laryngoscope (MLS) in patients undergoing surgery for cervical spondylosis. Methods: A total of 270 patients scheduled for elective surgery for cervical spondylosis of spinal cord and nerve root type from August 2012 to January 2016 were enrolled and randomly allocated to the MLS or SOS group by random numbers. Patients were evaluated for difficult airway preoperatively, and Cormack-Lehane laryngoscopy classification was determined during anesthesia induction. Difficult airway was defined as Cormack-Lehane Grades III–IV. Patients were intubated with the randomly assigned intubation device. The success rate, intubation time, required assistance, immediate complications, and postoperative complaints were recorded. Categorical variables were analyzed by Chi-square test, and continuous variables were analyzed by independent samples t-test or rank sum test. Results: The success rate of intubation among normal airways was 100% in both groups. In patients with difficult airway, the success rates in the MLS and SOS groups were 84.2% and 94.1%, respectively (P = 0.605). Intubation with SOS took longer compared with MLS (normal airway: 25.1 ± 5.8 s vs. 24.5 ± 5.7 s, P = 0.426; difficult airway: 38.5 ± 8.5 s vs. 36.1 ± 8.2 s, P = 0.389). Intubation with SOS required less assistance in patients with difficult airway (5.9% vs. 100%, P < 0.001). The frequency of postoperative sore throat was lower in SOS group versus MLS group in patients with normal airway (22.0% vs. 34.5%, P = 0.034). Conclusions: SOS is a safe and effective airway management device in patients undergoing surgery for cervical spondylosis. Compared with MLS, SOS appears clinically beneficial for intubation

  5. Anesthetic considerations in the patients of chronic obstructive pulmonary disease undergoing laparoscopic surgeries

    PubMed Central

    Khetarpal, Ranjana; Bali, Kusum; Chatrath, Veena; Bansal, Divya

    2016-01-01

    The aim of this study was to review the various anesthetic options which can be considered for laparoscopic surgeries in the patients with the chronic obstructive pulmonary disease. The literature search was performed in the Google, PubMed, and Medscape using key words “analgesia, anesthesia, general, laparoscopy, lung diseases, obstructive.” More than thirty-five free full articles and books published from the year 1994 to 2014 were retrieved and studied. Retrospective data observed from various studies and case reports showed regional anesthesia (RA) to be valid and safer option in the patients who are not good candidates of general anesthesia like patients having obstructive pulmonary diseases. It showed better postoperative patient outcome with respect to safety, efficacy, postoperative pulmonary complications, and analgesia. So depending upon disease severity RA in various forms such as spinal anesthesia, paravertebral block, continuous epidural anesthesia, combined spinal epidural anesthesia (CSEA), and CSEA with bi-level positive airway pressure should be considered. PMID:26957682

  6. Emotional and sexual concerns in women undergoing pelvic surgery and associated treatment for gynecologic cancer

    PubMed Central

    Stabile, Cara; Gunn, Abigail; Sonoda, Yukio

    2015-01-01

    The surgical management of gynecologic cancer can cause short- and long-term effects on sexuality, emotional well being, reproductive function, and overall quality of life (QoL). Fortunately, innovative approaches developed over the past several decades have improved oncologic outcomes and reduced treatment sequelae; however, these side effects of treatment are still prevalent. In this article, we provide an overview of the various standard-of-care pelvic surgeries and multimodality cancer treatments (chemotherapy and radiation therapy) by anatomic site and highlight the potential emotional and sexual consequences that can influence cancer survivorship and QoL. Potential screening tools that can be used in clinical practice to identify some of these concerns and treatment side effects and possible solutions are also provided. These screening tools include brief assessments that can be used in the clinical care setting to assist in the identification of problematic issues throughout the continuum of care. This optimizes quality of care, and ultimately, QoL in these women. Prospective clinical trials with gynecologic oncology populations should include patient-reported outcomes to identify subgroups at risk for difficulties during and following treatment for early intervention. PMID:26816823

  7. Practical anesthetic considerations in patients undergoing tracheobronchial surgeries: a clinical review of current literature

    PubMed Central

    Ahuja, Sanchit; Cohen, Barak; Hinkelbein, Jochen; Diemunsch, Pierre

    2016-01-01

    Tracheobronchial surgeries require close cooperation and extensive communication between the anesthesia providers and the surgeons. Anesthetic management of tracheal and bronchial pathologies differ basically from regular upper airways management, due access to the patients airway is limited, mostly even practically impossible for the anesthesia providers. As a consequence, the surgeon overtakes responsibility for the airway access from the anesthesia provider in the variety of the cases. Preoperative recognition of a difficult airway, detailed planning and being aware of plan B and plan C are the elementary keys to success. Providers have to be aware, that preoperative airway assessment does not always correlate with the ease of oxygenation and ventilation. Therefore, various methods have been described in the literature and several authors have adopted unique ways to manage the airways in a successful manner. With the advancement of surgical techniques over the years, anesthetic management has also evolved tremendously to match the needs. The commonly encountered conditions requiring surgical interventions include post-intubation stenosis and foreign body aspiration. In this review we will discuss the most common pathologies of tracheobronchial lesions and specific anesthetic management considerations related to them. PMID:28066624

  8. Lateral interbody fusion combined with open posterior surgery for adult spinal deformity.

    PubMed

    Strom, Russell G; Bae, Junseok; Mizutani, Jun; Valone, Frank; Ames, Christopher P; Deviren, Vedat

    2016-12-01

    OBJECTIVE Lateral interbody fusion (LIF) with percutaneous screw fixation can treat adult spinal deformity (ASD) in the coronal plane, but sagittal correction is limited. The authors combined LIF with open posterior (OP) surgery using facet osteotomies and a rod-cantilever technique to enhance lumbar lordosis (LL). It is unclear how this hybrid strategy compares to OP surgery alone. The goal of this study was to evaluate the combination of LIF and OP surgery (LIF+OP) for ASD. METHODS All thoracolumbar ASD cases from 2009 to 2014 were reviewed. Patients with < 6 months follow-up, prior fusion, severe sagittal imbalance (sagittal vertical axis > 200 mm or pelvic incidence-LL > 40°), and those undergoing anterior lumbar interbody fusion were excluded. Deformity correction, complications, and outcomes were compared between LIF+OP and OP-only surgery patients. RESULTS LIF+OP (n = 32) and OP-only patients (n = 60) had similar baseline features and posterior fusion levels. On average, 3.8 LIFs were performed. Patients who underwent LIF+OP had less blood loss (1129 vs 1833 ml, p = 0.016) and lower durotomy rates (0% vs 23%, p = 0.002). Patients in the LIF+OP group required less ICU care (0.7 vs 2.8 days, p < 0.001) and inpatient rehabilitation (63% vs 87%, p = 0.015). The incidence of new leg pain, numbness, or weakness was similar between groups (28% vs 22%, p = 0.609). All leg symptoms resolved within 6 months, except in 1 OP-only patient. Follow-up duration was similar (28 vs 25 months, p = 0.462). LIF+OP patients had significantly less pseudarthrosis (6% vs 27%, p = 0.026) and greater improvement in visual analog scale back pain (mean decrease 4.0 vs 1.9, p = 0.046) and Oswestry Disability Index (mean decrease 21 vs 12, p = 0.035) scores. Lumbar coronal correction was greater with LIF+OP surgery (mean [± SD] 22° ± 13° vs 14° ± 13°, p = 0.010). LL restoration was 22° ± 13°, intermediately between OP-only with facet osteotomies (11° ± 7°, p < 0.001) and

  9. Postoperative epidural analgesia for patients undergoing pectus excavatum corrective surgery: a 10-year retrospective analysis

    PubMed Central

    Siddiqui, Asad; Tse, Andrew; Paul, James E; Fitzgerald, Peter; Teh, Bernice

    2016-01-01

    Introduction Managing postoperative pain in patients undergoing minimally invasive pectus excavatum repair (Nuss procedure) is challenging but essential in facilitating ambulation and minimizing the length of stay. Although multiple epidural regimens with varying opioids are presently used for pain management, there is currently no clinical consensus regarding which epidural regimen provides the best analgesia outcomes with the fewest side effects. This 10-year retrospective cohort study was performed to compare the quality of analgesia and the incidence of side effects associated with the three most common epidural regimens used at a tertiary care children’s hospital, in patients undergoing the Nuss procedure. Methods Seventy-two pediatric patients were identified as having been treated with one of three epidural regimens for postoperative pain management following the Nuss procedure: Group A (n=12) received 0.125% bupivacaine and 5 µg/mL fentanyl, Group B (n=21) received 0.125% bupivacaine and 10 µg/mL hydromorphone, and Group C (n=39) received 0.1% ropivacaine and 20 µg/mL hydromorphone. Our primary outcome was maximal daily pain scores (numerical rating scale 0–10), with an analytical focus on postoperative day 1 scores. The primary outcome was analyzed using linear regression. The secondary outcomes included the length of stay, side-effect profiles as reflected by the number of treatments for nausea and pruritus, pain scores according to epidural site insertion, occurrence of breakthrough pain, and presence of severe pain throughout their hospital stay. Secondary outcomes were analyzed using linear or logistic regression adjusted for pain scores at baseline. The criterion for statistical significance was set a priori at alpha =0.05. Results Group A had significantly higher day-1 pain scores (score 5.42/10) than Group B (4.52/10; P=0.030) and Group C (4.49/10; P=0.015) after adjusting for baseline pain and age. No significant difference in maximum daily

  10. Perioperative Elevation in Cell-Free DNA Levels in Patients Undergoing Cardiac Surgery: Possible Contribution of Neutrophil Extracellular Traps to Perioperative Renal Dysfunction

    PubMed Central

    Qi, Yu; Yamamoto, Mamoru; Yamamoto, Yudai; Kido, Koji; Ito, Hiroyuki; Ohno, Nagara; Asahara, Miho; Yamada, Yoshitsugu; Yamaguchi, Osamu; Mitaka, Chieko; Tomita, Makoto; Makita, Koshi

    2016-01-01

    Background. This study aimed to determine the perioperative change in serum double-strand DNA (dsDNA) as a marker potentially reflecting neutrophil extracellular trap concentration in samples from patients undergoing cardiac surgery and to analyze a relationship between serum dsDNA concentrations and perioperative renal dysfunction. Methods. Serum dsDNA concentrations in samples that were collected during a previously conducted, prospective, multicenter, observational study were measured. Eighty patients undergoing elective cardiac surgery were studied. Serum samples were collected at baseline, immediately after surgery, and the day after surgery (POD-1). Results. Serum dsDNA concentration was significantly increased from baseline (median, 398 ng/mL [interquartile range, 372–475 ng/mL]) to immediately after surgery (median, 540 ng/mL [437–682 ng/mL], p < 0.001), and they were reduced by POD-1 (median, 323 ng/mL [256–436 ng/mL]). The difference in serum creatinine concentration between baseline and POD-1 was correlated with dsDNA concentration on POD-1 (rs = 0.61, p < 0.001). Conclusions. In patients undergoing cardiac surgery, serum dsDNA concentration is elevated postoperatively. Prolonged elevation in dsDNA concentration is correlated with perioperative renal dysfunction. Further large-scale studies are needed to determine the relationship between serum concentration of circulating dsDNA and perioperative renal dysfunction. PMID:27882047

  11. Hemolysis in Cardiac Surgery Patients Undergoing Cardiopulmonary Bypass: A Review in Search of a Treatment Algorithm

    PubMed Central

    Vercaemst, Leen

    2008-01-01

    Abstract: Hemolysis is a fact in all extracorporeal circuits, as shown in various studies by the increasing levels of plasma-free hemoglobin (PfHb) and decreasing levels of haptoglobin during and after cardiopulmonary bypass (CPB). Beside complete red blood cell (RBC) destruction or hemolysis, RBCs can also be damaged on a sublethal level, resulting in altered rheological properties. Increased levels of free RBC constituents together with an exhaust of their scavengers result in a variety of serious clinical sequela, such as increased systemic and pulmonary vascular resistance, altered coagulation profile, platelet dysfunction, renal tubular damage, and increased mortality. Sublethal RBC damage is characterized by decreased microperfusion and hypoxic RBCs, leading to end organ dysfunction caused by cellular ischemia. Isolated extracorporeal circuit components can be considered non-hemolytic if used according to recommendations, but extracorporeal circuit composition and management during CPB can still be optimized, avoiding cell damaging mechanical forces. Although most RBC destruction in standard CPB remains within the capacity of the endogenous clearing mechanisms, in some cases, levels of PfHb do substantially rise, and precautionary measures need to be taken. Higher degree of hemolysis can be expected in young children, after extensive surgery, and in prolonged support as in patients supported by ventricular assist devices (VADs) or extracorporeal membrane oxygenation (ECMO). These patients are especially susceptible to the toxic influences of unscavenged RBC constituents and the loss of rheologic properties of the RBCs. Considering the high percentage of neurologic and renal sequela in post-cardiotomy patients, all imbalances possibly contributing to these morbidities should be focused on and prevented, if not treated. Considering the severity of the consequences of RBC damage, the high incidence of this complication, and especially the lack of interventional

  12. Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: a meta-analysis of randomized trials.

    PubMed

    Pöpping, Daniel M; Elia, Nadia; Marret, Emmanuel; Wenk, Manuel; Tramèr, Martin R

    2012-04-01

    Opioids are widely used as additives to local anesthetics for intrathecal anesthesia. Benefit and risk remain unclear. We systematically searched databases and bibliographies to February 2011 for full reports of randomized comparisons of any opioid added to any intrathecal local anesthetic with the local anesthetic alone in adults undergoing surgery (except cesarean section) and receiving single-shot intrathecal anesthesia without general anesthesia. We included 65 trials (3338 patients, 1932 of whom received opioids) published between 1983 and 2010. Morphine (0.05-2mg) and fentanyl (10-50 μg) added to bupivacaine were the most frequently tested. Duration of postoperative analgesia was prolonged with morphine (weighted mean difference 503 min; 95% confidence interval [CI] 315 to 641) and fentanyl (weighted mean difference 114 min; 95% CI 60 to 168). Morphine decreased the number of patients needing opioid analgesia after surgery and decreased pain intensity to the 12th postoperative hour. Morphine increased the risk of nausea (number needed to harm [NNH] 9.9), vomiting (NNH 10), urinary retention (NNH 6.5), and pruritus (NNH 4.4). Fentanyl increased the risk of pruritus (NNH 3.3). With morphine 0.05 to 0.5mg, the NNH for respiratory depression varied between 38 and 59 depending on the definition of respiratory depression chosen. With fentanyl 10 to 40 μg, the risk of respiratory depression was not significantly increased. For none of these effects, beneficial or harmful, was there evidence of dose-responsiveness. Consequently, minimal effective doses of intrathecal morphine and fentanyl should be sought. For intrathecal buprenorphine, diamorphine, hydromorphone, meperidine, methadone, pentazocine, sufentanil, and tramadol, there were not enough data to allow for meaningful conclusions.

  13. Preoperative Nutritional Assessment in Elderly Cancer Patients Undergoing Elective Surgery: MNA or PG-SGA?

    PubMed

    Dubhashi, S P; Kayal, Akshat

    2015-12-01

    This study aims to evaluate and compare the use of patient-generated subjective global assessment (PG-SGA) and mini nutritional assessment (MNA) as a preoperative nutritional assessment tool in elderly cancer patients. This was a prospective study carried out on 47 patients, 45 years and above suffering from cancer and admitted to Padmashree Dr. D.Y. Patil Medical College and Hospital, Pune. The patients were evaluated with PG-SGA and MNA tools at the time of admission and baseline data were collected. All patients had undergone surgeries as per indications. Postoperatively, the surgical outcomes and adverse events were noted and statistically evaluated. The average age of the study sample was 61.46 years and 29 patients were females. The patients classified by PG-SGA were ten in group A and 37 in group B and C. The patients classified by MNA were five in no risk group and 42 in group with patients at risk and malnourished. When evaluated with PG-SGA in group B and C, wound infections and requirement of change of antibiotic were seen in 86.4 % patients and their average day of onset of infection was 5.6 days. Antibiotics were administered to these patients for an average of 14.2 days and their average duration of stay was 29 days. On the other hand, the evaluation of patients with MNA, at risk and malnourished patients, wound infections, and requirement of change of antibiotic were seen in 81 % of patients and their average day of onset of infection was 5.6 days. Antibiotics were administered to these patients for an average of 13.8 days and their average duration of stay was 27 days. The results were statistically significant. The mini nutritional assessment is more exhaustive in identifying patients at risk and is useful in screening populations to identify frail elderly persons allowing us to intervene earlier, thereby improving the patient prognosis. The patient-generated subjective global assessment is a more comprehensive tool for elderly cancer

  14. The Importance of Symptom Validity Testing in Adolescents and Young Adults Undergoing Assessments for Learning or Attention Difficulties

    ERIC Educational Resources Information Center

    Harrison, Allyson G.; Green, Paul; Flaro, Lloyd

    2012-01-01

    It is almost self-evident that test results will be unreliable and misleading if those undergoing assessments do not make a full effort on testing. Nevertheless, objective tests of effort have not typically been used with young adults to determine whether test results are valid or not. Because of the potential economic and/or recreational benefits…

  15. Neuroinflammation Induced by Surgery Does Not Impair the Reference Memory of Young Adult Mice

    PubMed Central

    Zhao, Yanhua; Huang, Lili; Xu, Huan; Wu, Guangxi; Zhu, Mengyi; Tian, Jie; Wang, Hao; Yu, Weifeng

    2016-01-01

    Postoperative cognitive dysfunction (POCD) increases morbidity and mortality after surgery. But the underlying mechanism is not clear yet. While age is now accepted as the top one risk factor for POCD, results from studies investigating postoperative cognitive functions in adults have been controversial, and data about the very young adult individuals are lacking. The present study investigated the spatial reference memory, IL-1β, IL-6, and microglia activation changes in the hippocampus in 2-month-old mice after anesthesia and surgery. We found that hippocampal IL-1β and IL-6 increased at 6 hours after surgery. Microglia were profoundly activated in the hippocampus 6 to 24 hours after surgery. However, no significant behavior changes were found in these mice. These results indicate that although anesthesia and surgery led to neuroinflammation, the latter was insufficient to impair the spatial reference memory of young adult mice. PMID:27956760

  16. Impact of Aprotinin - A Proteolytic Enzyme on Postsurgical Symptoms in Patients Undergoing Third Molar Surgeries

    PubMed Central

    Jegadeesan, Visakan

    2016-01-01

    Introduction Dealing with postoperative pain and inflammation remains an arena for never ending research. Different agents have been the subject of many studies to prevent the occurrence of unpleasant postoperative sequel. Extraction of third molars is often associated with significant deterioration in oral health related quality of life (physical, social and psychological) in immediate postoperative period. The complaints of pain, swelling and limitation of mouth opening, which ensue as a result of acute inflammatory response, are frequent consequences of postsurgical procedures involving extraction of impacted 3rd molars. Aim Aprotinin, a naturally occurring protease inhibitor was assessed for its effectiveness in plummeting postsurgical pain and swelling, after surgical removal of impacted 3rd molars. Materials and Methods Thirty randomly selected adult patients age ranging from 16-35 years, who required simultaneous surgical removal of bilateral impacted mandibular third molars were recruited. Before the surgical procedure, randomly selected side of the patient was injected with 1 m of 10,000 Kallikrein Inactivator Units (KIU) of aprotinin sub-mucosally around the surgical site and the contra lateral side with 1ml of isotonic saline as a control following which adequate local anaesthesia was obtained. The surgical removal of impacted 3rd molars was conducted in a similar manner on both test and control sides on all patients. Postoperatively, the patients were evaluated for pain and swelling for one week i.e., 1st, 2nd and 7th day. Results It was observed that there was marked clinical reduction in postoperative pain and swelling. There were no adverse affects observed after using aprotinin. Conclusion Since, the current pharmacologic agents being used have adverse effects and associated morbidity which still pose a problem, aprotinin a naturally occurring agent could be efficiently used after surgical extraction of 3rd molars in management of postsurgical

  17. Extended prophylaxis of venous thromboembolism with fondaparinux in patients undergoing major orthopaedic surgery in Italy: a cost-effectiveness analysis.

    PubMed

    Capri, Stefano; Ageno, Walter; Imberti, Davide; Palareti, Gualtiero; Piovella, Franco; Scannapieco, Gianluigi; Moia, Marco

    2010-02-01

    Enoxaparin is the most frequently used low-molecular weight heparin in the world, given in order to prevent venous thromboembolism (VTE) in patients undergoing major orthopaedic surgery (MOS). Fondaparinux is an effective and safe alternative. The aim of our study was to compare the cost-effectiveness of enoxaparin and fondaparinux in the extended thromboprophylaxis of patients undergoing MOS in Italy. A decision-tree model was developed: probabilities of symptomatic events were derived from the published trials; use of resources in Italy was evaluated by means of a questionnaire administered to a panel of experts. Only the direct costs of VTE (acute treatment of events and of complications) were considered. Cost units were derived from the current cost of drugs, and from the Italian National Healthcare tariffs in 2007. Incremental cost-effectiveness ratios were analysed at three time points: 30 days, 1 year and 5 years. The higher cost of fondaparinux was counterbalanced by reduced rates of early DVT, early PE and prophylaxis-related major bleeding. If compared with enoxaparin, after 30 days of extended prophylaxis, fondaparinux is associated with a savings of 48.83 per patient; at the end of the first year, the savings increased to 72.13, and after 5 years, the savings are 74.36. One-way sensitivity analysis shows that the results are robust to the variation in unit costs for VTE-related care, or in event rates for both treatments. In conclusion, our model shows that, when administered for extended prophylaxis of VTE following MOS, fondaparinux is more effective and cost saving than enoxaparin.

  18. A randomized comparison of the Ambu AuraGain versus the LMA supreme in patients undergoing gynaecologic laparoscopic surgery.

    PubMed

    Lopez, Ana M; Agusti, Merce; Gambus, Pedro; Pons, Montserrat; Anglada, Teresa; Valero, Ricard

    2016-11-26

    Second generation supraglottic airway devices providing high seal airway pressures are suitable for patients undergoing gynecologic laparoscopy. We compared the seal pressure achieved by the new Ambu AuraGain™ versus LMA Supreme™ following pneumoperitoneum in the Trendelenburg position. Sixty female patients were randomly allocated to ventilation with either the AuraGain or the Supreme. A target-controlled system was used to administer total intravenous anesthesia. Intracuff pressure was maintained below 60 cm H2O. The following parameters were registered: Time, number of attempts and manoeuvres required for insertion; seal pressure and peak inspiratory pressure at four time points; ease of gastric tube insertion, flexible scope view, complications and postoperative morbidity. Both devices were quick and easily inserted, although the Supreme required less rotation manoeuvres (16 in AuraGain vs. 6 in LMA Supreme; p = 0.01). The AuraGain achieved higher seal pressures (34 ± 5 in AuraGain vs. 29 ± 5 in LMA Supreme; p = 0.0002). Following pneumoperitoneum in head-down position, peak airway pressure increased 9 ± 3 cm H2O in both groups, exceeding seal pressure in 3 patients in the Supreme group (p = 0.06). The vocal cords were seen through all AuraGain and 90% of the Supreme devices; epiglottis was often visible inside the tube (68%). No differences were found in the incidence of traces of blood on the mask or postoperative symptoms. Both devices allowed effective ventilation in patients undergoing gynaecologic laparoscopic surgery with a low rate of complications. The Ambu AuraGain provided higher seal pressures and a clear view of glottic inlet in all patients offering the possibility to guide direct tracheal intubation if required.

  19. Nutrient Transporter Expression in the Jejunum in Relation to Body Mass Index in Patients Undergoing Bariatric Surgery

    PubMed Central

    Irving, Brian A.; Wood, G. Craig; Bennotti, Peter N.; Babu, Ellappan; Deshpande, Abhishek; Lent, Michelle R.; Petrick, Anthony; Gabrielsen, Jon; Strodel, William; Gerhard, Glenn S.; Still, Christopher D.; Ganapathy, Vadivel; Rolston, David D. K.

    2016-01-01

    Nutrient tranters (NT) facilitate nutrient absorption and contribute to the regulation of circulating nutrients. In this cross-sectional study, we determined the associations between the level of obesity; mRNA abundance for NTs; and serum concentrations of amino acids, short-chain fatty acids, and glucose in patients with morbid obesity undergoing a Roux-en-Y gastric bypass. Proximal jejunal samples were obtained at the time of surgery from 42 patients (90% female, age = 42.6 ± 11.9 years, pre-operative body mass index (BMI) = 55.5 ± 11.3 kg/m2) undergoing a Roux-en-Y gastric bypass. RNA was extracted from the jejunal mucosa and quantitative real-time–PCR was performed for the NTs studied. BMI negatively correlated with jejunal mRNA abundance of the amino acid NTs TauT (r = −0.625, p < 0.0001), ASCT2 (r = −0.320, p = 0.039), LAT1 (r = −0.304, p = 0.05). BMI positively correlated with jejunal mRNA abundance of the lactate/short-chain fatty acid NT SMCT1 (r = 0.543, p = 0.0002). Serum concentrations of the short-chain fatty acids, butyric, valeric, and isocaproic acid correlated positively with BMI (n = 30) (r = 0.45, r = 0.44, r = 0.36, p ≤ 0.05; respectively). Lower jejunal mRNA abundance for the amino acid NTs TauT, ASCT2, and LAT1 could protect against further obesity-related elevations in circulating amino acids. The positive correlation between BMI and the jejunal mRNA abundance of the high-affinity short-chain fatty acid/monocarboxylate transporter SMCT1 is intriguing and requires further investigation. PMID:27801863

  20. Prophylactic treatment with coenzyme Q10 in patients undergoing cardiac surgery: could an antioxidant reduce complications? A systematic review and meta-analysis.

    PubMed

    de Frutos, Fernando; Gea, Alfredo; Hernandez-Estefania, Rafael; Rabago, Gregorio

    2015-02-01

    Coenzyme Q10 (CoQ10) is a lipid-soluble antioxidant that could have beneficial effects in patients undergoing cardiac surgery with cardiopulmonary bypass. There is no clear evidence about its clinical effects or a systematic review published yet. We aimed to conduct a systematic review and meta-analysis of the literature to elucidate the role of coenzyme Q10 in preventing complications in patients undergoing cardiac surgery with cardiopulmonary bypass. We searched the PubMed Database using the following keywords: Coenzyme Q10, ubiquinone, ubiquinol, CoQ10, Heart Surgery, Cardiac surgery. Articles were systematically retrieved, selected, assessed and summarized for this review. We performed separate meta-analyses for different outcomes (inotropic drug requirements after surgery, incidence of ventricular arrhythmias and atrial fibrillation, cardiac index 24 h after surgery and hospital stay), estimating pooled odds ratios (ORs) or mean differences of the association of CoQ10 administration with the risk of these outcomes. Eight clinical trials met our inclusion criteria. Patients with CoQ10 treatment were significantly less likely to require inotropic drugs after surgery {OR [95% confidence interval (CI) 0.47 (0.27-0.81)]}, and to develop ventricular arrhythmias after surgery [OR (95% CI) 0.05 (0.01-0.31)]. However, CoQ10 treatment was not associated with Cardiac index 24 h after surgery [mean difference (95% CI) 0.06 (-0.30 to 0.43)], hospital stay (days) [mean difference (95% CI) -0.61 (-4.61 to 3.39)] and incidence of atrial fibrillation [OR (95% CI) 1.06 (0.19-6.04)]. Since none of the clinical trials included in this review report any adverse effects associated to CoQ10 administration, and coenzyme Q10 has been demonstrated to be safe even at much higher doses in other studies, we conclude that CoQ10 should be considered as a prophylactic treatment for preventing complications in patients undergoing cardiac surgery with cardiopulmonary bypass. However, better

  1. Implementation of a Breast/Reconstruction Surgery Coordinator to Reduce Preoperative Delays for Patients Undergoing Mastectomy With Immediate Reconstruction

    PubMed Central

    Losk, Katya; Mallory, Melissa A.; Camuso, Kristen; Cutone, Linda; Caterson, Stephanie; Bunnell, Craig A.

    2016-01-01

    Purpose: Mastectomy with immediate reconstruction (MIR) requires coordination between breast and reconstructive surgical teams, leading to increased preoperative delays that may adversely impact patient outcomes and satisfaction. Our cancer center established a target of 28 days from initial consultation with the breast surgeon to MIR. We sought to determine if a centralized breast/reconstructive surgical coordinator (BRC) could reduce care delays. Methods: A 60-day pilot to evaluate the impact of a BRC on timeliness of care was initiated at our cancer center. All reconstructive surgery candidates were referred to the BRC, who had access to surgical clinic and operating room schedules. The BRC worked with both surgical services to identify the earliest surgery dates and facilitated operative bookings. The median time to MIR and the proportion of MIR cases that met the time-to-treatment goal was determined. These results were compared with a baseline cohort of patients undergoing MIR during the same time period (January to March) in 2013 and 2014. Results: A total of 99 patients were referred to the BRC (62% cancer, 21% neoadjuvant, 17% prophylactic) during the pilot period. Focusing exclusively on patients with a cancer diagnosis, an 18.5% increase in the percentage of cases meeting the target (P = .04) and a 7-day reduction to MIR (P = .02) were observed. Conclusion: A significant reduction in time to MIR was achieved through the implementation of the BRC. Further research is warranted to validate these findings and assess the impact the BRC has on operational efficiency and workflows. PMID:26883406

  2. Do we need to establish guidelines for patients with neuromodulation implantable devices, including spinal cord stimulators undergoing nonspinal surgeries?

    PubMed Central

    Ghaly, Ramsis F.; Tverdohleb, Tatiana; Candido, Kenneth D.; Knezevic, Nebojsa Nick

    2016-01-01

    Background: Spinal cord stimulation is currently approved to treat chronic intractable pain of the trunk and limbs. However, such implantable electronic devices are vulnerable to external electrical currents and magnetic fields. Within the hospitals and modern operating rooms (ORs), there is an abundance of electrical devices and other types of equipment that could interfere with such devices. Despite the increasing number of patients with neuromodulation implantable devices, there are no written guidelines available or consensus of cautions for such patients undergoing unrelated surgery. Case Descriptions: A 60-year-old female with a permanent St. Jude's spinal cord stimulator (SCS) presented for open total abdominal hysterectomy. Both the anesthesia and gynecology staffs were aware of the device presence, but were unaware of any precautions regarding intraoperative management. The device was found to be nonmagnetic resonance imaging compatible, and bipolar cautery was used instead of monopolar cautery. A 59-year-old female with a 9-year-old permanent Medtronic SCS, presented for right total hip arthroplasty. The device was switched off prior to entering the OR, bipolar cautery was used, and grounding pads were placed away from her battery site. In each case, the manufacturer's representative was contacted preoperative. Both surgeries proceeded uneventfully. Conclusions: The Food and Drug Administration safety information manual warns about the use of diathermy, concomitant implanted stimulation devices, lithotripsy, external defibrillation, radiation therapy, ultrasonic scanning, and high-output ultrasound, all of which can lead to permanent implant damage if not turned off prior to undertaking procedures. Lack of uniform guidelines makes intraoperative management, as well as remote anesthesia care of patients with previously implanted SCSs unsafe. PMID:26958424

  3. Comparison Between Ultrasound-Guided Supraclavicular and Interscalene Brachial Plexus Blocks in Patients Undergoing Arthroscopic Shoulder Surgery

    PubMed Central

    Ryu, Taeha; Kil, Byung Tae; Kim, Jong Hae

    2015-01-01

    Abstract Although supraclavicular brachial plexus block (SCBPB) was repopularized by the introduction of ultrasound, its usefulness in shoulder surgery has not been widely reported. The objective of this study was to compare motor and sensory blockades, the incidence of side effects, and intraoperative opioid analgesic requirements between SCBPB and interscalene brachial plexus block (ISBPB) in patients undergoing arthroscopic shoulder surgery. Patients were randomly assigned to 1 of 2 groups (ISBPB group: n = 47; SCBPB group: n = 46). The side effects of the brachial plexus block (Horner's syndrome, hoarseness, and subjective dyspnea), the sensory block score (graded from 0 [no cold sensation] to 100 [intact sensation] using an alcohol swab) for each of the 5 dermatomes (C5–C8 and T1), and the motor block score (graded from 0 [complete paralysis] to 6 [normal muscle force]) for muscle forces corresponding to the radial, ulnar, median, and musculocutaneous nerves were evaluated 20 min after the brachial plexus block. Fentanyl was administered in 50 μg increments when the patients complained of pain that was not relieved by the brachial plexus block. There were no conversions to general anesthesia due to a failed brachial plexus block. The sensory block scores for the C5 to C8 dermatomes were significantly lower in the ISBPB group. However, the percentage of patients who received fentanyl was comparable between the 2 groups (27.7% [ISBPB group] and 30.4% [SCBPB group], P = 0.77). SCBPB produced significantly lower motor block scores for the radial, ulnar, and median nerves than did ISBPB. A significantly higher incidence of Horner's syndrome was observed in the ISBPB group (59.6% [ISBPB group] and 19.6% [SCBPB group], P < 0.001). No patient complained of subjective dyspnea. Despite the weaker degree of sensory blockade provided by SCBPB in comparison to ISBPB, opioid analgesic requirements are similar during arthroscopic shoulder surgery under

  4. Penetration of teicoplanin into heart valves and subcutaneous and muscle tissues of patients undergoing open-heart surgery.

    PubMed

    Frank, U K; Schmidt-Eisenlohr, E; Mlangeni, D; Schindler, M; Hoh, A; Beyersdorf, F; Daschner, F D

    1997-11-01

    Penetration of teicoplanin into serum, heart valves, and subcutaneous and muscle tissues was determined in 22 patients undergoing open-heart surgery. Each patient received 12 mg of teicoplanin per kg of body weight as a 30-min intravenous infusion preoperatively. Within 10 h, serum concentrations of teicoplanin declined from 43.1 to 2.8 microg/ml. Teicoplanin concentrations in subcutaneous tissues reached their peak of 9.2 microg/g after 2 to 3 h and decreased slowly to 2.3 microg/g after 9 to 10 h. Concentrations in muscle decreased from 8.7 microg/g to nondetectable levels. Teicoplanin concentrations in cardiac valvular tissue reached their peak of 6.1 microg/g and decreased thereafter to 1.7 microg/g. Teicoplanin concentrations in heart valves were high enough to inhibit methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci, which are known to cause postoperative wound infections and infective endocarditis.

  5. Penetration of teicoplanin into heart valves and subcutaneous and muscle tissues of patients undergoing open-heart surgery.

    PubMed Central

    Frank, U K; Schmidt-Eisenlohr, E; Mlangeni, D; Schindler, M; Hoh, A; Beyersdorf, F; Daschner, F D

    1997-01-01

    Penetration of teicoplanin into serum, heart valves, and subcutaneous and muscle tissues was determined in 22 patients undergoing open-heart surgery. Each patient received 12 mg of teicoplanin per kg of body weight as a 30-min intravenous infusion preoperatively. Within 10 h, serum concentrations of teicoplanin declined from 43.1 to 2.8 microg/ml. Teicoplanin concentrations in subcutaneous tissues reached their peak of 9.2 microg/g after 2 to 3 h and decreased slowly to 2.3 microg/g after 9 to 10 h. Concentrations in muscle decreased from 8.7 microg/g to nondetectable levels. Teicoplanin concentrations in cardiac valvular tissue reached their peak of 6.1 microg/g and decreased thereafter to 1.7 microg/g. Teicoplanin concentrations in heart valves were high enough to inhibit methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci, which are known to cause postoperative wound infections and infective endocarditis. PMID:9371368

  6. Profile evaluation of patients with cleft lip and palate undergoing surgery at a reference center in rio de janeiro, Brazil.

    PubMed

    Franco, Diogo; Iani, Marcella; Passalini, Ronaldo; Demolinari, Ivan; Arnaut, Marcio; Franco, Talita

    2012-01-01

    In Brazil, the classic timeline for operating on cleft lip and palate is three months old for cheiloplasty and is 12 to 18 months old for palatoplasty. As from Brazilian treatment centers are usually located in major cities, patients living in more remote areas are often unable to receive treatment at the ideal ages. Data were analyzed retrospectively on 45 patients with cleft lip and/or palate, consecutively operated at the Reference Center, Rio de Janeiro Federal University, Brazil. Particularly noteworthy among these data are gender, clinical presentation, operations performed, age of surgery, and the distance between their homes and the hospital. The average age of patients undergoing primary cheiloplasty was 9.4 months, with primary palatoplasties performed at an average age of 7.2 years. As 67% of these patients lived in other towns, they encountered difficulties in seeking and continuing specialized care. Despite attempts to decentralize cleft palate care in Brazil, suitable conditions are not yet noted for following the treatment protocols in a full and adequate manner.

  7. Protective Effects of Edaravone in Adult Rats with Surgery and Lipopolysaccharide Administration-Induced Cognitive Function Impairment

    PubMed Central

    Liu, Na; Ma, Li; Zhou, Xueyue; Zhang, Hong; Wang, Yongan

    2016-01-01

    Postoperative cognitive dysfunction (POCD) is a clinical syndrome characterized by cognitive declines in patients after surgery. Previous studies have suggested that surgery contributed to such impairment. It has been proven that neuroinflammation may exacerbate surgery-induced cognitive impairment in aged rats. The free radical scavenger edaravone has high blood brain barrier permeability, and was demonstrated to effectively remove free radicals from the brain and alleviate the development of POCD in patients undergoing carotid endarterectomy, suggesting its potential role in preventing POCD. For this reason, this study was designed to determine whether edaravone is protective against POCD through its inhibitory effects on inflammatory cytokines and oxidative stress. First, Sprague Dawley adult male rats were administered 3 mg/kg edaravone intraperitoneally after undergoing a unilateral nephrectomy combined with lipopolysaccharide injection. Second, behavioral parameters related to cognitive function were recorded by fear conditioning and Morris Water Maze tests. Last, superoxide dismutase activities and malondialdehyde levels were measured in the hippocampi and prefrontal cortex on postoperative days 3 and 7, and microglial (Iba1) activation, p-Akt and p-mTOR protein expression, and synaptic function (synapsin 1) were also examined 3 and 7 days after surgery. Rats that underwent surgery plus lipopolysaccharide administration showed significant impairments in spatial and working memory, accompanied by significant reductions in hippocampal-dependent and independent fear responses. All impairments were attenuated by treatment with edaravone. Moreover, an abnormal decrease in superoxide dismutase activation, abnormal increase in malondialdehyde levels, significant increase in microglial reactivity, downregulation of p-Akt and p-mTOR protein expression, and a statistically significant decrease in synapsin-1 were observed in the hippocampi and prefrontal cortices of

  8. Predictors of Mortality Up to One Year After Emergent Major Abdominal Surgery in Older Adults

    PubMed Central

    Cooper, Zara; Mitchell, Susan L.; Gorges, Rebecca J.; Rosenthal, Ronnie A.; Lipsitz, Stuart R.; Kelley, Amy S.

    2015-01-01

    Background The number of older patients who undergo emergent major abdominal procedures is expected to increase yet little is known about mortality beyond 30 days after surgery. Objective Identify factors associated with mortality among older patients at 30, 180 and 365 days after emergency major abdominal surgery. Design A retrospective study of the Health and Retirement Study (HRS) linked to Medicare Claims from 2000-2010. Setting N/A Participants Medicare beneficiaries > 65.5 years enrolled in the Health and Retirement Study (HRS) from 2000-2010, with at least one urgent/emergent major abdominal surgery and a core interview from the HRS within 3 years prior to surgery. Main Outcomes and Measures Survival analysis was used to describe all-cause mortality at 30, 180 and 365 days after surgery. Complementary log-log regression was used to identify patient characteristics and postoperative events associated with worse survival. Results 400 patients had one of the urgent/emergent surgeries of interest. Of these 24% were > 85 years; 50% had coronary artery disease, 48% had cancer, and 33% had congestive heart failure; and 37% experienced a postoperative complication. Postoperative mortality was 20%, 31% and 34% at 30, 180 days and 365 days. Among those > 85 years, 50% were dead one year after surgery. After multivariate adjustment including postoperative complications, dementia (Hazard ratio (HR) 2.02, 95%CI 1.24-3.31), hospitalization within 6 months before surgery (HR 1.63, 95% CI 1.12-2.28) and complications (HR 3.45, 95%CI (2.32-5.13) were independently associated with worse one-year survival. Conclusion Overall mortality is high up to one year after surgery in many older patients undergoing emergency major abdominal surgery. The occurrence of a complication is the clinical factor most strongly associated with worse survival. PMID:26661929

  9. Cardioprotection of Electroacupuncture for Enhanced Recovery after Surgery on Patients Undergoing Heart Valve Replacement with Cardiopulmonary Bypass: A Randomized Control Clinical Trial

    PubMed Central

    Zhang, Fangxiang; Xiao, Hong

    2017-01-01

    We attempted to investigate cardioprotection of electroacupuncture (EA) for enhanced recovery after surgery on patients undergoing heart valve replacement with cardiopulmonary bypass. Forty-four patients with acquired heart valve replacement were randomly allocated to the EA group or the control group. Patients in the EA group received EA stimulus at bilateral Neiguan (PC6), Ximen (PC4), Shenting (GV24), and Baihui (GV20) acupoints twenty minutes before anesthesia induction to the end of surgery. The primary end point was cardioprotection effect of electroacupuncture postoperatively and the secondary endpoints were quality of recovery and cognitive functioning postoperatively. The present study demonstrated that electroacupuncture reduced the occurrence of complications and played a role of cardioprotective effect on patients after heart valve replacement surgery with cardiopulmonary bypass, and it benefits patients more comfortable and contributes to recovery after surgery. This trial is registered with ChiCTR-IOC-16009123. PMID:28298935

  10. Benefits of preoperative education for adult elective surgery patients.

    PubMed

    Kruzik, Nancy

    2009-09-01

    Patient education is a major concern for perioperative nurses in an ambulatory surgery setting. It has proven difficult to develop formal preoperative teaching programs in this environment, but research has shown that preoperative education can improve patient outcomes and satisfaction with the surgical experience. Typical patient education consists of pamphlets that are given to the patient before surgery and verbal instructions from the physicians and nurses on the day of surgery. Ideally, preoperative patient education should begin in the surgeon's office, continue through preadmission testing, and be completed at admission. Having a well-designed preoperative education program enables perioperative nurses in ambulatory surgery centers to provide a thoughtful approach to perioperative teaching in a limited time. AORN J 90 (September 2009) 381-387. (c) AORN, Inc, 2009.

  11. Beating heart versus conventional cardiopulmonary bypass: the octopus experience: a randomized comparison of 281 patients undergoing coronary artery bypass surgery with or without cardiopulmonary bypass.

    PubMed

    van Dijk, Diederik; Diephuis, Jan C; Nierich, Arno P; Keizer, Annemieke M A; Kalkman, Cor J

    2006-06-01

    In the Octopus Study, 281 coronary artery bypass surgery patients were randomized to surgery with or without cardiopulmonary bypass. The primary objective was to compare cognitive outcome between off-pump and on-pump coronary artery bypass surgery. Before and after surgery, psychologists administered a battery of 10 neuropsychological tests to the patients. Cognitive decline was defined as a decrease in an individual's performance of at least 20% from baseline, in at least 20% of the main variables. According to this definition, cognitive decline was present in 21% in the off-pump group and 29% in the on-pump group, 3 months after the procedure (P = .15). At 12 months, cognitive decline was present in 31% in the off-pump group and 34% in the on-pump group (P = .69). These results indicated that patients undergoing coronary artery bypass surgery without cardiopulmonary bypass had improved cognitive outcomes 3 months after the procedure, but the effects were limited and became negligible at 12 months. The same definition of cognitive decline was also applied to 112 volunteers not undergoing surgery. The definition labeled 28% of the control subjects as suffering from cognitive decline, 3 months after their first assessment. This suggests that the natural fluctuations in performance during repeated neuropsychological testing should be included in the statistical analysis of cognitive decline. Using an alternative definition of cognitive decline that takes these natural fluctuations in performance into account, the proportions of coronary artery bypass surgery patients displaying cognitive decline were substantially lower. This indicates that the incidence of cognitive decline after coronary artery bypass surgery has been overestimated.

  12. Caudal Levobupivacaine Supplemented with Caudal or Intravenous Clonidine in Children Undergoing Infraumbilical Surgery: A Randomized, Prospective Double-blind Study

    PubMed Central

    Potti, Laxmi Ramya; Bevinaguddaiah, Yatish; Archana, S.; Pujari, Vinayak Seenappa; Abloodu, C. Manjunath

    2017-01-01

    Background: Caudal analgesia is the most popular regional anesthesia technique in pediatric population for intraoperative and postoperative analgesia. Clonidine, an α2 agonist, prolongs analgesia without causing significant respiratory depression after systemic or neuraxial administration. However, the most beneficial route of its administration is still controversial. Thus, we compared the effects of caudal and intravenous (i.v) clonidine on postoperative analgesia produced by caudal levobupivacaine in children undergoing infraumbilical surgery. Methods: A comparative three group study was carried out in seventy-five pediatric patients who underwent elective surgery for infraumbilical procedures, under general anesthesia with caudal block. Group A (n = 25) received levobupivacaine 0.25% 1 mL/kg caudally and 5 mL of normal saline i.v, Group B (n = 25) received levobupivacaine 0.25% 1 mL/kg with 1 μg/kg clonidine caudally and 5 mL of normal saline i.v, and Group C (n = 25) received levobupivacaine 0.25% 1 mL/kg caudally and 1 μg/kg clonidine in 5 mL normal saline i.v. Postoperative pain was assessed for 24 h using the Children and Infants Postoperative Pain Scale Score. Ramsay sedation scale and modified Bromage scale were assessed at predetermined time intervals for sedation and motor blockade, respectively. Results: The mean duration of postoperative analgesia was significantly longer in Group B (16.68 ± 4.7 h) than in Group A (4.24 ± 1.42) and Group C (9.44 ± 3.88 h): P < 0.001. The number of patients not requiring rescue analgesia in Group B was 5, which was significantly higher than in Group C (one patient) and Group A (zero patient): P < 0.001. No motor blockade or sedation was observed in any of the groups. Conclusions: Clonidine in a dose of 1 μg/kg added to 0.25% levobupivacaine for caudal analgesia significantly prolongs the duration of analgesia, without any side effects. PMID:28298787

  13. Development of a preoperative predictive model for major complications following adult spinal deformity surgery.

    PubMed

    Scheer, Justin K; Smith, Justin S; Schwab, Frank; Lafage, Virginie; Shaffrey, Christopher I; Bess, Shay; Daniels, Alan H; Hart, Robert A; Protopsaltis, Themistocles S; Mundis, Gregory M; Sciubba, Daniel M; Ailon, Tamir; Burton, Douglas C; Klineberg, Eric; Ames, Christopher P

    2017-03-24

    interbody fusion levels, Physical Component Summary of the SF-36, Scoliosis Research Society (SRS)-Schwab coronal curve type, Charlson Comorbidity Index, SRS activity, T-1 pelvic angle, American Society of Anesthesiologists grade, presence of osteoporosis, pelvic tilt, sagittal vertical axis, primary versus revision surgery, SRS pain, SRS total, use of bone morphogenetic protein, use of iliac crest graft, and pelvic incidence-lumbar lordosis mismatch. CONCLUSIONS A successful model (87% accuracy, 0.89 AUROC curve) was built predicting major intraoperative or perioperative complications following ASD surgery. This model can provide the foundation toward improved education and point-of-care decision making for patients undergoing ASD surgery.

  14. Bacteriological Profile of Patients Undergoing Open Heart Surgery and Evaluation of a Bacterial Filter using Protected Broncho-Alveolar Lavage.

    PubMed

    Tempe, D K; Mehta, N; Mishra, B; Tondon, M S; Tomar, A S; Budharaja, P; Nigam, M

    1998-01-01

    Twenty seven patients undergoing elective open heart surgery were included in this prospective study. They were randomly divided into two groups. Group C (n = 12) constituted the control group in whom no breathing filter was used in the anaesthesia circuit in the operating room or in the ICU. Humidification of breathing gases was achieved with the help of conventional heated humidifier. In group F (n = 15), heat and moisture exahanging bacterial / viral filter was incorporated in the breathing circuit at the patient end between the catheter mount and Y connection of the breathing circuit. In both the groups, samples of throat swab, protected broncho-alveolar lavage with double catheter and Ryles tube aspirate were collected preoperatively (in the operation theatre) and postoperatively (in the Intensive Care Unit on day 1). All the samples were sent to the laboratory immediately after the collection for Gram staining and culture and sensitivity. Pathogenic organisms were isolated from a total of 9 patients (33%) preoperatively. Exogenous spread of the organisms to the lungs was considered to have occurred if new pathogenic organisms were isolated from the postoperative bronchoalveolar lavage and the simultaneous samples of the throat swab and Ryles tube did not contain the same organism. By this definition, the exogenous spread of the organisms occurred in one patient in group C and in no patient in group F (P = 0.46, Fishers test). The commonest organisms isolated were Staphylococcus aureus, Klebsiella sp. and Pseudomonas sp. We conclude that colonization of the pathogenic organisms is common (33%) in orophrynx and gastrointestinal tract in hospitalized patients. There was no difference in the exogenous spread of the organisms between the two groups. The unity of the filter, therefore, appears to be limited to prevent contamination of anaesthesia machines or ventilators as has been shown by earlier studies.

  15. Intestinal parasitosis among subjects undergoing cataract surgery at the eye camps in rural hilly areas of Nepal.

    PubMed

    Rai, S K; Gurung, R; Saiju, R; Bajracharya, L; Rai, N; Gurung, K; Shakya, B; Pant, J; Psharma; Shrestha, A; Rai, C K

    2008-06-01

    Present study investigated the intestinal parasitosis among 221 subjects undergoing cataract surgery (M: 129 and F: 92; aged 13-86 years) at the eye camps in three rural hilly districts (Ramechhap, Sindhupalchok and Dhading) in 2006. Stool samples collected in clean, dry, screw capped plastic containers were examined locally by direct smear technique and anti-parasitic drugs were distributed to parasite positive subjects. The remaining stool samples were fixed with 10% formal-saline, transported to Shi-Gan Health Foundation/Nat'l Inst of Trop Med and Public Health Research, Kathmandu and re-examined by formal-ether sedimentation technique. A total of 148 samples (66.9%) were positive for some kind of intestinal parasites (F: 68.5% and M: 65.9%; P > 0.05). Ramechhap (Manthali) and Sindhupalchok (Chautara) had higher positive rate (71.8% and 70.7%, respectively) than in Dhading (Salyantar) (60.0%) (P > 0.05). Tibeto-Burman (indigenous nationalities) ethnic group had highest positive rate (70.1%) compared with Indo-Aryan (64.7%) and Dalits (57.7%). Subjects without toilet (latrine) had marginally higher positive rate (69.7%) than those having toilet at their home (65.5) (P> 0 .05). Age was independent of positive rate. Vegetarians had marginally higher parasitic infection rate compared to their non-vegetarian counterparts. Helminths were more common than protozoa. Overall, hookworm was the commonest parasite detected. However, Ascaris was common in Dhading District. Entamoeba histolytica was most common among protozoa and was followed by Cyclospora and others.

  16. Epidural ropivacaine with dexmedetomidine reduces propofol requirement based on bispectral index in patients undergoing lower extremity and abdominal surgeries

    PubMed Central

    Joy, Renu; Pujari, Vinayak Seenappa; Chadalawada, Mohan V. R.; Cheruvathoor, Ajish Varghese; Bevinguddaiah, Yatish; Sheshagiri, Nirmal

    2016-01-01

    Background and Aim: To assess the amount of propofol required for induction based on bispectral index (BIS) after administering epidural anesthesia with ropivacaine alone and ropivacaine with dexmedetomidine in patients undergoing lower extremities and abdominal surgeries. Subjects and Methods: A double-blinded randomized clinical trial was carried out in 60 patients over a period of 2 years in a tertiary care hospital. American Society of Anaesthesiologists I or II in age group 18–65 years were included in the study. Group R received epidural anesthesia with ropivacaine alone, and Group D received ropivacaine and dexmedetomidine. General anesthesia was induced with propofol under BIS monitoring after 15 min. Onset of sensory and motor block, time for loss of consciousness and total amount of propofol used during induction to achieve the BIS value < 55 were recorded. Student's t-test and Chi-square test were used to find the significance of study parameters. Results: Time of onset of sensory block (Group R 11.30 ± 1.64/Group D 8.27 ± 0.83 min), motor block (Group R 14.16 ± 1.33/Group D 12.63 ± 1.22 min), time for loss of consciousness (Group R 90.57 ± 11.05/Group D 73.67 ± 16.34 s), and total amount of propofol (Group R 129.83 ± 22.38/Group D 92.13 ± 12.93 s) were reduced in Group D which was statistically significant with P < 0.001. Conclusion: Epidural ropivacaine with dexmedetomidine significantly reduces the total propofol dose required for induction of anesthesia. Also, it decreases the onset time of sensory and motor block and provides good hemodynamic stability. PMID:26957689

  17. Ventricular morphology is a determinant of diastolic performance in patients with single ventricle physiology undergoing stage 3 palliative surgery.

    PubMed

    Seckeler, Michael D; O'Leary, Edward; Anitha Jayakumar, K

    2015-04-01

    Patients with single ventricle anatomy undergo staged surgical palliation which results in pulmonary and systemic circulations in series with a single systemic pump. Single right ventricular morphology has been found to be an independent risk factor for worse survival. We sought to compare patients with single left (SLV) and single right (SRV) ventricular morphology to identify hemodynamic differences that may contribute to worse survival in patients with a single right ventricular. Single center, retrospective review of invasive hemodynamic data. All patients with single ventricle anatomy who underwent superior cavo-pulmonary anastomosis (Stage 2 palliation) and/or total cavo-pulmonary anastomosis (Stage 3 palliation) from August 1995 through May 2011 were identified. Patients were compared over time, and SLV and SRV patients were compared. Seventy-nine single ventricle patients (56 % SRV) underwent staged palliation and were analyzed. There was no difference in overall mortality (12 % SLV, 11 % SRV). There was no difference in hemodynamics at pre-Stage 2 catheterization between ventricular morphology, but SRV patients had higher ventricular end-diastolic pressure at pre-Stage 3 catheterization (7.6 vs. 6.4 mmHg, p = 0.026). End-diastolic pressure decreased after Stage 2 surgery for SLV patients, but not SRV patients. Intrinsic differences in morphology, function, and response to performing as the systemic ventricle between single right and left ventricles may lead to an elevated ventricular end-diastolic pressure. This could limit passive flow through the pulmonary circuit and coronary perfusion after Stage 3 palliation and potentially lead to poorer long-term performance for SRV patients.

  18. The effects of chrysin, a Passiflora incarnata extract, on natural killer cell activity in male Sprague-Dawley rats undergoing abdominal surgery.

    PubMed

    Beaumont, Denise M; Mark, Terrence M; Hills, Reginald; Dixon, Patricia; Veit, Bruce; Garrett, Normalynn

    2008-04-01

    Chrysin, a passion flower extract, may be beneficial because of its potential to attenuate surgical suppression of natural killer (NK) cell activity. We divided 37 male Sprague-Dawley rats into 3 treatment groups: (1) rats undergoing abdominal surgery and administered isoflurane and a 5% solution of dimethyl sulfoxide in saline (vehicle), (2) rats undergoing abdominal surgery and administered isoflurane and chrysin solubilized in 5% dimethyl sulfoxide, and (3) rats not undergoing surgery but administered isoflurane and chrysin. Natural killer cell activity was measured before and 24 hours after the experiment. Analysis of covariance, with preoperative NK cell activity as the covariate, was used to compare differences in NK cell activity among groups. The Scheffe procedure was used to make post hoc comparisons. Analysis revealed a significant difference (P = .006) such that group 2 had significantly less NK cell suppression compared with groups 1 and 3. These findings suggest that chrysin may attenuate surgical suppression of NK cell activity, thereby minimizing metastatic spread of cancer.

  19. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: The Driving Force for Improvement in Cardiac Surgery.

    PubMed

    Winkley Shroyer, Annie Laurie; Bakaeen, Faisal; Shahian, David M; Carr, Brendan M; Prager, Richard L; Jacobs, Jeffrey P; Ferraris, Victor; Edwards, Fred; Grover, Frederick L

    2015-01-01

    Initiated in 1989, the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) includes more than 1085 participating centers, representing 90%-95% of current US-based adult cardiac surgery hospitals. Since its inception, the primary goal of the STS ACSD has been to use clinical data to track and improve cardiac surgical outcomes. Patients' preoperative risk characteristics, procedure-related processes of care, and clinical outcomes data have been captured and analyzed, with timely risk-adjusted feedback reports to participating providers. In 2006, STS initiated an external audit process to evaluate STS ACSD completeness and accuracy. Given the extremely high inter-rater reliability and completeness rates of STS ACSD, it is widely regarded as the "gold standard" for benchmarking cardiac surgery risk-adjusted outcomes. Over time, STS ACSD has expanded its quality horizons beyond the traditional focus on isolated, risk-adjusted short-term outcomes such as perioperative morbidity and mortality. New quality indicators have evolved including composite measures of key processes of care and outcomes (risk-adjusted morbidity and risk-adjusted mortality), longer-term outcomes, and readmissions. Resource use and patient-reported outcomes would be added in the future. These additional metrics provide a more comprehensive perspective on quality as well as additional end points. Widespread acceptance and use of STS ACSD has led to a cultural transformation within cardiac surgery by providing nationally benchmarked data for internal quality assessment, aiding data-driven quality improvement activities, serving as the basis for a voluntary public reporting program, advancing cardiac surgery care through STS ACSD-based research, and facilitating data-driven informed consent dialogues and alternative treatment-related discussions.

  20. Bypass surgery versus medical treatment for symptomatic moyamoya disease in adults.

    PubMed

    Jang, Dong-Kyu; Lee, Kwan-Sung; Rha, Hyoung Kyun; Huh, Pil-Woo; Yang, Ji-Ho; Park, Ik Seong; Ahn, Jae-Geun; Sung, Jae Hoon; Han, Young-Min

    2016-11-11

    OBJECTIVE In this study the authors evaluated whether extracranial-intracranial bypass surgery can prevent stroke occurrence and decrease mortality in adult patients with symptomatic moyamoya disease (MMD). METHODS The medical records of 249 consecutive adult patients with symptomatic MMD that was confirmed by digital subtraction angiography between 2002 and 2011 at 8 institutions were retrospectively reviewed. The study outcomes of stroke recurrence as a primary event and death during the 6-year follow-up and perioperative complications within 30 days as secondary events were compared between the bypass and medical treatment groups. RESULTS The bypass group comprised 158 (63.5%) patients, and the medical treatment group comprised 91 (36.5%) patients. For 249 adult patients with MMD, bypass surgery showed an HR of 0.48 (95% CI 0.27-0.86, p = 0.014) for stroke recurrence calculated by Cox regression analysis. However, for the 153 patients with ischemic MMD, the HR of bypass surgery for stroke recurrence was 1.07 (95% CI 0.43-2.66, p = 0.887). For the 96 patients with hemorrhagic MMD, the multivariable adjusted HR of bypass surgery for stroke recurrence was 0.18 (95% CI 0.06-0.49, p = 0.001). For the treatment modality, indirect bypass and direct bypass (or combined bypass) did not show any significant difference for stroke recurrence, perioperative stroke, or mortality (log rank; p = 0.524, p = 0.828, and p = 0.616, respectively). CONCLUSIONS During the treatment of symptomatic MMD in adults, bypass surgery reduces stroke recurrence for the hemorrhagic type, but it does not do so for the ischemic type. The best choice of bypass methods in adult patients with MMD is uncertain. In adult ischemic MMD, a prospective randomized study to evaluate the effectiveness and safety of bypass surgery to prevent recurrent stroke is necessary.

  1. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2017 Update on Outcomes and Quality.

    PubMed

    D'Agostino, Richard S; Jacobs, Jeffrey P; Badhwar, Vinay; Paone, Gaetano; Rankin, J Scott; Han, Jane M; McDonald, Donna; Edwards, Fred H; Shahian, David M

    2017-01-01

    Established in 1989, The Society of Thoracic Surgeons Adult Cardiac Surgery Database is one of the most comprehensive clinical data registries in health care. It is widely regarded as the gold standard for benchmarking risk-adjusted outcomes in cardiac surgery and is the foundation for all quality measurement and improvement activities of The Society of Thoracic Surgeons. This is the second in a series of annual reports that summarizes current aggregate national outcomes in cardiac surgery and reviews database-related activities in the areas of quality measurement and performance improvement during the past year.

  2. Use of EF5 to Measure the Oxygen Level in Tumor Cells of Patients Undergoing Surgery or Biopsy for Newly Diagnosed Supratentorial Malignant Glioma

    ClinicalTrials.gov

    2013-01-15

    Adult Anaplastic Astrocytoma; Adult Anaplastic Ependymoma; Adult Anaplastic Oligodendroglioma; Adult Diffuse Astrocytoma; Adult Ependymoma; Adult Giant Cell Glioblastoma; Adult Glioblastoma; Adult Gliosarcoma; Adult Mixed Glioma; Adult Myxopapillary Ependymoma; Adult Oligodendroglioma; Adult Pilocytic Astrocytoma; Adult Pineal Gland Astrocytoma; Adult Subependymoma

  3. Effect of Prewarming during Induction of Anesthesia on Microvascular Reactivity in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery: A Randomized Clinical Trial

    PubMed Central

    Cho, Youn Joung; Lee, Seo Yun; Kim, Tae Kyong; Hong, Deok Man; Jeon, Yunseok

    2016-01-01

    Background General anesthesia may induce inadvertent hypothermia and this may be related to perioperative cardiovascular complications. Microvascular reactivity, measured by the recovery slope during a vascular occlusion test, is decreased during surgery and is also related to postoperative clinical outcomes. We hypothesized that microvascular changes during surgery may be related to intraoperative hypothermia. To evaluate this, we conducted a randomized study in patients undergoing off-pump coronary artery bypass surgery, in which the effect of prewarming on microvascular reactivity was evaluated. Methods Patients scheduled for off-pump coronary artery bypass surgery were screened. Enrolled patients were randomized to the prewarming group to receive forced-air warming during induction of anesthesia or to the control group. Measurement of core and skin temperatures and vascular occlusion test were conducted before anesthesia induction, 1, 2, and 3 h after induction, and at the end of surgery. Results In total, 40 patients were enrolled and finished the study (n = 20 in the prewarming group and n = 20 in the control group). During the first 3 h of anesthesia, core temperature was higher in the prewarming group than the control group (p < 0.001). The number of patients developing hypothermia was lower in the prewarming group than the control group (4/20 vs. 13/20, p = 0.004). However, tissue oxygen saturation and changes in recovery slope following a vascular occlusion test at 3 h after anesthesia induction did not differ between the groups. There was no difference in clinical outcome, including perioperative transfusion, wound infection, or hospital stay, between the groups. Conclusions Prewarming during induction of anesthesia decreased intraoperative hypothermia, but did not reduce the deterioration in microvascular reactivity in patients undergoing off-pump coronary artery bypass surgery. Trial Registration ClinicalTrials.gov NCT02186210 PMID:27442052

  4. Management of adults with prior failed hypospadias surgery

    PubMed Central

    Craig, James R.; Wallis, Chad; Brant, William O.; Hotaling, James M.

    2014-01-01

    Hypospadias is one of the most prevalent anomalies of the male genitalia. Contemporary hypospadias repair is very successful, but patients that have the surgery fail often require multiple surgeries throughout their life. Complications from failed hypospadias repairs have a significant impact on patients both psychologically and physically. Failed hypospadias repair encompasses a spectrum of problems that include hypospadias recurrence with an ectopic meatus, urethral fistula, urethral stricture, and ventral penile curvature. Repairs of hypospadias complications can be challenging due to the poor quality of surrounding tissue from disruption of normal vasculature in the re-operative field associated with the underlying disorder. One of the most challenging issues is dealing with urethral strictures. There have been multiple methods described at repairs of these in both a single stage and multiple staged procedures. Particular attention has been directed towards applications of grafts due to worse outcomes with flaps. Buccal mucosa has emerged as the leading graft material in staged repairs. When counseling patients with failed hypospadias it is important to discuss the expected outcome as repairs directed towards a terminally positioned meatus with a straight phallus may require multiple surgeries due to post-operative complications as well as the necessity of proceeding in a staged approach. PMID:26816767

  5. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2016 Update on Outcomes and Quality.

    PubMed

    D'Agostino, Richard S; Jacobs, Jeffrey P; Badhwar, Vinay; Paone, Gaetano; Rankin, J Scott; Han, Jane M; McDonald, Donna; Shahian, David M

    2016-01-01

    The Society of Thoracic Surgeons Adult Cardiac Database is one of the longest-standing, largest, and most highly regarded clinical data registries in health care. It serves as the foundation for all quality measurement and improvement activities of The Society of Thoracic Surgeons. This report summarizes current aggregate national outcomes in adult cardiac surgery and reviews database-related activities in the areas of quality measurement and performance improvement.

  6. Controversies in anaesthesia for noncardiac surgery in older adults

    PubMed Central

    Murthy, S.; Hepner, D. L.; Cooper, Z.; Bader, A. M.; Neuman, M. D.

    2015-01-01

    As the population of the world is rapidly ageing, the amount of surgery being performed in older patients is also increasing. Special attention is required for the anaesthetic and perioperative management of these patients. The clinical and non-clinical issues specific to older surgical patients are reviewed, with a special emphasis on areas of debate related to anaesthesia care in this group. These issues include the role of frailty and disability in preoperative assessment, choice of anaesthesia technique for hip fracture, postoperative delirium, and approaches to shared decision-making before surgical procedures. PMID:26658197

  7. Positron Emission Tomography Using Fluorine F 18 EF5 to Find Oxygen in Tumor Cells of Patients Who Are Undergoing Surgery or Biopsy for Newly Diagnosed Brain Tumors

    ClinicalTrials.gov

    2013-01-15

    Adult Anaplastic Astrocytoma; Adult Anaplastic Ependymoma; Adult Anaplastic Oligodendroglioma; Adult Brain Stem Glioma; Adult Central Nervous System Germ Cell Tumor; Adult Choroid Plexus Tumor; Adult Craniopharyngioma; Adult Diffuse Astrocytoma; Adult Ependymoblastoma; Adult Ependymoma; Adult Giant Cell Glioblastoma; Adult Glioblastoma; Adult Gliosarcoma; Adult Grade I Meningioma; Adult Grade II Meningioma; Adult Grade III Meningioma; Adult Medulloblastoma; Adult Meningeal Hemangiopericytoma; Adult Mixed Glioma; Adult Myxopapillary Ependymoma; Adult Oligodendroglioma; Adult Pilocytic Astrocytoma; Adult Pineoblastoma; Adult Pineocytoma; Adult Subependymoma; Adult Supratentorial Primitive Neuroectodermal Tumor (PNET); Meningeal Melanocytoma

  8. A Survey on Awareness about the Role of Anesthesia and Anesthesiologists among the Patients Undergoing Surgeries in a Tertiary Care Teaching Women and Children Hospital

    PubMed Central

    Marulasiddappa, Vinay; Nethra, H. N.

    2017-01-01

    Background: Although anesthesiology has grown tremendously and although anesthesiologists play a crucial role in the perioperative management of patients and also outside operating theater (OT) such as critical care, pain clinic, and labor analgesia, they do not get due recognition. We conducted a study to assess the awareness about the role of anesthesia and anesthesiologists among patients scheduled to undergo surgery in a Government Tertiary Care Teaching Women and Children Hospital. Designs: A prospective cross-sectional survey with a sample size of 100 patients. Materials and Methods: Patients scheduled to undergo elective surgery in the age group of 18–65 years with the American Society of Anesthesiologists (ASA) Grades 1 and 2, who are willing to participate and given written informed consent. Patients whose age <18 years and more than 65 years, ASA health status Class 3 and above were excluded. Analysis: Statistical analysis was done by calculating percentages using Chi-square test. Results: Twenty percent of the participants were illiterate and of the educated, none were graduates or postgraduates. Patients with higher level of education had better knowledge of anesthesiology and role of an anesthesiologist with P < 0.05 than those with lesser education. Forty-eight percent of the participants had no idea about anesthesia despite the majority (62%) having previous surgery with no statistically significant difference (P > 0.05) between those with previous surgery and those without previous surgery regarding their knowledge of anesthesiology and anesthesiologist. Ninety percent did not know the complications, types of anesthesia and 44% did not know that anesthesiologist is a doctor. Conclusion: Most of the participants were not aware of the role of anesthesia and anesthesiologists inside and outside OT. Although this could be attributed to their lower level of education, the fraternity of anesthesiologists has to educate patients and surgeons about the

  9. Perioperative assessment of psychological state and quality of life of head and neck cancer patients undergoing surgery.

    PubMed

    Mochizuki, Yumi; Matsushima, Eisuke; Omura, Ken

    2009-02-01

    This study assessed psychological state and quality of life (QOL) in head and neck cancer patients during the perioperative period. Patients who had undergone primary surgery at the Department of Oral and Maxillofacial Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan were enrolled. After obtaining informed consent, three tests were administered: the Hospital Anxiety and Depression Scale (HADS) to assess psychological state, and the Functional Assessment of Cancer Therapy General (FACT-G) and Functional Assessment of Head and Neck (FACT-H&N) to assess QOL. Japanese language versions of all tests were administered. Tests were administered 1 day before surgery, 1 week after surgery, and 1 and 6 months after discharge. Test scores were analyzed, as were relationships between psychological state, QOL and clinical factors. Anxiety was greatest before surgery, while depression was greatest immediately after surgery. QOL in the somatic and specific domains also decreased immediately after surgery. QOL in most domains improved 1 month after discharge. This study offers important information regarding perioperative psychological state and QOL in head and neck cancer patients.

  10. The perioperative dialogue--a model of caring for the patient undergoing a hip or a knee replacement surgery under spinal anaesthesia.

    PubMed

    Pulkkinen, Maria; Junttila, Kristiina; Lindwall, Lillemor

    2016-03-01

    The aim of the study was to describe how patients undergoing either a hip or a knee replacement surgery under spinal anaesthesia experienced to be a part of the perioperative dialogue as an ideal model of caring. A qualitative approach was chosen as a method. Nineteen patients undergoing either a hip or a knee replacement surgery under spinal anaesthesia participated. These patients and their nurse anaesthetists had three perioperative dialogues in the pre-, intra- and postoperative phase of care. Data were collected by means of conversational interviews by four voluntary nurse anaesthetists who wrote the dialogues from each perioperative phase. The text from the collected data was analysed by qualitative, latent content analysis. The findings of the analysis show three identified themes: Suffering while waiting for surgery (preoperative dialogue), Continuity creates togetherness (intraoperative dialogue) and Uniqueness - the patient has been seen (postoperative dialogue). The findings show evidence that the perioperative dialogue is an ideal model of caring and serves the patients' desires of individual and dignified care. The patients have a deep appreciation when there is time to develop a caring encounter with his or her own nurse. When a caring encounter has been established, the patient is involved in his or her own care. This model of caring offers the perioperative nurses a new way of caring and arouses reflections about their main task caring for the suffering patient. The continuity created by the perioperative dialogue probably has an influence on both patient satisfaction and patient safety.

  11. [Optimization of preoperative hemoglobin levels in patients without anemia and/or patients who undergo surgery with high blood loss].

    PubMed

    Colomina, M J; Basora Macaya, M

    2015-06-01

    To minimize allogeneic blood transfusions (ABTs) during complex surgery and surgery with considerable blood loss risk, various blood-sparing techniques are needed (multimodal approach). All surgical patients should be assessed with sufficient time to optimize hemoglobin levels and iron reserves so that the established perioperative transfusion strategy is appropriate. Even if the patient does not have anemia, improving hemoglobin levels to reduce the risk of ABT is justified in some cases, especially those in which the patient refuses a transfusion. Treatment with iron and/or erythropoietic agents might also be justified for cases that need a significant autologous blood reserve to minimize ABT during surgery with considerable blood loss.

  12. Nutritional Recommendations for Adult Bariatric Surgery Patients: Clinical Practice.

    PubMed

    Sherf Dagan, Shiri; Goldenshluger, Ariela; Globus, Inbal; Schweiger, Chaya; Kessler, Yafit; Kowen Sandbank, Galit; Ben-Porat, Tair; Sinai, Tali

    2017-03-01

    Bariatric surgery is currently the most effective treatment for morbid obesity and its associated metabolic complications. To ensure long-term postoperative success, patients must be prepared to adopt comprehensive lifestyle changes. This review summarizes the current evidence and expert opinions with regard to nutritional care in the perioperative and long-term postoperative periods. A literature search was performed with the use of different lines of searches for narrative reviews. Nutritional recommendations are divided into 3 main sections: 1) presurgery nutritional evaluation and presurgery diet and supplementation; 2) postsurgery diet progression, eating-related behaviors, and nutritional therapy for common gastrointestinal symptoms; and 3) recommendations for lifelong supplementation and advice for nutritional follow-up. We recognize the need for uniform, evidence-based nutritional guidelines for bariatric patients and summarize recommendations with the aim of optimizing long-term success and preventing complications.

  13. Radiological evaluation by magnetic resonance of the 'new anatomy' of transsexual patients undergoing male to female sex reassignment surgery.

    PubMed

    Brunocilla, E; Soli, M; Franceschelli, A; Schiavina, R; Borghesi, M; Gentile, G; Pultrone, C V; Martorana, G; Orrei, M G; Colombo, F

    2012-09-01

    Magnetic resonance (MR) is the best way to assess the new anatomy of the pelvis after male to female (MtF) sex reassignment surgery. The aim of the study was to evaluate the radiological appearance of the small pelvis after MtF surgery and to compare it with the normal women's anatomy. Fifteen patients who underwent MtF surgery were subjected to pelvic MR at least 6 months after surgery. The anthropometric parameters of the small pelvis were measured and compared with those of ten healthy women (control group). Our personal technique (creation of the mons Veneris under the pubic skin) was performed in all patients. In patients who underwent MtF surgery, the mean neovaginal depth was slightly superior than in women (P=0.009). The length of the inferior pelvic aperture and of the inlet of pelvis was higher in the control group (P<0.005). The inclination between the axis of the neovagina and the inferior pelvis aperture, the thickness of the mons Veneris and the thickness of the rectovaginal septum were comparable between the two study groups. MR consents a detailed assessment of the new pelvic anatomy after MtF surgery. The anthropometric parameters measured in our patients were comparable with those of women.

  14. Surgery for Tetralogy of Fallot in Adults: Early Outcomes

    PubMed Central

    Khan, Imran; Tufail, Zafar; Afridi, Saeed; Iqbal, Madiha; Khan, Tipu; Waheed, Abdul

    2016-01-01

    Objective To study the in-hospital outcome of adult patients who had undergone surgical repair for Tetralogy of Fallot. Methods A retrospective descriptive study was conducted at the Punjab Institute of Cardiology searching the hospital records. All those adult patients who had undergone repair for Tetralogy of Fallot from January 2012 to December 2014 were included in the study. All the patients were operated by the same surgical team. Patients who underwent primary repair as well as those with previous palliative procedures were included in the study. Thirty days outcome was studied by recording variables from the database. Data was analysed using Statistical Package for Social Sciences version 16. Results A total of 80 patients was included in the study, in which there were 48 (60%) male patients and 32 (40%) female patients. Mean age was 21±0.21 years. Those with previous palliation were 15 (18.75%). The associated problems observed were: atrial septal defect 27 (33.75%), right aortic arch 30 (37.5%), patent ductus arteriosus 6 (7.5%) and double outlet right ventricle 3 (3.75%). In-hospital mortality recorded was 7 (8%). Postoperative complications encountered were low cardiac output syndrome 9 (11.25%), pleural effusion requiring tapping 3 (3.75%), reoperation for bleeding 3 (3.8%), pulmonary regurgitation (moderate to severe) 20 (25%) which occurred in the transannular patch group only and atrial arrhythmia 4 (5%). Conclusion A large number of adult patients are still operated for tetralogy of Fallot in Pakistan. With increasing experience in the technique the mortality and morbidity is comparable to international literature. PMID:27849302

  15. Comparison of Four Different Supraglottic Airway Devices in Terms of Efficacy, Intra-ocular Pressure and Haemodynamic Parameters in Children Undergoing Ophthalmic Surgery

    PubMed Central

    Peker, Gökhan; Takmaz, Suna Akın; Baltacı, Bülent; Başar, Hülya; Kotanoğlu, Mustafa

    2015-01-01

    Objective The aim of this study was to compare insertion parameters of four different types of supraglottic airway devices (SGAD) (Classic LMA, I-gel LMA, Proseal LMA, Cobra PLA) in children undergoing ophthalmic surgery and to determine the effect on intra-ocular pressure (IOP) and haemodynamic responses during insertion. Methods Sixty American society of Anesthesiologists (ASA) I–II children aged 1–10 years undergoing extra-ocular ophthalmic surgery were randomly divided into four groups (Group LMA, Group I-gel LMA, Group PLMA and Group CPLA) in this prospective, randomised study. Anaesthesia was induced with decreasing sevoflurane concentrations (8%–2%) in a mixture of 50% N2O-O2. All SGADs were inserted under deep anaesthesia. The characteristics of insertion (number of attempts, ease and time), oropharyngeal leak pressure (OLP) and complications were recorded. IOP in both eyes, heart rate (HR), mean arterial pressure (MAP) and EtCO2 were measured before and 2 and 5 min after insertion of the SGADs. Results There was no difference between the groups in terms of the characteristics of insertion. The mean IOP did not increase significantly in all groups. MAP and HR changes were similar among the groups during follow-up. In all groups, HR increased 2 min after insertion (statistically insignificant) and returned to the baseline value 5 min after insertion. A statistically significant correlation was seen between HR increase and IOP values before and after insertion of the SGADs (p=0.006, correlation coefficient=0.352). Desaturation was seen in one patient in Groups LMA, PLMA and CPLA, and laryngospasm was seen in two patients in Group CPLA and in one patient in Group LMA. Conclusion It was seen that during insertion of Classic LMA, I-gel LMA, Proseal LMA and Cobra PLA, IOP did not increase and haemodynamic stability was maintained in children undergoing extra-ocular ophthalmic surgery. PMID:27366519

  16. Intravenous palonosetron compared with a combination of ramosetron and dexamethasone in preventing post operative nausea and vomiting in patients undergoing gynaecological surgeries under spinal anaesthesia, a randomised study

    PubMed Central

    Narayanappa, Archana B; Gurulingaswamy, Shivakumar; Prabhakaraiah, Umesh N; Gurushanth, Somsundar R; Sapare, Vinay; Goud, Nagaraj

    2017-01-01

    Background and Aims: Post-operative nausea and vomiting (PONV) is one of the most common complications in patients undergoing gynaecological surgeries under spinal anaesthesia (SA). Palonosetron has the unique property of controlling 'delayed chemotherapy-induced nausea and vomiting' when compared to older serotonin antagonists. This study compared the effectiveness of palonosetron with a combination of ramosetron and dexamethasone in preventing PONV. Methods: Sixty patients undergoing gynaecological surgeries under SA were randomly allocated into two groups of thirty each, to receive either a combination of 0.3 mg of ramosetron and 8 mg of dexamethasone intravenously (IV) (Group RD) or 0.075 mg of palonosetron IV (Group P). The incidence of PONV, number of complete responders (no nausea, vomiting or use of rescue anti-emetics) and severity of nausea were evaluated during intra- and post-operative period. Results: The incidence of complete responders during intraoperative period was 80.0% in Group RD and 76.7% in Group P (P = 0.074) whereas postoperatively at 0–2 h and 2–6 h, it was 73.3% and 83.3% in Group RD respectively as compared to 46.6% and 56.6% in Group P respectively (P = 0.016 and P = 0.024). The incidence of PONV during 24 h of post-operative period was 30.00% in Group RD as compared to 60.00% in Group P (P = 0.0195). Nausea severity score and use of rescue anti-emetics did not vary between the groups. Conclusion: Combination of ramosetron and dexamethasone is more effective than palonosetron alone in preventing PONV in patients undergoing gynaecological surgeries under SA. PMID:28250483

  17. Description and design considerations of a randomized clinical trial investigating the effect of a multidisciplinary cognitive-behavioural intervention for patients undergoing lumbar spinal fusion surgery

    PubMed Central

    2014-01-01

    Background The ideal rehabilitation strategy following lumbar spinal fusion surgery has not yet been established. This paper is a study protocol, describing the rationale behind and the details of a cognitive-behavioural rehabilitation intervention for lumbar spinal fusion patients based on the best available evidence. Predictors of poor outcome following spine surgery have been identified to provide targets for the intervention, and the components of the intervention were structured in accordance with the cognitive-behavioural model. The study aims to compare the clinical and economical effectiveness of a cognitive-behavioural rehabilitation strategy to that of usual care for patients undergoing lumbar spinal fusion surgery. Methods/Design The study is a randomized clinical trial including 96 patients scheduled for lumbar spinal fusion surgery due to degenerative disease or spondylolisthesis. Patients were recruited in the period October 2011 to July 2013, and the follow-up period is one year from date of surgery. Patients are allocated on a 1:2 ratio (control: intervention) to either treatment as usual (control group), which implies surgery and the standard postoperative rehabilitation, or in addition to this, a patient education focusing on pain behaviour and pain coping (intervention group). It takes place in a hospital setting, and consists of six group-based sessions, managed by a multidisciplinary team of health professionals. The primary outcomes are disability (Oswestry Disability Index) and sick leave, while secondary outcomes include coping (Coping Strategies Questionnaire), fear-avoidance belief (Fear Avoidance Belief Questionnaire), pain (Low Back Pain Rating Scale, pain index), mobility during hospitalization (Cumulated Ambulation Score), generic health-related quality of life (EQ-5D) and resource use. Outcomes are measured using self report questionnaires, medical records and national registers. Discussion It is expected that the intervention can

  18. Regional differences between US and Europe in radiological osteoarthritis and self assessed quality of life in patients undergoing total hip arthroplasty surgery.

    PubMed

    Gromov, Kirill; Greene, Meridith E; Sillesen, Nanna H; Troelsen, Anders; Malchau, Henrik; Huddleston, James I; Emerson, Roger; Garcia-Cimbrelo, Eduardo; Gebuhr, Peter

    2014-11-01

    Precise indications for THA remain unclear and regional differences might exist in selecting patients for surgery. In this study we investigate radiological OA grade and self-reported quality of life in 909 patients undergoing THA in 16 centers across US and Europe. Patients in US were younger and had higher BMI. More patients with mild Tönnis OA grade underwent surgery in the US compared to Europe. Patients in the US had significantly higher pain VAS and significantly lower SF-36 Physical, while having significantly higher EQ-VAS scores preoperatively. Patient demographics and disease severity according to radiological OA grade and self-reported survey scores vary between the United States and Europe. This knowledge can be used in the interpretation of US and European based studies on outcome following THA.

  19. The outcome of lumbar disc herniation surgery is worse in old adults than in young adults

    PubMed Central

    Strömqvist, Fredrik; Strömqvist, Björn; Jönsson, Bo; Karlsson, Magnus K

    2016-01-01

    Background and purpose The outcome of surgical treatment of lumbar disc herniation (LDH) has been thoroughly evaluated in middle-aged patients, but less so in elderly patients. Patients and methods With validated patient-reported outcome measures (PROMs) and using SweSpine (the national Swedish Spine Surgery Register), we analyzed the preoperative clinical status of LDH patients and the 1-year postoperative outcome of LDH surgery performed over the period 2000–2012. We included 1,250 elderly patients (≥ 65 years of age) and 12,840 young and middle-aged patients (aged 20–64). Results Generally speaking, elderly patients were referred for LDH surgery with worse PROM scores than young and middle-aged patients, they improved less by surgery, they experienced more complications, they had inferior 1-year postoperative PROM scores, and they were less satisfied with the outcome (with all differences being statistically significant). Interpretation Elderly patients appear to have a worse postoperative outcome after LDH surgery than young and middle-aged patients, they are referred to surgery with inferior clinical status, and they improve less after the surgery. PMID:27391663

  20. Population pharmacokinetics of daptomycin in adult patients undergoing continuous renal replacement therapy

    PubMed Central

    Xu, Xiaoying; Khadzhynov, Dmytro; Peters, Harm; Chaves, Ricardo L.; Levi, Micha; Corti, Natascia

    2016-01-01

    Aim The objective of this population pharmacokinetic (PK) analysis was to provide guidance for the dosing interval of daptomycin in patients undergoing continuous renal replacement therapy (CRRT). Methods A previously published population PK model for daptomycin was updated with data from patients undergoing continuous veno‐venous haemodialysis (CVVHD; n = 9) and continuous veno‐venous haemodiafiltration (CVVHDF; n = 8). Model‐based simulations were performed to compare the 24 h AUC, C max and C min of daptomycin following various dosing regimens (4, 6, 8, 10, and 12 mg kg−1 every [Q] 24 h and Q48 h), with the safety and efficacy exposure references for Staphylococcus aureus bacteraemia/right‐sided infective endocarditis. Results The previously developed daptomycin structural population PK model could reasonably describe data from the patients on CRRT. The clearance in patients undergoing CVVHDF and CVVHD was estimated at 0.53 and 0.94 l h−1, respectively, as compared with 0.75 l h−1 in patients with creatinine clearance (CrCl) ≥ 30 ml min−1. Daptomycin Q24 h dosing in patients undergoing CRRT resulted in optimal exposure for efficacy, with AUC comparable to that in patients with CrCl ≥ 30 ml min−1. In contrast, Q48 h dosing was associated with considerably lower AUC24–48h in all patients for doses up to 12 mg kg−1 and is therefore inappropriate. Conclusions Q24 h dosing of daptomycin up to 12 mg kg−1 provides comparable drug exposure in patients on CVVHD and in those with CrCl ≥ 30 ml min−1. Daily daptomycin use up to 8 mg kg−1 doses are appropriate for patients on CVVHDF, but higher doses may increase the risk of toxicity. PMID:27628437

  1. SurgiCal Obesity Treatment Study (SCOTS): protocol for a national prospective cohort study of patients undergoing bariatric surgery in Scotland

    PubMed Central

    Logue, Jennifer; Stewart, Sally; Munro, Jane; Grieve, Eleanor; Lean, Mike; Lindsay, Robert S; Bruce, Duff; Ali, Abdulmajid; Briggs, Andrew; Sattar, Naveed; Ford, Ian

    2015-01-01

    Introduction The efficacy of bariatric surgery for large-scale, long-term weight loss is well established. However, many questions remain over the continual benefits and cost-effectiveness of that weight loss for overall health, particularly when accounting for potential complications and adverse events of surgery. Health research institutes in the UK and the USA have called for high-quality longitudinal cohort studies of patients undergoing bariatric surgery, assessing outcomes such as surgical complications, mortality, diabetes remission, microvascular complications, cardiovascular events, mental health, cost and healthcare use. Methods and analysis SurgiCal Obesity Treatment Study (SCOTS) is a national, prospective, observational, cohort study of patients undergoing primary bariatric surgical procedures in Scotland. This study aims to recruit 2000 patients and conduct a follow-up for 10 years postbariatric surgery using multiple data collection methods: surgeon-recorded data, electronic health record linkage, and patient-reported outcome measures. Outcomes measured will include: mortality, weight change, diabetes, surgical, cardiovascular, cancer, behavioural, reproductive/urological and nutritional variables. Healthcare utilisation and economic productivity will be collected to inform cost-effectiveness analysis. Ethics and dissemination The study has received a favourable ethical opinion from the West of Scotland Research Ethics committee. All publications arising from this cohort study will be published in open-access peer-reviewed journals. All SCOTS investigators (all members of the research team at every recruiting site) will have the ability to propose research suggestions and potential publications using SCOTS data; a publications committee will approve all requests for use of SCOTS data and propose writing committees and timelines. Lay-person summaries of all research findings will be published simultaneously on the SCOTS website (http

  2. Method to Calculate the Protamine Dose Necessary for Reversal of Heparin as a Function of Activated Clotting Time in Patients Undergoing Cardiac Surgery

    PubMed Central

    Cuenca, Javier Suárez; Diz, Pilar Gayoso; Sampedro, Francisco Gude; Zincke, J. Marcos Gómez; Acuña, Helena Rey; Fontanillo, M. Manuela Fontanillo

    2013-01-01

    Abstract: Activated clotting time (ACT) has been used to monitor coagulation and guide management of anticoagulation control in patients undergoing cardiac surgery for decades. However, reversal of heparin with protamine is typically empirically based on total heparin administered. Dose-related adverse effects of protamine are well described. The aim of this study was to evaluate a heparin reversal strategy based on calculation of the protamine dose based on ACT measurements. We present a method using a mathematical formula based on the dose–response line (1). To check the formula, we performed a retrospective observational cohort study of 177 patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The study group of 80 patients was administered the dose of protamine obtained using our formula, and the control group of 97 patients was administered the empirically calculated dose. The ACT returned to normal values in patients who were given doses of protamine that were calculated using our formula; all but two had a final ACT of 141. The application of the formula resulted in a significant reduction in the dose of protamine (p < .023). The formula we present is a valid method for calculating the dose of protamine necessary to neutralize heparin. This same method can be used working with a target ACT to adjust the dose of heparin. As a result of its functionality, it allows application on a daily basis standardizing the process. We believe that the formula we developed can be applied in all those procedures in which it is necessary to anticoagulate patients with heparin and later neutralization (cardiac surgery with or without CPB, vascular surgery, procedures of interventional cardiology, and extracorporeal depuration procedures). PMID:24649571

  3. Perioperative management of antiplatelet therapy in patients with coronary stents undergoing cardiac and non-cardiac surgery: a consensus document from Italian cardiological, surgical and anaesthesiological societies.

    PubMed

    Rossini, Roberta; Musumeci, Giuseppe; Visconti, Luigi Oltrona; Bramucci, Ezio; Castiglioni, Battistina; De Servi, Stefano; Lettieri, Corrado; Lettino, Maddalena; Piccaluga, Emanuela; Savonitto, Stefano; Trabattoni, Daniela; Capodanno, Davide; Buffoli, Francesca; Parolari, Alessandro; Dionigi, Gianlorenzo; Boni, Luigi; Biglioli, Federico; Valdatta, Luigi; Droghetti, Andrea; Bozzani, Antonio; Setacci, Carlo; Ravelli, Paolo; Crescini, Claudio; Staurenghi, Giovanni; Scarone, Pietro; Francetti, Luca; D'Angelo, Fabio; Gadda, Franco; Comel, Andrea; Salvi, Luca; Lorini, Luca; Antonelli, Massimo; Bovenzi, Francesco; Cremonesi, Alberto; Angiolillo, Dominick J; Guagliumi, Giulio

    2014-05-01

    Optimal perioperative antiplatelet therapy in patients with coronary stents undergoing surgery still remains poorly defined and a matter of debate among cardiologists, surgeons and anaesthesiologists. Surgery represents one of the most common reasons for premature antiplatelet therapy discontinuation, which is associated with a significant increase in mortality and major adverse cardiac events, in particular stent thrombosis. Clinical practice guidelines provide little support with regard to managing antiplatelet therapy in the perioperative phase in the case of patients with non-deferrable surgical interventions and/or high haemorrhagic risk. Moreover, a standard definition of ischaemic and haemorrhagic risk has never been determined. Finally, recommendations shared by cardiologists, surgeons and anaesthesiologists are lacking. The present consensus document provides practical recommendations on the perioperative management of antiplatelet therapy in patients with coronary stents undergoing surgery. Cardiologists, surgeons and anaesthesiologists have contributed equally to its creation. On the basis of clinical and angiographic data, the individual thrombotic risk has been defined. All surgical interventions have been classified according to their inherent haemorrhagic risk. A consensus on the optimal antiplatelet regimen in the perioperative phase has been reached on the basis of the ischaemic and haemorrhagic risk. Aspirin should be continued perioperatively in the majority of surgical operations, whereas dual antiplatelet therapy should not be withdrawn for surgery in the case of low bleeding risk. In selected patients at high risk for both bleeding and ischaemic events, when oral antiplatelet therapy withdrawal is required, perioperative treatment with short-acting intravenous glycoprotein IIb/IIIa inhibitors (tirofiban or eptifibatide) should be taken into consideration.

  4. Nutritional Risk Screening 2002 as a Predictor of Postoperative Outcomes in Patients Undergoing Abdominal Surgery: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

    PubMed Central

    Sun, Zhen; Kong, Xin-Juan; Jing, Xue; Deng, Run-Jun; Tian, Zi-Bin

    2015-01-01

    Background The nutritional risk screening (NRS 2002) has been applied increasingly in patients who underwent abdominal surgery for nutritional risk assessment. However, the usefulness of the NRS 2002 for predicting is controversial. This meta-analysis was to examine whether a preoperative evaluation of nutritional risk by NRS 2002 provided prediction of postoperative outcomes in patients undergoing abdominal surgery. Methods A systematic literature search for published papers was conducted using the following online databases: MEDLINE, EMBASE, the Cochrane library, EBSCO, CRD databases, Cinahl, PsycInfo and BIOSIS previews. The pooled odds ratio (OR) or weight mean difference (WMD) was calculated using a random-effect model or a fix-effect model. Results Eleven studies with a total of 3527 patients included in this study. Postoperative overall complications were more frequent in nutritional risk patients versus patients without nutritional risk (the pooled OR 3.13 [2.51, 3.90] p<0.00001). The pooled OR of mortality for the nutritional risk group and non-nutritional risk group was 3.61 [1.38, 9.47] (p = 0.009). Furthermore, the postoperative hospital stay was significant longer in the preoperative nutritional risk group than in the nutritional normal group (WMD 5.58 [4.21, 6.95] p<0.00001). Conclusions The present study has demonstrated that patients at preoperative nutritional risk have increased complication rates, high mortality and prolonged hospital stay after surgery. However, NRS 2002 needs to be validated in larger samples of patients undergoing abdominal surgery by better reference method. PMID:26172830

  5. Comparison of Perioperative Thoracic Epidural Fentanyl with Bupivacaine and Intravenous Fentanyl for Analgesia in Patients Undergoing Coronary Artery Bypass Grafting Surgery

    PubMed Central

    Sen, Amitabh Chanchal; Rajan, Sunil; Balachandran, Rakhi; Kumar, Lakshmi; Nair, Suresh Gangadharan

    2017-01-01

    Context: Two-thirds of patients undergoing coronary artery bypass grafting (CABG) surgery report moderate to severe pain, particularly with ambulatory or respiratory effort. Aims: The aim of this study is to compare the analgesic effect of perioperative thoracic epidural fentanyl with bupivacaine and intravenous fentanyl in patients undergoing CABG surgery. Settings and Design: The study was a prospective, randomized, nonblinded comparative study. Materials and Methods: A total of 60 patients coming under the American Society of Anesthesiologists Class III who were posted for CABG surgery were recruited in this study. The patients were randomized into one of two groups, higher thoracic epidural analgesia (HTEA) group receiving general anesthesia with thoracic epidural analgesia (TEA) in the postoperative period, and intravenous fentanyl analgesia group receiving general anesthesia with fentanyl infusion in the postoperative period. The pain was assessed at 4 h after extubation when the patient was fully awake, then at 8, 12, 18, and 24 h. Both groups received intravenous tramadol 100 mg as rescue analgesia whenever visual analog scale score was 5 and above. Heart rate, mean arterial pressure (MAP), sedation scores, and physiotherapy cooperation were also assessed. Statistical Analysis Used: The numerical data were analyzed using an independent t-test, repeated-measures ANOVA, and Mann–Whitney U-test. Results: Pain at rest and on cough was significantly lower in HTEA patients as compared to control group. Patients HTEA group got less frequent rescue analgesia than the control group. Physiotherapy cooperation was significantly better in HTEA patients at 4, 12, and 24 h postextubation. They also had significantly lower heart rate, MAP, and sedation scores. Conclusion: Perioperative TEA using fentanyl with bupivacaine provided optimal postoperative analgesia at rest and during coughing in patients following CABG surgery as compared to postoperative analgesia with

  6. Performance, pain, and quality of life on use of central venous catheter for management of pericardial effusions in patients undergoing coronary artery bypass graft surgery

    PubMed Central

    Ghods, Kamran; Razavi, Mohammad Reza; Forozeshfard, Mohammad

    2016-01-01

    Different pericardial catheters have been suggested as an effective alternative method for drainage of pericardial effusion. The aim of this study was to determine the performance, pain, and quality of life on use of central venous catheter (CVC) for drainage of pericardial effusion in patients undergoing open heart surgery. Fifty-five patients who had developed pericardial effusion after an open heart surgery (2012–2015) were prospectively assessed. Triple-lumen central catheters were inserted under echocardiographic guidance. Clinical, procedural, complication, and outcome details were analyzed. Intensity of pain and quality of life of patients were assessed using the numerical rating scale and Short-Form Health Survey. CVC was inserted for 36 males and 19 females, all of whom had a mean age of 58.5±15 years, and the mean duration of the open heart surgery was 8±3.5 hours. The mean central venous pressure catheter life span was 14.6 days. No cases of recurrent effusion and complication were reported. The technical success rate of procedure was 100%. Intensity of pain and quality of life of patients had improved during follow-up. CVC insertion is a safe and effective technique for the management of pericardial effusion in patients after open heart surgery. PMID:27826210

  7. Providing preoperative information for children undergoing surgery: a randomized study testing different types of educational material to reduce children's preoperative worries.

    PubMed

    Fernandes, S C; Arriaga, P; Esteves, F

    2014-12-01

    This study developed three types of educational preoperative materials and examined their efficacy in preparing children for surgery by analysing children's preoperative worries and parental anxiety. The sample was recruited from three hospitals in Lisbon and consisted of 125 children, aged 8-12 years, scheduled to undergo outpatient surgery. The participants were randomly assigned to one of the seven independent conditions that were combined into the following three main groups: an experimental group, which received educational materials with information about surgery and hospitalization (a board game, a video or a booklet); a comparison group, which received entertaining material with the same format type; and a control group, which did not receive any material. Children's preoperative worries and parental anxiety were evaluated after the experimental manipulation. Children who received educational materials were significantly less worried about surgery and hospital procedures than children in the comparison and the control groups, although no statistically differences were found between the type of materials within the experimental group, and no significant effect occurred on parental state anxiety. These results do however support the hypothesis that providing preoperative materials with educational information reduce children's preoperative worries.

  8. Effect of 22q11.2 deletion on bleeding and transfusion utilization in children with congenital heart disease undergoing cardiac surgery

    PubMed Central

    Brenner, Michelle K.; Clarke, Shanelle; Mahnke, Donna K.; Simpson, Pippa; Bercovitz, Rachel S.; Tomita-Mitchell, Aoy; Mitchell, Michael E.; Newman, Debra K.

    2016-01-01

    Background Post-surgical bleeding causes significant morbidity and mortality in children undergoing surgery for congenital heart defects (CHD). 22q11.2 deletion syndrome (DS) is the second most common genetic risk factor for CHD. The deleted segment of chromosome 22q11.2 encompasses the gene encoding glycoprotein (GP) Ibβ, which is required for expression of the GPIb-V-IX complex on the platelet surface, where it functions as the receptor for von Willebrand factor (VWF). Binding of GPIb-V-IX to VWF is important for platelets to initiate hemostasis. It is not known whether hemizygosity for the gene encoding GPIbβ increases the risk for bleeding following cardiac surgery for patients with 22q11.2 DS. Methods We performed a case-control study of 91 pediatric patients who underwent cardiac surgery with cardiopulmonary bypass from 2004–2012 at Children’s Hospital of Wisconsin. Results Patients with 22q11.2 DS had larger platelets and lower platelet counts, bled more excessively and received more transfusion support with packed red blood cells in the early post-operative period relative to control patients. Conclusions Pre-surgical genetic testing for 22q11.2 DS may help to identify a subset of pediatric cardiac surgery patients who are at increased risk for excessive bleeding and who may require more transfusion support in the post-operative period. PMID:26492284

  9. Long-term stability of adolescent versus adult surgery for treatment of mandibular deficiency

    PubMed Central

    Proffit, William R.; Phillips, Ceib; Turvey, Timothy A.

    2010-01-01

    In mandibular deficient patients, mandibular growth is not expected after the adolescent growth spurt, so mandibular advancement surgery is often carried out at 13 years. To test if the long-term stability for younger patients is similar to that for adult patients, the authors compared cephalometric changes from 1 year postsurgery (when changes due to the surgery should be completed) to 5 year follow up. 32 patients who had early mandibular advancement with or without simultaneous maxillary surgery (aged up to 16 for girls and 18 for boys), and 52 patients with similar surgery at older ages were studied. Beyond 1 year postsurgery, the younger patients showed significantly greater change in the horizontal and vertical position of points B and pogonion, the horizontal (but not vertical) position of gonion, and mandibular plane angle. 50% of younger patients had 2–4 mm backward movement of Pg and another 25% had >4 mm. 15% of older patients had 2–4 mm change and none had >4 mm. Long-term changes in younger patients who had 2-jaw surgery were greater than for mandibular advancement only. Changes in younger groups were greater than for adult groups. Satisfaction with treatment and perception of problems were similar for both groups. PMID:20181460

  10. Incidence of Venous Thromboembolism in Patients Undergoing Major Hip Surgeries at a Single Institution: A Prospective Study

    PubMed Central

    Yamanaka, Yasuhiro; Ito, Hiroshi

    2016-01-01

    Background: Venous thoromboembolism (VTE) is one of the most significant complications after hip surgeries. Many studies have been reported about the incidence of VTE after THA, but a small number of reports were found concerning Periacetabular osteotomy, Revision THA and Surgery for hip fracture postoperatively. Furthermore, there exists no comparative study of the incidence of VTE among major hip surgeries at a single institution. We reported the incidence of VTE among hip surgeries performed at a single institution. Methods: A total of 820 Hip surgeries were performed at same institution. The procedures included 420 hips that underwent primary total hip arthroplasties (THA), 91 revision or removal of total hip arthroplasties (Revision THA), 144 periacetabular osteotomy (PAO) and 165 surgery for hip fracture (SHF) between 2006 and 2012. VTE was detected by Multidetector computed tomography (MDCT) that scanned 768 cases and by ultrasound that scanned 52cases postoperative 10-14 days. Results: The overall incidence of VTE was 12.2% (100 of 820). The incidence of VTE after THA was 13.1% (55 of 420), Revision THA was 13.2% (12 of 91), PAO was 2.1% (3 of 144) and SHF was 18.1% (30 of 165). The incidence of VTE was significantly higher in SHF than in PAO. Conclusion: This data indicates that the incidence of VTE after PAO is significantly lower than SHF and relatively lower than THA and Revision THA. A younger age and non-invasion of the bone marrow of the femur may have affected the result. Prophylaxis therapy was effective especially on SHF. PMID:27499823

  11. Lack of extended venous thromboembolism prophylaxis in high-risk patients undergoing major orthopaedic or major cancer surgery. Electronic Assessment of VTE Prophylaxis in High-Risk Surgical Patients at Discharge from Swiss Hospitals (ESSENTIAL).

    PubMed

    Kalka, Christoph; Spirk, David; Siebenrock, Klaus-Arno; Metzger, Urs; Tuor, Philipp; Sterzing, Daniel; Oehy, Kurt; Wondberg, Daniela; Mouhsine, El Yazid; Gautier, Emanuel; Kucher, Nils

    2009-07-01

    Extended pharmacological venous thromboembolism (VTE) prophylaxis beyond discharge is recommended for patients undergoing high-risk surgery. We prospectively investigated prophylaxis in 1,046 consecutive patients undergoing major orthopaedic (70%) or major cancer surgery (30%) in 14 Swiss hospitals. Appropriate in-hospital prophylaxis was used in 1,003 (96%) patients. At discharge, 638 (61%) patients received prescription for extended pharmacological prophylaxis: 564 (77%) after orthopaedic surgery, and 74 (23%) after cancer surgery (p < 0.001). Patients with knee replacement (94%), hip replacement (81%), major trauma (80%), and curative arthroscopy (73%) had the highest prescription rates for extended VTE prophylaxis; the lowest rates were found in patients undergoing major surgery for thoracic (7%), gastrointestinal (19%), and hepatobiliary (33%) cancer. The median duration of prescribed extended prophylaxis was longer in patients with orthopaedic surgery (32 days, interquartile range 14-40 days) than in patients with cancer surgery (23 days, interquartile range 11-30 days; p<0.001). Among the 278 patients with an extended prophylaxis order after hip replacement, knee replacement, or hip fracture surgery, 120 (43%) received a prescription for at least 35 days, and among the 74 patients with an extended prophylaxis order after major cancer surgery, 20 (27%) received a prescription for at least 28 days. In conclusion, approximately one quarter of the patients with major orthopaedic surgery and more than three quarters of the patients with major cancer surgery did not receive prescription for extended VTE prophylaxis. Future effort should focus on the improvement of extended VTE prophylaxis, particularly in patients undergoing major cancer surgery.

  12. The effects of deep and light propofol anesthesia on stress response in patients undergoing open lung surgery: a randomized controlled trial

    PubMed Central

    Jung, Sung Mee

    2015-01-01

    Background This prospective, randomized controlled study was undertaken to compare stress hormone response to open thoracotomy for lung resection at different anesthetic depths, as determined by bispectral index (BIS) monitoring, in patients under propofol-remifentanil anesthesia. Methods Forty-eight adult patients scheduled for lung resection surgery using one-lung ventilation were randomly assigned to either a deep anesthesia group (BIS score of 40 ± 5, n = 24) or a light anesthesia group (BIS score of 60 ± 5, n = 24) by adjusting propofol infusion rates. Blood norepinephrine, epinephrine, adrenocorticotropic hormone, and cortisol levels were measured before the induction of anesthesia, at the end of surgery, and at 2 hours postoperatively. Blood glucose, hemodynamic, and oxygenation-ventilation variables, and postoperative outcomes were also measured. Results Norepinephrine and epinephrine levels remained unchanged over time in the deep group, but norepinephrine levels significantly increased in the light group at 2 h after surgery than at baseline (P = 0.007 and 0.004, respectively). Temporal changes in norepinephrine, but not in epinephrine, were significantly different between the two groups (P = 0.036). Plasma glucose levels in the light group increased with time and were significantly higher than in the deep group at the end of surgery (P = 0.002). Conclusions A deep level of anesthesia achieved using high propofol infusion rates during lung surgery provided lower perioperative norepinephrine and glucose responses than light level of anesthesia during the early postoperative period but failed to affect immediate postoperative outcomes. PMID:26045924

  13. Organ doses for reference adult male and female undergoing computed tomography estimated by Monte Carlo simulations

    SciTech Connect

    Lee, Choonsik; Kim, Kwang Pyo; Long, Daniel; Fisher, Ryan; Tien, Chris; Simon, Steven L.; Bouville, Andre; Bolch, Wesley E.

    2011-03-15

    Purpose: To develop a computed tomography (CT) organ dose estimation method designed to readily provide organ doses in a reference adult male and female for different scan ranges to investigate the degree to which existing commercial programs can reasonably match organ doses defined in these more anatomically realistic adult hybrid phantomsMethods: The x-ray fan beam in the SOMATOM Sensation 16 multidetector CT scanner was simulated within the Monte Carlo radiation transport code MCNPX2.6. The simulated CT scanner model was validated through comparison with experimentally measured lateral free-in-air dose profiles and computed tomography dose index (CTDI) values. The reference adult male and female hybrid phantoms were coupled with the established CT scanner model following arm removal to simulate clinical head and other body region scans. A set of organ dose matrices were calculated for a series of consecutive axial scans ranging from the top of the head to the bottom of the phantoms with a beam thickness of 10 mm and the tube potentials of 80, 100, and 120 kVp. The organ doses for head, chest, and abdomen/pelvis examinations were calculated based on the organ dose matrices and compared to those obtained from two commercial programs, CT-EXPO and CTDOSIMETRY. Organ dose calculations were repeated for an adult stylized phantom by using the same simulation method used for the adult hybrid phantom. Results: Comparisons of both lateral free-in-air dose profiles and CTDI values through experimental measurement with the Monte Carlo simulations showed good agreement to within 9%. Organ doses for head, chest, and abdomen/pelvis scans reported in the commercial programs exceeded those from the Monte Carlo calculations in both the hybrid and stylized phantoms in this study, sometimes by orders of magnitude. Conclusions: The organ dose estimation method and dose matrices established in this study readily provides organ doses for a reference adult male and female for different

  14. Eosinophilic esophagitis prevalence in an adult population undergoing upper endoscopy in southeastern Mexico.

    PubMed

    De la Cruz-Patiño, E; Ruíz Juárez, I; Meixueiro Daza, A; Grube Pagola, P; Roesch-Dietlen, F; Remes-Troche, J M

    2015-01-01

    Eosinophilic esophagitis (EoE) prevalence fluctuates according to the population studied and varies from 0.4% in an open population to 6.5% in subjects with esophageal symptoms. Even though this entity has been described in North American and European populations, it is still considered an 'unusual' condition in Latin America. The study aimed to determine EoE prevalence in patients undergoing elective endoscopy in a tertiary referral center in southeastern Mexico. Consecutive patients were evaluated that had been referred to the Medical and Biological Research Institute, Veracruz, Mexico, for upper endoscopy due to gastrointestinal symptoms. Demographic variables and symptoms were analyzed in all the cases. Eight mucosal biopsies of the esophagus (four proximal and four distal) were obtained and were reviewed by a blinded pathologist. Histological diagnosis was established when the mean eosinophil count at a large magnification was ≥15. A total of 235 subjects (137 women, 51.16 years) were evaluated, and EoE prevalence was 1.7% (4/235 95% confidence interval 0.2-3.6%). In all four cases, pH test were normal. Among patients with histological diagnosis of EoE, a greater number of patients with a past history of asthma (50% vs. 19.3%, P = 0.04) and a tendency for a greater frequency of dysphagia (50% vs. 25%, P = 0.10). There were no differences in the endoscopic findings (rings, grooves, plaques, or stricture) when compared with the patients presenting with erosive esophagitis. EoE prevalence among patients undergoing upper endoscopy from southeastern Mexico was 1.7%, which can be regarded as intermediate to low.

  15. Pre-operative factors indicating risk of multiple operations versus a single operation in women undergoing surgery for screen detected breast cancer.

    PubMed

    O'Flynn, E A M; Currie, R J; Mohammed, K; Allen, S D; Michell, M J

    2013-02-01

    We aim to identify preoperative factors at diagnosis which could predict whether women undergoing wide local excision (WLE) would require further operations. 1593 screen-detected invasive and non-invasive breast cancers were reviewed. Age, presence of ductal carcinoma in situ (DCIS), invasive cancer size on mammography, mammographic sign, tumour type, grade and confidence of the radiologist in malignancy were compared. 83%(1315/1593) of women had a WLE. Of these, 70%(919/1315) had a single operation, and 30%(396/1315) multiple operations. These included repeat WLE to clear margins (60%(238/396)), mastectomy (34%(133/396)) and axillary dissection (6%(25/396)). The presence of mammographic microcalcification, lobular carcinoma and grade 2 malignancy on core biopsy were independent risk factors for multiple operations on multivariate analysis. Women with mammographic DCIS >30 mm were 3.4 times more likely to undergo repeat surgery than those with smaller foci. The multidisciplinary team should pay particular attention to these factors when planning surgery.

  16. Intravenous paracetamol infusion: Superior pain management and earlier discharge from hospital in patients undergoing palliative head-neck cancer surgery

    PubMed Central

    Majumdar, Saikat; Das, Anjan; Kundu, Ratul; Mukherjee, Dipankar; Hazra, Bimal; Mitra, Tapobrata

    2014-01-01

    Background: Paracetamol; a cyclooxygenase inhibitor; acts through the central nervous system as well as serotoninergic system as a nonopioid analgesic. A prospective, double-blinded, and randomized-controlled study was carried out to compare the efficacy of preoperative 1g intravenous (iv) paracetamol with placebo in providing postoperative analgesia in head-neck cancer surgery. Materials and Methods: From 2008 February to 2009 December, 80 patients for palliative head-neck cancer surgery were randomly divided into (F) and (P) Group receiving ivplacebo and iv paracetamol, respectively, 5 min before induction. Everybody received fentanyl before induction and IM diclofenac for pain relief at8 hourly for 24 h after surgery. Visual analogue scale (VAS) and amount of fentanyl were measured for postoperative pain assessment (24 h). Results and Statistical analysis: The mean VAS score in 1st, 2nd postoperative hour, and fentanyl requirement was less and the need for rescue analgesic was delayed in ivparacetamol group which were all statistically significant. Paracetamol group had a shorter surgical intensive care unit (SICU) and hospital stay which was also statistically significant. Conclusion: The study demonstrates the effectiveness of ivparacetamol as preemptive analgesic in the postoperative pain control after head-neck cancer surgery and earlier discharge from hospital. PMID:25276627

  17. Effects of Perioperative Low Dose Ketamine Infusion on Postoperative Pain Perception in Males and Females Undergoing Laparoscopic Surgery

    DTIC Science & Technology

    2003-12-01

    Fifty to 75% of patients report that postoperative pain management is grossly inadequate. A contributing factor to this analgesic deficit may be...produces hyperalgesia. Ketamine, an NMDA receptor antagonist, administered preemptively may inhibit central sensitization and thereby reduce postoperative ...2 factorial, double blind, placebo- controlled study, 37 female and 18 male (N =55) ASA 1-3 participants who underwent elective laparoscopic surgery

  18. I-gel Laryngeal Mask Airway Combined with Tracheal Intubation Attenuate Systemic Stress Response in Patients Undergoing Posterior Fossa Surgery

    PubMed Central

    Tang, Chaoliang; Chai, Xiaoqing; Kang, Fang; Huang, Xiang; Hou, Tao; Tang, Fei; Li, Juan

    2015-01-01

    Background. The adverse events induced by intubation and extubation may cause intracranial hemorrhage and increase of intracranial pressure, especially in posterior fossa surgery patients. In this study, we proposed that I-gel combined with tracheal intubation could reduce the stress response of posterior fossa surgery patients. Methods. Sixty-six posterior fossa surgery patients were randomly allocated to receive either tracheal tube intubation (Group TT) or I-gel facilitated endotracheal tube intubation (Group TI). Hemodynamic and respiratory variables, stress and inflammatory response, oxidative stress, anesthesia recovery parameters, and adverse events during emergence were compared. Results. Mean arterial pressure and heart rate were lower in Group TI during intubation and extubation (P < 0.05 versus Group TT). Respiratory variables including peak airway pressure and end-tidal carbon dioxide tension were similar intraoperative, while plasma β-endorphin, cortisol, interleukin-6, tumor necrosis factor-alpha, malondialdehyde concentrations, and blood glucose were significantly lower in Group TI during emergence relative to Group TT. Postoperative bucking and serious hypertensions were seen in Group TT but not in Group TI. Conclusion. Utilization of I-gel combined with endotracheal tube in posterior fossa surgery patients is safe which can yield more stable hemodynamic profile during intubation and emergence and lower inflammatory and oxidative response, leading to uneventful recovery. PMID:26273146

  19. Determinants of Weight Loss following Laparoscopic Sleeve Gastrectomy: The Role of Psychological Burden, Coping Style, and Motivation to Undergo Surgery

    PubMed Central

    Figura, Andrea; Ahnis, Anne; Stengel, Andreas; Hofmann, Tobias; Elbelt, Ulf; Ordemann, Jürgen; Rose, Matthias

    2015-01-01

    Background. The amount of excess weight loss (%EWL) among obese patients after bariatric surgery varies greatly. However, reliable predictors have not been established yet. The present study evaluated the preoperative psychological burden, coping style, and motivation to lose weight as factors determining postoperative treatment success. Methods. The sample included 64 morbidly obese patients with a preoperative BMI of 51 ± 8 kg/m2 who had undergone laparoscopic sleeve gastrectomy (LSG). Well-established questionnaires were applied before surgery to assess the psychological burden in terms of “perceived stress” (PSQ-20), “depression” (PHQ-9), “anxiety” (GAD-7), and “mental impairment” (ISR) as well as coping style (Brief COPE) and motivation to lose weight. %EWL as an indicator for treatment success was assessed on average 20 months after surgery. Results. Based on the %EWL distribution, patients were classified into three %EWL groups: low (14–39%), moderate (40–59%), and high (60–115%). LSG patients with high %EWL reported significantly more “active coping” behavior prior to surgery than patients with moderate and low %EWL. Patients' preoperative psychological burden and motivation to lose weight were not associated with %EWL. Conclusion. An “active coping” style might be of predictive value for better weight loss outcomes in patients following LSG intervention. PMID:26649192

  20. Patterns and determinants of functional and absolute iron deficiency in patients undergoing cardiac rehabilitation following heart surgery.

    PubMed

    Tramarin, Roberto; Pistuddi, Valeria; Maresca, Luigi; Pavesi, Marco; Castelvecchio, Serenella; Menicanti, Lorenzo; de Vincentiis, Carlo; Ranucci, Marco

    2017-01-01

    Background Anaemia and iron deficiency are frequent following major surgery. The present study aims to identify the iron deficiency patterns in cardiac surgery patients at their admission to a cardiac rehabilitation programme, and to determine which perioperative risk factor(s) may be associated with functional and absolute iron deficiency. Design This was a retrospective study on prospectively collected data. Methods The patient population included 339 patients. Functional iron deficiency was defined in the presence of transferrin saturation <20% and serum ferritin ≥100 µg/l. Absolute iron deficiency was defined in the presence of serum ferritin values <100 µg/l. Results Functional iron deficiency was found in 62.9% of patients and absolute iron deficiency in 10% of the patients. At a multivariable analysis, absolute iron deficiency was significantly ( p = 0.001) associated with mechanical prosthesis mitral valve replacement (odds ratio 5.4, 95% confidence interval 1.9-15) and tissue valve aortic valve replacement (odds ratio 4.5, 95% confidence interval 1.9-11). In mitral valve surgery, mitral repair carried a significant ( p = 0.013) lower risk of absolute iron deficiency (4.4%) than mitral valve replacement with tissue valves (8.3%) or mechanical prostheses (22.5%). Postoperative outcome did not differ between patients with functional iron deficiency and patients without iron deficiency; patients with absolute iron deficiency had a significantly ( p = 0.017) longer postoperative hospital stay (median 11 days) than patients without iron deficiency (median nine days) or with functional iron deficiency (median eight days). Conclusions Absolute iron deficiency following cardiac surgery is more frequent in heart valve surgery and is associated with a prolonged hospital stay. Routine screening for iron deficiency at admission in the cardiac rehabilitation unit is suggested.

  1. Palonosetron has superior prophylactic antiemetic efficacy compared with ondansetron or ramosetron in high-risk patients undergoing laparoscopic surgery: a prospective, randomized, double-blinded study

    PubMed Central

    Kim, Sung-Hoon; Hong, Jeong-Yeon; Kim, Won Oak; Karm, Myong-Hwan; Hwang, Jai-Hyun

    2013-01-01

    Background Postoperative nausea and vomiting (PONV) continues to be a major problem, because PONV is associated with delayed recovery and prolonged hospital stay. Although the PONV guidelines recommended the use of 5-hydroxy-tryptamine (5-HT3) receptor antagonists as the first-line prophylactic agents in patients categorized as high-risk, there are few studies comparing the efficacies of ondansetron, ramosetron, and palonosetron. The aim of present study was to compare the prophylactic antiemetic efficacies of three 5HT3 receptor antagonists in high-risk patients after laparoscopic surgery. Methods In this prospective, randomized, double-blinded trial, 109 female nonsmokers scheduled for elective laparoscopic surgery were randomized to receive intravenous 4 mg ondansetron (n = 35), 0.3 mg ramosetron (n = 38), or 75 µg palonosetron (n = 36) before anesthesia. Fentanyl-based intravenous patient-controlled analgesia was administered for 48 h after surgery. Primary antiemetic efficacy variables were the incidence and severity of nausea, the frequency of emetic episodes during the first 48 h after surgery, and the need to use a rescue antiemetic medication. Results The overall incidence of nausea/retching/vomiting was lower in the palonosetron (22.2%/11.1%/5.6%) than in the ondansetron (77.1%/48.6%/28.6%) and ramosetron (60.5%/28.9%/18.4%) groups. The rescue antiemetic therapy was required less frequently in the palonosetron group than the other groups (P < 0.001). Kaplan-Meier analysis showed that the order of prophylactic efficacy in delaying the interval to use of a rescue emetic was palonosetron, ramosetron, and ondansetron. Conclusions Single-dose palonosetron is the prophylactic antiemetics of choice in high-risk patients undergoing laparoscopic surgery. PMID:23814652

  2. Postoperative vascular complications in unrecognised Obstructive Sleep apnoea (POSA) study protocol: an observational cohort study in moderate-to-high risk patients undergoing non-cardiac surgery

    PubMed Central

    Chan, Matthew T V; Wang, Chew-Yin; Seet, Edwin; Tam, Stanley; Lai, Hou-Yee; Walker, Stuart; Short, Timothy G; Halliwell, Richard; Chung, Frances

    2014-01-01

    Introduction Emerging epidemiological data suggest that obstructive sleep apnoea (OSA) is common in the general surgical population. Unfortunately, the majority of these patients are unrecognised and untreated at the time of surgery. There is substantial biological rationale to indicate that patients with unrecognised OSA are at a higher risk of postoperative vascular events. However, the extent of this morbidity is currently unknown. We have initated the postoperative vascular complications in the unrecognised obstructive sleep apnoea (POSA) study to determine the associations between OSA, nocturnal hypoxia and major postoperative vascular events in 1200 moderate-to-high risk patients undergoing major non-cardiac surgery. Methods and analysis The POSA study is an international prospective observational cohort study. Using a type 3 portable sleep monitoring device and ambulatory oximetry, we will quantify the severity of OSA. The primary outcome is a composite of vascular death, myocardial infarction; non-fatal cardiac arrest; stroke; pulmonary embolism; congestive heart failure and new arrhythmia within 30 days of surgery. As of November 2013, we have recruited over 700 patients from nine centres in six countries. The mean age is 68 years, the mean body mass index is 27 kg/m2 and 55% of patients are men. 27.9% of patients have known coronary artery disease, over 76% have diabetes. The majority of patients underwent orthopaedic surgery (28%) and colorectal resection (18.5%). Ethics and dissemination The POSA study has received ethics approval from all study sites before patient recruitment. Informed consent will be obtained from all patients. The POSA study will determine the risk of unrecognised OSA in major non-cardiac surgery. We will publish these findings in peer-reviewed journals. Trial Registration: ClinicalTrials.gov Identifier: NCT01494181 PMID:24413351

  3. Effect of melatonin on depressive symptoms and anxiety in patients undergoing breast cancer surgery: a randomized, double-blind, placebo-controlled trial.

    PubMed

    Hansen, Melissa V; Andersen, Lærke T; Madsen, Michael T; Hageman, Ida; Rasmussen, Lars S; Bokmand, Susanne; Rosenberg, Jacob; Gögenur, Ismail

    2014-06-01

    Depression, anxiety and sleep disturbances are known problems in patients with breast cancer. The effect of melatonin as an antidepressant in humans with cancer has not been investigated. We investigated whether melatonin could lower the risk of depressive symptoms in women with breast cancer in a three-month period after surgery and assessed the effect of melatonin on subjective parameters: anxiety, sleep, general well-being, fatigue, pain and sleepiness. Randomized, double-blind, placebo-controlled trial undertaken from July 2011 to December 2012 at a department of breast surgery in Copenhagen, Denmark. Women, 30-75 years, undergoing surgery for breast cancer and without signs of depression on Major Depression Inventory (MDI) were included 1 week before surgery and received 6 mg oral melatonin or placebo for 3 months. The primary outcome was the incidence of depressive symptoms measured by MDI. The secondary outcomes were area under the curve (AUC) for the subjective parameters. 54 patients were randomized to melatonin (n = 28) or placebo (n = 26) and 11 withdrew from the study (10 placebo group and 1 melatonin group, P = 0.002). The risk of developing depressive symptoms was significantly lower with melatonin than with placebo (3 [11 %] of 27 vs. 9 [45 %] of 20; relative risk 0.25 [95 % CI 0.077-0.80]), giving a NNT of 3.0 [95 % CI 1.7-11.0]. No significant differences were found between AUC for the subjective parameters. No differences in side effects were found (P = 0.78). Melatonin significantly reduced the risk of depressive symptoms in women with breast cancer during a three-month period after surgery.

  4. Applied investigation of person-specific and context-specific factors on postoperative recovery and clinical outcomes of patients undergoing gastrointestinal cancer surgery: multicentre European study

    PubMed Central

    Markar, Sheraz R; Mavroveli, Stella; Petrides, Konstantinos V; Scarpa, Marco; Christophe, Veronique; Castoro, Carlo; Mariette, Christophe; Lagergren, Pernilla; Hanna, George B

    2016-01-01

    Introduction Cancer treatments have greatly advanced over the past two decades causing survival improvements and reduced complications from cancer surgery. However, the cancer diagnosis and the effects of treatment modalities pose a major risk to patients' psychological well-being. Given current interest and emerging evidence about the importance of psychological and social factors on cancer survival and coping with cancer treatments, this study will build and expand research in order to identify key modifiable psychosocial variables that contribute to better physical and mental health following gastrointestinal cancer (GIC) surgery. Objectives To elucidate the incidence of postoperative psychiatric morbidity within 6 months following GIC surgery. To identify key measurable modifiable preoperative psychological factors that can significantly affect postoperative psychiatric morbidity in patients undergoing surgery for GIC. To clarify the changes seen in a patient's psychological well-being during their treatment pathway for GIC. Methods and analysis This multicentre study has an observational longitudinal study design. In total, 1000 patients will be screened with a multicomponent psychological questionnaire at four different time points: at diagnosis, preoperatively, 1 and 6 months after surgery. Data from this questionnaire will be linked to postoperative complications including psychiatric morbidity, length of hospital stay and recovery to normal activity. Ethics and dissemination NHS Health Research Authority approval was gained on (REC reference 15.LO/1847) for the completion of this study. Multiple platforms will be used for the dissemination of the research data, including international clinical and patient group presentations and publication of research outputs in a high impact clinical journal. PMID:27798009

  5. Malaysian Cardiothoracic Surgery Registry--a patient registry to evaluate the health outcomes of patients undergoing surgery for cardiothoracic diseases in Malaysia.

    PubMed

    Anas, R; Rahman, I; Jahizah, H; Hassan, A; Ezani, T; Jong, Y H; Norzalina, E; Ziyadi, G; Balan, S; Ramadan, J; Lim, T O; Jamaiyah, H; Hidayah, H

    2008-09-01

    The formulation of the Cardiothoracic Registry. Cardiothoracic surgery is the field of medicine involved in surgical treatment of diseases affecting organs inside the thorax (the chest). It is a general treatment of conditions of the heart (heart disease) and lungs (lung disease). In Malaysia, due to lack of data collection we do not have estimates of number and outcome of such procedure in the country. Western figures are often used as our reference values and this may not accurately reflect our Malaysian population. The Malaysian Cardiothoracic Surgery Registry (MyCARE) by the Ministry of Health will be a valuable tool to provide timely and robust data of cardiology practice, its safety and cost effectiveness and most importantly the outcome of these patients in the Malaysian setting.

  6. Long-term prognostic value of preoperative dipyridamole thallium imaging and clinical indexes in patients with diabetes mellitus undergoing peripheral vascular surgery.

    PubMed

    Cohen, M C; Curran, P J; L'Italien, G J; Mittleman, M A; Zarich, S W

    1999-04-01

    The objective of this study is to assess the prognostic impact of preoperative dipyridamole thallium imaging and clinical variables on the long-term outcome of diabetic patients undergoing peripheral vascular surgery. Complete follow-up was obtained in 101 consecutive patients with diabetes mellitus undergoing routine dipyridamole thallium scintigraphy before vascular surgery (mean 4.2 +/- 3.2 years, range 1 month to 11 years). Low risk was defined by diabetes alone with a normal resting electrocardiogram. High risk was defined as a history of angina, myocardial infarction, congestive heart failure, or resting electrocardiogram abnormalities. There were 71 deaths in 98 patients discharged alive from the hospital (median survival 4.4 years). Age, the presence of resting electrocardiogram abnormalities, and an abnormal thallium scan were independent predictors of late death. After adjusting for age >70 years and thallium abnormalities, high-risk patients had a death rate 4.8 times (95% confidence interval 1.7 to 13.4, p <0.002) greater than low-risk patients. The presence of >2 reversible thallium defects was useful in further risk stratification of both low- and high-risk patients. Low-risk patients with >2 reversible defects had a median survival of 4.0 years compared with 9.4 years in those with < or =2 reversible defects (p <0.001). Similarly, high-risk patients with < or =2 reversible defects had an intermediate median survival rate of 4.7 years compared with 1.8 years in the group with >2 reversible defects (p <0.001). Therefore, advanced age and the presence of resting electrocardiographic or thallium abnormalities identifies a subset of diabetic patients with a poor long-term outcome after vascular surgery. Combined clinical and thallium variables may identify a population in whom intensive medical or surgical interventions may be warranted to reduce both perioperative and late cardiac events.

  7. The Impact of Evidence-Based Practices on Postoperative Pain in Patients undergoing Gastrointestinal Surgery in Amiralmomenin Hospital in Zabol During 2014-2015

    PubMed Central

    Haghighi, Maryam Jahantigh; Moghadam, Mahdieh Poodineh; Balouchi, Abbas

    2016-01-01

    Introduction The Evidence-Based Practices (EBP), have gained considerable ground in treatment and care, increases the quality of nurses’ clinical care. Yet EBP is less frequently employed despite its efficiency and importance. Pain management is an important component of nursing care and sufficient pain control has still remained as a challenge despite routine nursing practices that are already provided. Aim The present study intended to define the impact of evidence-based nursing practices on postoperative pain in patients undergoing gastrointestinal surgery. Materials and Methods The present study was a single group quasi-experimental study with before/after design. The study was conducted in the General Surgery Departments of the Amiralmomenin Hospital in Zabol during 2014-2015. A purposive sampling method was used to study 55 patients undergoing abdominal surgery. The data collection tool was a questionnaire. The patients pain severity was defined before and after implementing evidence-based practices. The collected data were analysed in SPSS using descriptive statistics and inferential statistics. Results The results showed that 61.8% of patients experienced severe postoperative pain. The mean perceived pain ratings in women and men were 7.88±1.78 and 9.42±0.81, respectively. The mean pain intensity was 8.48±1.66 before the intervention and reached 7.16±1.71 after the intervention, which was significant based on Kruskal-Wallis test (p=0.003). The mean postoperative pain experienced by the patients (p<0.01) and pain-relief following the intervention (p=0.002) was significant for gender. Conclusion This study suggests that a high percentage of patients experienced acute postoperative pain despite routine nursing care, while evidence-based nursing practices could significantly alleviate pain. PMID:27630865

  8. Hemodynamic Responses to Two Different Anesthesia Regimens in Compromised Left Ventricular Function Patients Undergoing Coronary Artery Bypass Graft Surgery: Etomidate-Midazolam Versus Propofol-Ketamine

    PubMed Central

    Aghdaii, Nahid; Ziyaeifard, Mohsen; Faritus, Seyedeh Zahra; Azarfarin, Rasoul

    2015-01-01

    Background: Various methods have been suggested to prevent hemodynamic instability caused by propofol and adverse effects caused by etomidate induction. The current study evaluated hemodynamic effects of propofol-ketamine mixture in comparison to etomidate-midazolam mixture during anesthesia induction. Objectives: The aim of this study was to evaluate the hemodynamic effects of etomidate-midazolam by comparing it with propofol-ketamine for the induction of anesthesia in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery. Patients and Methods: One-hundred patients aged between 40 and 65 with coronary artery disease and low ejection fraction scheduled for elective coronary artery bypass surgery participated in this study. The patients were randomly allotted to one of the two groups to receive either propofol-ketamine or etomidate-midazolam combination. Two groups were compared for pain on injection and myoclonus, Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), Cardiac Index (CI) and Systemic Vascular Resistance (SVR), before and one minute after induction of anesthesia, and one, three and five minutes after intubation. Results: Incidence of pain on injection (2 - 4%) and myoclonus (10%) was less in both groups. The hemodynamic response was similar in the two groups for all variables over the time interval, except for CI at one and three minutes after intubation (P = 0.024 and P = 0.048, respectively), and SVR in five minutes after intubation (P = 0.009), with differences being statistically significant. Conclusions: Both anesthetic regimens were acceptable for induction in patients with coronary artery disease and left ventricular dysfunction undergoing coronary artery bypass graft surgery. PMID:26161330

  9. Hand-held echocardiography in the setting of pre-operative cardiac evaluation of patients undergoing non-cardiac surgery: results from a randomized pilot study.

    PubMed

    Cavallari, Ilaria; Mega, Simona; Goffredo, Costanza; Patti, Giuseppe; Chello, Massimo; Di Sciascio, Germano

    2015-06-01

    Transthoracic echocardiography is not a routine test in the pre-operative cardiac evaluation of patients undergoing non-cardiac surgery but may be considered in those with known heart failure and valvular heart disease or complaining cardiac symptoms. In this setting, hand-held echocardiography (HHE) could find a potential application as an alternative to standard echocardiography in selected patients; however, its utility in this context has not been investigated. The aim of this pilot study was to evaluate the conclusiveness of HHE compared to standard echocardiography in this subset of patients. 100 patients scheduled for non-cardiac surgery were randomized to receive a standard exam with a Philips Ie33 or a bedside evaluation with a pocket-size imaging device (Opti-Go, Philips Medical System). The primary endpoint was the percentage of satisfactory diagnosis at the end of the examination referred as conclusiveness. Secondary endpoints were the mean duration time and the mean waiting time to perform the exams. No significant difference in terms of conclusiveness between HHE and standard echo was found (86 vs 96%; P = 0.08). Mean duration time of the examinations was 6.1 ± 1.2 min with HHE and 13.1 ± 2.6 min with standard echocardiography (P < 0.001). HHE resulted in a consistent save of waiting time because it was performed the same day of clinical evaluation whereas patients waited 10.1 ± 6.1 days for a standard echocardiography (P < 0.001). This study suggests the potential role of HHE for pre-operative evaluation of selected patients undergoing non-cardiac surgery, since it provided similar information but it was faster and earlier performed compared to standard echocardiography.

  10. Miniscrews versus surgical archwires for intermaxillary fixation in adults after orthognathic surgery

    PubMed Central

    Son, Sieun; Son, Woo-Sung; Kim, Yong-Il; Kim, Yong-Deok; Shin, Sang-Hun

    2015-01-01

    Objective We compared the skeletal and dental changes that resulted from the use of two methods of intermaxillary fixation (IMF)-miniscrews and surgical archwire-in 74 adult patients who had Class III malocclusion and were treated with the same orthognathic surgical procedure at a hospital in Korea. Methods All the patients underwent Le Fort I osteotomy and bilateral sagittal split ramus osteotomy with rigid fixation. They were divided into two groups according to the type of IMF used-group 1 underwent surgical archwire fixation and group 2 underwent orthodontic miniscrew fixation. In a series of cephalograms for each patient, we compared vertical and horizontal tooth-position measurements: (a) immediately after surgery (T0), (b) 3 months after surgery (T1), and (c) 6 months after surgery (T2). Cephalometric changes within each group were examined using one-way analysis of variance (ANOVA) while the independent samples t-test procedure was used to compare the two groups. Results After surgery, the maxillary incisors tended to be proclined in both groups although there were no significant differences. Incisor overbite increased significantly in both groups from T0 to T1, and the miniscrew group (group 2) showed slightly greater overbite than the archwire group (group 1). Conclusions This study suggest that the use of orthodontic miniscrews and orthodontic surgical archwire for IMF in adult patients results in similar skeletal and dental changes. PMID:25667912

  11. Are daily routine chest radiographs necessary after pulmonary surgery in adult patients?

    PubMed Central

    Reeb, Jeremie; Falcoz, Pierre-Emmanuel; Olland, Anne; Massard, Gilbert

    2013-01-01

    A best evidence topic was constructed according to a structured protocol. The question addressed was whether daily routine (DR) chest radiographs (CXRs) are necessary after pulmonary surgery in adult patients. Of the 66 papers found using a report search, seven presented the best evidence to answer the clinical question. Four of these seven studies specifically addressed post-cardiothoracic adult patients. Three of these seven studies addressed intensive care unit (ICU) patients and included post-cardiothoracic adult patients in well-designed studies. Six of these seven studies compared the DR CXRs strategy to the clinically indicated, on-demand (OD) CXRs strategy. Another study analysed the clinical impact of ceasing to perform the DR, postoperative, post-chest tubes removal CXRs. The authors, journal, date and country of publication, study type, group studied, relevant outcomes and results of these papers are given. We conclude that, on the whole, the seven studies are unanimously in favour of forgoing DR CXRs after lung resection and advocate OD CXRs. One study suggested that hypoxic patients could benefit from a DR CXRs strategy, while other studies failed to identify any subgroup for whom performing DR CXRs was beneficial. Indeed, DR CXRs, commonly taken after thoracic surgery, have poor diagnostic and therapeutic value. Eliminating them for adult patients having undergone thoracic surgery significantly decreases the number of CXRs per patient without increasing mortality rates, length of hospital stays (LOSs), readmission rates and adverse events. Hence, current evidence shows that DR CXRs could be forgone after lung resection because OD CXRs, recommended by clinical monitoring, have a better impact on management and have not been proved to negatively affect patient outcomes. Moreover, an OD CXRs strategy lowers the cost of care. Nevertheless, an OD CXRs strategy requires close clinical monitoring by experienced surgeons and dedicated intensivists. However

  12. Effects of Addition of Systemic Tramadol or Adjunct Tramadol to Lidocaine Used for Intravenous Regional Anesthesia in Patients Undergoing Hand Surgery

    PubMed Central

    Yektaş, Abdulkadir; Gümüş, Funda; Karayel, Abdulhalim; Alagöl, Ayşin

    2016-01-01

    Intravenous regional anesthesia (IVRA) is used in outpatient hand surgery as an easily applicable and cost-effective technique with clinical advantages. The present study aimed to investigate the effects of addition of systemic tramadol or adjunct tramadol to lidocaine for IVRA in patients undergoing hand surgery. American Society of Anesthesiologists (ASA) I-II patients (n = 60) who underwent hand surgery were included. For this purpose, only lidocaine (LDC), lidocaine+adjunct tramadol (LDC+TRA group), or lidocaine+systemic tramadol (LDC+SysTRA group) was administered to the patients for IVRA and the groups were compared in terms of onset and recovery time of sensory and motor blocks, quality of anesthesia, and the degree of intraoperative and postoperative pain. The onset time of sensorial block was significantly shorter in the LDC+TRA group than that in the LDC+SysTRA group. The motor block recovery time was significantly shorter in the LDC+SysTRA group than that in the LDC+TRA and LDC groups. Administration of tramadol as an adjunct showed some clinical benefits by providing a shorter onset time of sensory and motor block, decreasing pain and analgesic requirement, and improving intraoperative conditions during IVRA. It was determined that systemic tramadol administration had no superiority. PMID:27313608

  13. Perioperative socialization, care and monitoring of National Institutes of Health miniature swine undergoing ocular surgery and sampling of peripheral blood.

    PubMed

    Nicholls, S M; Mitchard, L K; Murrell, J C; Dick, A D; Bailey, M

    2012-01-01

    Swine are a frequent species of choice for testing new surgical procedures and for transplantation studies. However, information concerning best practice to prepare pigs for surgery and postoperative treatment and monitoring is limited, despite a perception that preoperative socialization is beneficial. Therefore we examined the effect of preoperative visits by project personnel on compliance of 26 National Institutes of Health (NIH) minipigs subject to corneal transplantation. We briefly describe sedation and anaesthesia protocols developed for surgery and multiple postoperative interventions in order to facilitate interpretation of data relating to pig compliance. Preoperative visit variables and measures of preoperative socialization were correlated with postoperative outcome. Principal component analysis (PCA) of postoperative outcome variables identified a factor accounting for 53.5% of the variance that was significantly associated with two factors derived from PCA of preoperative factors (accounting, respectively, for 54.7% and 26.0% of the variance; P = 0.019 for the overall model, P = 0.041 and 0.040 for factors 1 and 2, respectively), such that more time spent with pigs before surgery and higher socialization scores were associated with less postoperative stress and difficulty of eye medication. Moreover, two of the preoperative visit variables, time spent with only one person in the pen and time spent with two or more people in the pen, contributed predominantly to PCA factors 1 and 2, respectively, indicating that they were fulfilling two qualitatively different requirements for socialization. We conclude that NIH minipigs are fully compliant with anaesthetic and postoperative experimental procedures provided they are well-socialized to project personnel before surgery.

  14. A Systematic Review of Clinical Outcomes and Prognostic Factors for Patients Undergoing Surgery for Spinal Metastases Secondary to Breast Cancer

    PubMed Central

    Sciubba, Daniel M.; Goodwin, C. Rory; Yurter, Alp; Ju, Derek; Gokaslan, Ziya L.; Fisher, Charles; Rhines, Laurence D.; Fehlings, Michael G.; Fourney, Daryl R.; Mendel, Ehud; Laufer, Ilya; Bettegowda, Chetan; Patel, Shreyaskumar R.; Rampersaud, Y. Raja; Sahgal, Arjun; Reynolds, Jeremy; Chou, Dean; Weber, Michael H.; Clarke, Michelle J.

    2015-01-01

    Study Design  Review of the literature. Objective  Surgery and cement augmentation procedures are effective palliative treatment of symptomatic spinal metastases. Our objective is to systematically review the literature to describe the survival, prognostic factors, and clinical outcomes of surgery and cement augmentation procedures for breast cancer metastases to the spine. Methods  We performed a literature review using PubMed to identify articles that reported outcomes and/or prognostic factors of the breast cancer patient population with spinal metastases treated with any surgical technique since 1990. Results  The median postoperative survival for metastatic breast cancer was 21.7 months (8.2 to 36 months), the mean rate of any pain improvement was 92.9% (76 to 100%), the mean rate of neurologic improvement was 63.8% (53 to 100%), the mean rate of neurologic decline was 4.1% (0 to 8%), and the local tumor control rate was 92.6% (89 to 100%). Kyphoplasty studies reported a high rate of pain control in selected patients. Negative prognostic variables included hormonal (estrogen and progesterone) and human epidermal growth factor receptor 2 (HER2) receptor refractory tumor status, high degree of axillary lymph node involvement, and short disease-free interval (DFI). All other clinical or prognostic parameters were of low or insufficient strength. Conclusion  With respect to clinical outcomes, surgery consistently yielded neurologic improvements in patients presenting with a deficit with a minimal risk of worsening; however, negative prognostic factors associated with shorter survival following surgery include estrogen receptor/progesterone receptor negativity, HER2 negativity, and a short DFI. PMID:27433433

  15. The Effect of Desmopressin on the Amount of Bleeding in Patients Undergoing Coronary Artery Bypass Graft Surgery with a Cardiopulmonary Bypass Pump After Taking Anti-Platelet Medicine

    PubMed Central

    Mirmansoori, Ali; Farzi, Farnoush; Sedighinejad, Abbas; Imantalab, Vali; mohammadzadeh, Ali; Atrkar Roushan, Zahra; Ghazanfar Tehran, Samaneh; Nemati, Maryam; Dehghan, Afsaneh

    2016-01-01

    Background Coronary artery bypass grafting (CABG) is a common surgical intervention at the end-stages of coronary artery occlusion disease. Despite the effectiveness of CABG, it may have particular complications, such as bleeding during and after surgery. So far, there have been many drugs used to reduce bleeding. Objectives This study aimed at investigating the effects of desmopressin on the amount of bleeding in patients undergoing CABG with a cardiopulmonary bypass pump (CPBP) who were taking anti-platelet medicine. Methods One hundred patients scheduled for elective CABG with a CPBP were included in a prospective, placebo-controlled, double-blinded clinical trial study. They were randomly divided into two groups. One group received desmopressin (40 μg) and the other group received a placebo (isotonic saline). Seven patients were excluded from the study, and 47 and 46 patients participated in the desmopressin and control groups, respectively. The methods of monitoring and the anesthetic techniques were similar in both groups, and all surgeries were performed by one surgeon. Variables including age, gender, pump time, aortic clamp time, duration of surgery, complications (e.g., nausea and vomiting, blood pressure changes), the necessity to receive blood products, and coagulation tests (prothrombin time, partial thromboplastin time, international normalized ratio, and bleeding time) were assessed. Data were statistically analyzed with SPSS software version 17. Results There was no significant difference between the groups regarding age, gender, pump time, clamp time, duration of surgery, complications, and the changes in hemoglobin and coagulation test measurements (P > 0.05). No significant difference was noted between the groups regarding the rate of bleeding after surgery (359.3 ± 266.2 in group D vs. 406.3 ± 341.6 in group P (control group); P = 0.208). However, the platelet changes after surgery in both groups were significantly different. The analysis

  16. Factors associated with major complications in the short-term postoperative period in dogs undergoing surgery for brachycephalic airway syndrome

    PubMed Central

    Ree, Jennifer J.; Milovancev, Milan; MacIntyre, Laura A.; Townsend, Katy L.

    2016-01-01

    Surgical correction of brachycephalic airway syndrome (BAS) in dogs has been reported to result in low complication rates and good long-term outcomes. Previous reports have not identified risk factors for the development of complications following BAS surgery. This retrospective study evaluated a wide variety of patient- and procedure-related, pre-operative, intra-operative, and post-operative factors for an association with the development of major postoperative complications in the short-term period following BAS surgery. The overall major complication rate, including death or euthanasia, was 4/55 (7%) dogs. Temporary tracheostomy was the only major surgical complication identified (n = 3). Multiple logistic regression identified postoperative radiographic evidence of pneumonia as associated with the development of any major complication overall, requirement of a temporary tracheostomy postoperatively, and death or euthanasia, within the short-term postoperative period. Future prospective studies should evaluate specific risk factors for an association with major complications following BAS surgery in dogs to improve patient outcomes. PMID:27587891

  17. Pre-anesthetic echocardiographic findings in children undergoing non-cardiac surgery at the University of Benin Teaching Hospital, Nigeria

    PubMed Central

    Wilson, E Sadoh,; Paul, Ikhurionan; Charles, Imarengiaye,

    2016-01-01

    Summary Background A pre-anaesthestic echocardiogram (echo) is requested for most non-cardiac surgeries to identify possible cardiac structural anomalies Objective To describe the prevalence and spectrum of structural cardiac abnormalities seen in various non-cardiac conditions Methods We carried out a retrospective review of pre-anaesthetic echos performed over five years on children scheduled for non-cardiac surgery. The requests were categorised according to referring specialities, and the biodata and echo findings were noted Results A total of 181 children and 181 echocardiograms were studied, and 100 (55.2%) of the patients were male. Most of the children (87, 48.1%) with oro-facial clefts were referred from dentistry. Of the 181 children, 39 (21.5%) had cardiac abnormalities, most (34, 87.2%) of whom had congenital heart disease (CHD). Ophthalmic requests with suspected congenital rubella syndrome (CRS) had the highest prevalence of 8/12 (66.7%) while the lowest was oro-facial clefts at 15/87 (17.2%). Atrial septal defect was the commonest abnormality, found in 14 patients (35.9%) Conclusion Pre-anaesthetic echo should be performed, especially for children with suspected CRS and other congenital anomalies, requiring non-cardiac surgery. PMID:27701485

  18. Factors associated with major complications in the short-term postoperative period in dogs undergoing surgery for brachycephalic airway syndrome.

    PubMed

    Ree, Jennifer J; Milovancev, Milan; MacIntyre, Laura A; Townsend, Katy L

    2016-09-01

    Surgical correction of brachycephalic airway syndrome (BAS) in dogs has been reported to result in low complication rates and good long-term outcomes. Previous reports have not identified risk factors for the development of complications following BAS surgery. This retrospective study evaluated a wide variety of patient- and procedure-related, pre-operative, intra-operative, and post-operative factors for an association with the development of major postoperative complications in the short-term period following BAS surgery. The overall major complication rate, including death or euthanasia, was 4/55 (7%) dogs. Temporary tracheostomy was the only major surgical complication identified (n = 3). Multiple logistic regression identified postoperative radiographic evidence of pneumonia as associated with the development of any major complication overall, requirement of a temporary tracheostomy postoperatively, and death or euthanasia, within the short-term postoperative period. Future prospective studies should evaluate specific risk factors for an association with major complications following BAS surgery in dogs to improve patient outcomes.

  19. [Mortality and morbidity in HIV-infected patients undergoing coronary artery bypass surgery: a case control study].

    PubMed

    Jiménez-Expósito, María J; Mestres, Carlos A; Claramonte, Xavier; Cartañá, Ramón; Josa, Miquel; Pomar, José L; Mulet, Jaume; Miró, José M

    2006-03-01

    The use of highly active antiretroviral therapy (HAART) in patients with HIV infection has improved survival. This improvement combined with the metabolic effects of treatment has increased cardiovascular risk and the need for cardiac surgery in these patients. We compared morbidity and mortality in HIV-infected patients (cases, n=7) and non-HIV-infected patients (controls, n=21) who underwent isolated coronary artery surgery between 1997 and 2004. The durations of extracorporeal circulation and aortic cross-clamping were shorter in HIV-infected patients (P=.002 and P=.014, respectively). The percentage of patients who experienced complications was similar, at 57.1% in both groups, but there was a slightly higher number of complications per patient in non-HIV-infected individuals. The mean length of total hospitalization was greater in HIV-infected patients (27.1 [13.3] versus 8.8 [5.3] days; P=.003), as was that of postoperative hospitalization (18.2 [15.4] vs 7.9 [4.2] days; P=.08). No HIV-infected patient died or needed a repeat cardiac operation. No progression of the HIV infection was observed. Isolated coronary artery surgery in HIV-infected patients produces good results, and there is no increase in morbidity or mortality. Extracorporeal circulation did not influence disease progression.

  20. Basilar impression of the skull in patients with adult coeliac disease and after gastric surgery.

    PubMed

    Hurwitz, L J; Banerji, N K

    1972-02-01

    Chamberlain's, McGregor's and Bull's angle measurements for basilar impression of the skull were made on 22 adult patients with idiopathic steatorrhoea (probable gluten enteropathy), 24 patients who had had previous gastric surgery, and 48 control subjects. For each of the three measurements a value greater than the mean plus two standard deviations was taken as the upper limit of normal. In seven patients with adult steatorrhoea all three measurements were abnormal suggesting basilar impression, while basilar impression was probable in only one patient who had gastric surgery. The trend towards abnormal measurements was significant in the steatorrhoea patients but not in those who had gastric surgery. Basilar impression also was present in patients who did not have rickets or present evidence of osteomalacia. It was argued that this study could support a hypothesis that some cases of primary basilar impression of the skull are secondary to bone softening associated with malabsorption in early life, the evidence of which may have disappeared in adult life.

  1. Nephrotoxicity of high-dose ifosfamide/carboplatin/etoposide in adults undergoing autologous stem cell transplantation.

    PubMed

    Agaliotis, D P; Ballester, O F; Mattox, T; Hiemenz, J W; Fields, K K; Zorsky, P E; Goldstein, S C; Perkins, J B; Rosen, R M; Elfenbein, G J

    1997-11-01

    The objective of this study was to evaluate nephrotoxicity in adult patients treated with high-dose ifosfamide, carboplatin, and etoposide followed by autologous stem cell transplantation. We conducted a retrospective analysis of clinical and laboratory data from 131 patients with various malignancies who received treatment with escalating doses of ifosfamide, carboplatin, and etoposide followed by autologous stem cell transplantation as part of a phase I/II therapeutic trial. Abnormalities in glomerular filtration were evaluated by measuring peak creatinine levels and tubular dysfunction by the lowest recorded serum levels of potassium, magnesium, and bicarbonate, at different time periods after administration of ifosfamide, carboplatin, and etoposide, and after autologous stem cell transplantation. For the entire group of 131 patients, peak creatinine levels were > 1.5 mg/dL but < 3.0 mg/dL in 37% and levels were > 3.0 mg/dL in 11% at some time during their hospital stay. At the time of discharge, creatinine levels were 1.6 mg/dL to 3.0 mg/dL in 25% of patients and were > 3 mg/dL in 5%. Immediately after high-dose therapy, peak creatinine levels were significantly higher in patients receiving higher doses of ifosfamide compared to those receiving lower doses (P < 0.00001) and those receiving intermediate doses (P < 0.005). There was a dramatic decrease in serum bicarbonate, potassium, and magnesium levels immediately after chemotherapy, and they remained significantly decreased throughout the patient's hospital stay, despite massive replacement efforts (P ranging between < 0.008 and < 0.001). This is the largest adult population study documenting the incidence and severity of ifosfamide/carboplatin/etoposide-associated acute nephrotoxicity. Renal dysfunction was dose related and reversible in the majority of patients.

  2. Trends, Major Medical Complications, and Charges Associated with Surgery for Lumbar Spinal Stenosis in Older Adults

    PubMed Central

    Deyo, Richard A.; Mirza, Sohail K.; Martin, Brook I.; Kreuter, William; Goodman, David C.; Jarvik, Jeffrey G.

    2010-01-01

    Context In recent decades, the fastest growth in lumbar surgery occurred in older patients with spinal stenosis. Trials indicate that for selected patients, decompressive surgery offers an advantage over non-operative treatment, but surgeons often recommend more invasive fusion procedures. Comorbidity is common in elderly patients, so benefits and risks must be carefully weighed in the choice of surgical procedure. Objective Examine trends in use of different types of stenosis operations and the association of complications and resource use with surgical complexity. Design, Setting, and Patients Retrospective cohort analysis of Medicare claims for 2002–2007, focusing on 2007 to assess complications and resource use in U.S. hospitals. Operations for Medicare recipients undergoing surgery for lumbar stenosis (n=32,152 in the first 11 months of 2007) were grouped into 3 gradations of invasiveness: decompression alone, simple fusion (one or two disc levels, single surgical approach) or complex fusion (more than 2 disc levels or combined anterior and posterior approach). Main Outcome Measures Rates of the 3 types of surgery, major complications, postoperative mortality, and resource use. Results Overall, surgical rates declined slightly from 2002–2007, but the rate of complex fusion procedures increased 15-fold, from 1.3 to 19.9 per 100,000 beneficiaries. Life-threatening complications increased with increasing surgical invasiveness, from 2.3% among patients having decompression alone to 5.6% among those having complex fusions. After adjustment for age, comorbidity, previous spine surgery, and other features, the odds ratio (OR) of life-threatening complications for complex fusion compared to decompression alone was 2.95 (95% CI 2.50–3.49). A similar pattern was observed for rehospitalization within 30 days, which occurred for 7.8% of patients undergoing decompression and 13.0% having a complex fusion (adjusted OR 1.94; 95% CI 1.74–2.17). Adjusted mean hospital

  3. Evaluation of the preliminary effectiveness of hand massage therapy on postoperative pain of adults in the intensive care unit after cardiac surgery: a pilot randomized controlled trial.

    PubMed

    Boitor, Mădălina; Martorella, Géraldine; Arbour, Caroline; Michaud, Cécile; Gélinas, Céline

    2015-06-01

    Although many intensive care unit patients experience significant pain, very few studies explored massage to maximize their pain relief. This study aimed to evaluate the preliminary effects of hand massage on pain after cardiac surgery in the adult intensive care unit. A pilot randomized controlled trial was used for this study. The study was conducted in a Canadian medical-surgical intensive care unit. Forty adults who were admitted to the intensive care unit after undergoing elective cardiac surgery in the previous 24 hours participated in the study. They were randomly assigned to the experimental (n = 21) or control (n = 19) group. The experimental group received a 15-minute hand massage, and the control group received a 15-minute hand-holding without massage. In both groups the intervention was followed by a 30-minute rest period. The interventions were offered on 2-3 occasions within 24 hours after surgery. Pain, muscle tension, and vital signs were assessed. Pain intensity and behavioral scores were decreased for the experimental group. Although hand massage decreased muscle tension, fluctuations in vital signs were not significant. This study supports potential benefits of hand massage for intensive care unit postoperative pain management. Although larger randomized controlled trials are necessary, this low-cost nonpharmacologic intervention can be safely administered.

  4. Lidocaine versus ropivacaine for postoperative continuous paravertebral nerve blocks in patients undergoing laparoscopic bowel surgery: a randomized, controlled, double-blinded, pilot study

    PubMed Central

    Ghisi, Daniela; Fanelli, Andrea; Jouguelet-Lacoste, Julie; La Colla, Luca; Auroux, Anne-Sophie; Chelly, Jacques E

    2015-01-01

    Background and objectives Lidocaine could provide many advantages in continuous regional anesthesia techniques, including faster onset, greater titratability, and lower cost than long-acting local anesthetics. This prospective, randomized, double-blinded, pilot study is therefore intended to compare lidocaine to ropivacaine in bilateral continuous paravertebral blocks using a multimodal approach for postoperative pain management following laparoscopic bowel surgery. Methods Thirty-five ASA I–III consecutive patients undergoing elective laparoscopic bowel surgery and bilateral thoracic paravertebral continuous blocks were analyzed: bilateral thoracic paravertebral infusions of ropivacaine 0.2% (Group Ropi, n=18) or lidocaine 0.25% (Group Lido, n=17) were started at 7 mL/h in the postanesthesia care unit. For each patient, we collected numerical rating scores (NRS) for pain at rest and during movement at baseline, at postanesthesia care unit discharge, at 24 hours and 48 hours after the end of surgery, as well as hydromorphone patient-controlled analgesia requirements, local anesthetic consumption, side effects, postoperative complications, and functional outcomes. Results No effect of group distribution on NRS scores for pain at rest or at movement (P=0.823 and P=0.146), nor on hydromorphone (P=0.635) or local anesthetic consumption (P=0.063) was demonstrated at any analyzed time point. Hospital length of stay and spontaneous ambulation were comparable between groups (P=0.636 and P=0.148). In the context of a multimodal approach, the two drugs showed comparable safety profiles. Discussion Lidocaine 0.25% and ropivacaine 0.2% provided similar analgesic profiles after elective abdominal surgeries, without any difference in terms of functional outcomes. The easier titratability of lidocaine together with its lower cost induced our clinical practice to definitely switch from ropivacaine to lidocaine for postoperative bilateral paravertebral continuous infusions. PMID

  5. Outcomes of mitral valve repair compared with replacement in patients undergoing concomitant aortic valve surgery: a meta-analysis of observational studies.

    PubMed

    Saurav, Alok; Alla, Venkata Mahesh; Kaushik, Manu; Hunter, Claire C; Mooss, Aryan V

    2015-09-01

    Long-term superiority of mitral valve (MV) repair compared with replacement is well established in degenerative MV disease. In rheumatic heart disease, its advantages are unclear and it is often performed in conjunction with aortic valve (AV) replacement. Herein, we performed a systematic review and meta-analysis comparing outcomes of MV repair vs replacement in patients undergoing concomitant AV replacement. PubMed, Cochrane and Web of Science databases were searched up to 25 January 2014 for English language studies comparing outcomes of MV repair vs replacement in patients undergoing simultaneous AV replacement. Data of selected studies were extracted. Study quality, publication bias and heterogeneity were assessed. Analysis was performed using a random effects model (meta-analysis of observational studies in epidemiology recommendation). A total of 1202 abstracts/titles were screened. Of these, 20 were selected for full text review and 8 studies (3924 patients) were included in the final analysis: 1255 underwent MV repair and 2669 underwent replacement. Late outcome data were available in seven studies (cumulative follow-up: 15 654 patient-years). The early (in hospital and up to 30 days post-surgery) mortality [risk ratio (RR): 0.68, 95% confidence interval (CI): 0.53-0.87, P = 0.003] and late (>30 days post-surgery) mortality (RR: 0.76, 95% CI: 0.64-0.90 P = 0.001) were significantly lower in the MV repair group compared with the MV replacement group. The MV reoperation rate (RR: 1.89, 95% CI: 0.87-4.10, P = 0.108), thromboembolism (including valve thrombosis) (RR: 0.65, 95% CI: 0.38-1.13, P = 0.128) and major bleeding rates (RR: 0.88, 95% CI: 0.49-1.57, P = 0.659) were found to be comparable between the two groups. In a separate analysis of studies with exclusively rheumatic patients (n = 1106), the early as well as late mortality benefit of MV repair was lost (RR: 0.92, 95% CI: 0.44-1.90, P = 0.81 and RR: 0.69, 95% CI: 0.39-1.22, P = 0.199, respectively

  6. Procalcitonin Is a Better Biomarker than C-Reactive Protein in Newborns Undergoing Cardiac Surgery: The PROKINECA Study

    PubMed Central

    Pérez, Sara Bobillo; Rodríguez-Fanjul, Javier; García, Iolanda Jordan; Hernando, Julio Moreno; Iriondo Sanz, Martín

    2016-01-01

    OBJECTIVES To assess the kinetics of procalcitonin (PCT) and C-reactive protein (CRP) in newborns after cardiothoracic surgery (CS), with and without cardiopulmonary bypass, and to assess whether PCT was better than CRP in identifying sepsis in the first 72 hours after CS. PATIENTS AND METHODS This is a prospective study of newborns admitted to the neonatal intensive care unit after CS. INTERVENTIONS PCT and CRP were sequentially drawn 2 hours before surgery and at 0, 12, 24, 48, and 72 hours after surgery. RESULTS A total of 65 patients were recruited, of which 14 were excluded because of complications. We compared the kinetics of PCT and CRP after CS in bypass and non-bypass groups without sepsis; there were no differences in the PCT values at any time (24 hours, P = 0.564; 48 hours, P = 0.117; 72 hours, P = 0.076). Thirty-five patients needed bypass, of whom four were septic (11.4%). Significant differences were detected in the PCT values on comparing the septic group to the nonseptic group at 48 hours after cardiopulmonary bypass (P = 0.018). No differences were detected in the CRP values in these groups. A suitable cutoff for sepsis diagnosis at 48 hours following bypass would be 5 ng/mL, with optimal area under the curve of 0.867 (confidence interval 0.709–0.958), P < 0.0001, and sensitivity and specificity of 87.5% (29.6–99.7) and 72.6% (53.5–86.4), respectively. CONCLUSION This is a preliminary study but PCT seems to be a good biomarker in newborns after CS. Values over 5 ng/mL at 48 hours after CS should alert physicians to the high risk of sepsis in these patients. PMID:27840575

  7. Can Comprehensive Imaging Analysis with Analytic Morphomics and Geriatric Assessment Predict Serious Complications in Patients Undergoing Pancreatic Surgery?

    PubMed

    Benjamin, Andrew J; Buschmann, Mary M; Schneider, Andrew; Derstine, Brian A; Friedman, Jeffrey F; Wang, Stewart C; Dale, William; Roggin, Kevin K

    2017-03-24

    We aimed to determine whether comprehensive imaging analysis with analytic morphomics (AM) enhances or replaces geriatric assessment (GA) in risk-stratifying pancreatic surgery patients. One hundred thirty-four pancreatic surgery patients were identified from a prospective cohort. Sixty-three patients in the cohort had preoperative CT scans in addition to comprehensive geriatric assessments. CT scans were processed using AM. Associations with National Surgical Quality Improvement Program (NSQIP) serious complications were evaluated using univariate analysis and robust elastic net modeling to obtain AUROC curves by adding AM and GA measures to our previously defined clinical base risk model (age, body mass index, American Society of Anesthesiologists classification, and Charlson comorbidity index). NSQIP serious complications were associated with low psoas Hounsfield units (HUs) (p = 0.002), low-density (0 to 30 HU) psoas area (p = 0.01), visceral fat HU (p ≤ 0.001), visceral fat area (p = 0.009), subcutaneous fat HU (p = 0.023), and total body area (p = 0.012) on univariate analysis. Elastic net models incorporating the base model with geriatric assessment and psoas HU (AUC = 0.751), and AM alone (AUC = 0.739) have greater predictive value than the base model alone (AUC = 0.601). The model utilizing AM and GA in combination had the highest predictive value (AUC = 0.841). When combined, AM and GA improve prediction of NSQIP serious complications compared to either technique alone. The additive nature of these two modalities suggests they likely capture unique aspects of a patient's fitness for surgery.

  8. Impact of early haemodynamic goal-directed therapy in patients undergoing emergency surgery: an open prospective, randomised trial.

    PubMed

    Pavlovic, Gordana; Diaper, John; Ellenberger, Christoph; Frei, Angela; Bendjelid, Karim; Bonhomme, Fanny; Licker, Marc

    2016-02-01

    Haemodynamic goal-directed therapies (GDT) may improve outcome following elective major surgery. So far, few data exist regarding haemodynamic optimization during emergency surgery. In this randomized, controlled trial, 50 surgical patients with hypovolemic or septic conditions were enrolled and we compared two algorithms of GDTs based either on conventional parameters and pressure pulse variation (control group) or on cardiac index, global end-diastolic volume index and stroke volume variation as derived from the PiCCO monitoring system (optimized group). Postoperative outcome was estimated by a composite index including major complications and by the Sequential Organ Failure Assessment (SOFA) Score within the first 3 days after surgery (POD1, POD2 and POD3). Data from 43 patients were analyzed (control group, N = 23; optimized group, N = 20). Similar amounts of fluid were given in the two groups. Intraoperatively, dobutamine was given in 45 % optimized patients but in no control patients. Major complications occurred more frequently in the optimized group [19 (95 %) versus 10 (40 %) in the control group, P < 0.001]. Likewise, SOFA scores were higher in the optimized group on POD1 (10.2 ± 2.5 versus 6.6 ± 2.2 in the control group, P = 0.001), POD2 (8.4 ± 2.6 vs 5.0 ± 2.4 in the control group, P = 0.002) and POD 3 (5.2 ± 3.6 and 2.2 ± 1.3 in the control group, P = 0.01). There was no significant difference in hospital mortality (13 % in the control group and 25 % in the optimized group). Haemodynamic optimization based on volumetric and flow PiCCO-derived parameters was associated with a less favorable postoperative outcome compared with a conventional GDT protocol during emergency surgery.

  9. Triggering the decision to undergo medical male circumcision: a qualitative study of adult men in Botswana.

    PubMed

    Wirth, Kathleen E; Semo, Bazghina-Werq; Ntsuape, Conrad; Ramabu, Nankie M; Otlhomile, Boyce; Plank, Rebeca M; Barnhart, Scott; Ledikwe, Jenny H

    2016-08-01

    In 2007, the World Health Organization endorsed voluntary medical male circumcision (VMMC) as part of comprehensive HIV-prevention strategies. A major challenge facing VMMC programs in sub-Saharan Africa remains demand creation; there is urgent need for data on key elements needed to trigger the decision among eligible men to seek VMMC. Using qualitative methods, we sought to better understand the circumcision decision-making process in Botswana related to VMMC. From July to November 2013, we conducted 27 focus group discussions in four purposively selected communities in Botswana with men (stratified by circumcision status and age), women (stratified by age) and community leaders. All discussions were facilitated by a trained same-sex interviewer, audio recorded, transcribed and translated to English, and analyzed for key themes using an inductive content analytic approach. Improved hygiene was frequently cited as a major benefit of circumcision and many participants believed that cleanliness was directly responsible for the protective effect of VMMC on HIV infection. While protection against HIV was frequently noted as a benefit of VMMC, the data indicate that increased sexual pleasure and perceived attractiveness, not fear of HIV infection, was an underlying reason why men sought VMMC. Data from this qualitative study suggest that more immediate benefits of VMMC, such as improved hygiene and sexual pleasure, play a larger role in the circumcision decision compared with protection from potential HIV infection. These findings have immediate implications for targeted demand creation and mobilization activities for increasing uptake of VMMC among adult men in Botswana.

  10. Development and validation of the Rapid Estimate of Adult Literacy in Vascular Surgery (REAL_VS).

    PubMed

    Wallace, Lorraine S; Ergen, William F; Cassada, David C; Freeman, Michael B; Grandas, Oscar H; Stevens, Scott L; Goldman, Mitchell H

    2009-01-01

    The purposes of this study were to develop and validate the (1) Rapid Estimate of Adult Literacy in Vascular Surgery (REAL_VS) for researchers studying the impact of literacy skills as related to vascular surgery-related knowledge and outcomes and (2) short version of the REAL_VS (REAL_VSs) to allow clinicians to gauge their patients' familiarity with vascular surgery-related terms. A three-phase process was used to identify potential words for inclusion in the REAL_VS, including reviewing Internet-based patient education material content and listening to a random sample of 50 archived audiorecordings of vascular surgeon-patient encounters. The REAL_VS was composed of 75 terms (e.g., stent, gangrene, invasive, aneurysm) of varying pronunciation difficulty. One hundred fifty-two English-speaking patients (>or=18 years of age) attending a university-based vascular surgery clinic were recruited to participate in this study (mean age = 61.4 +/- 14.6 years). During face-to-face interviews, patients' sociodemographic information was collected, and patients were administered the widely used Rapid Estimate of Adult Literacy in Medicine (REALM) and REAL_VS. Mean scores on the REALM (56.9 +/- 14.0) and REAL_VS (63.3 +/- 15.6) were highly correlated (Spearmans rank correlation [rho] = 0.91; p < 0.00). Internal consistency of the REAL_VS (Cronbachs alpha = 0.98) was excellent. Mean scores on the REAL_VSs (4.1 +/- 2.7) were highly correlated with both the REALM (rho = 0.82; p < 0.00) and REAL_VS (rho = 0.94; p < 0.00). Internal consistency, measured using Cronbachs alpha, of the REAL_VSs was 0.86. This study demonstrates that both the REAL_VS and REAL_VSs are both promising tools for use in vascular surgery research and clinical practice, respectively.

  11. Comparative Study of Untethering and Spine-Shortening Surgery for Tethered Cord Syndrome in Adults

    PubMed Central

    Nakashima, Hiroaki; Imagama, Shiro; Matsui, Hiroki; Yukawa, Yasutsugu; Sato, Koji; Kanemura, Tokumi; Kamiya, Mitsuhiro; Ito, Kenyu; Matsuyama, Yukihiro; Ishiguro, Naoki; Kato, Fumihiko

    2015-01-01

    Study Design  Retrospective multicenter study. Objective  Although untethering surgery has been a standard treatment in patients with adult tethered cord syndrome (TCS), spine-shortening osteotomy (SSO) has recently been performed as an alternative technique. The purpose of this study was to compare the clinical outcomes of the two procedures for TCS in adults. Methods  Fourteen patients (37.7 ± 12.5 years) with TCS were enrolled at 6 hospitals. Their clinical charts, operative records, and follow-up data were reviewed. The categories of tethering lesions were tight terminal filum in 1 patient, lipoma in 5 patients, and lipomyelomeningocele in 8 patients. Eleven patients underwent untethering surgery, and 3 patients underwent SSO surgery. Results  There were no significant differences in age, sex, types of preoperative symptoms, or duration of follow-up between the two groups. The preoperative duration of symptoms was significantly longer (25 ± 12.4 years) and the percentage of those with prior surgery was higher in the SSO group (66.7%). The preoperative pathology was lipomeningocele in all SSO group and lipoma or tight terminal filum in the untethering group. Cerebrospinal fluid leakage and urinary infection occurred in 1 patient each among those with untethering, and massive intraoperative bleeding occurred in 1 patient with SSO. SSO provided better clinical improvement than untethering surgery (p = 0.003). Conclusions  Based on this small retrospective case series, SSO appears to provide clinical improvement at least comparable to the untethering procedure, especially in more challenging cases. PMID:27555994

  12. Kinking of internal carotid artery: is it a risk factor for cerebro-vascular damage in patients undergoing cardiac surgery?

    PubMed

    Borioni, R; Garofalo, M; Actis Dato, G M; Pierri, M D; Caprara, E; Albano, P; Chiariello, L

    1994-08-01

    The incidence of carotid artery kinking is reported from 4% to 25% in different studies. During cardiopulmonary by-pass (CPB) in cardiac surgery the hemodynamic effects related to the kinking could produce hypoperfusion especially if associated with atherosclerotic lesions of the carotid arteries. We report our experience of 653 patients (538 males, 115 females, mean age 58.3 years) studied by coronaroangiography and internal carotid artery duplex scanning during the period January 1991-December 1992. Thirty-seven patients (22 males, 15 females, mean age 64.9 years), revealed anomalies of the internal carotid artery classificated as tortuosity (9 patients; 24.4%), and kinking (28 patients; 75.6%). All but 4 patients underwent cardiac surgery isolated or associated with carotid thrombo-endarterectomy (TEA) with Dacron patch arterioplasty. Three patients died (8.1%), one of them from cerebrovascular accident. He was a patient who had thromboembolism from the ascending aorta but without associated atherosclerotic lesions of carotid arteries. Asymptomatic isolated internal carotid artery kinking does not seem to be a risk factor for neurological complications during CPB. If carotid kinking is symptomatic and associated with atherosclerotic plaque producing internal carotid artery stenosis greater than 75%, we strongly suggest surgical treatment before cardiac operation.

  13. Serum tryptophan and its metabolites in female dogs undergoing ovariohysterectomy as treatment of pyometra or as elective spay surgery.

    PubMed

    Dąbrowski, Roman; Hagman, Ragnvi; Tvarijonaviciute, Asta; Pastor, Josep; Kocki, Tomasz; Turski, Waldemar A

    2015-05-01

    This study compares serum concentrations of tryptophan (TRP), kynurenine (KYN), kynurenic acid (KYNA), and indoleamine 2,3-dioxygenase (IDO) activity in healthy bitches and bitches with bacterial uterine infection (pyometra). The effects of surgery were also assessed by measuring these variables in both groups of dogs before and after ovariohysterectomy. Presurgery, mean (±standard deviation) TRP, KYN, and KYNA concentrations and IDO activity were 68.44 ± 21.77, 2.00 ± 0.33, 112.11 ± 111.91 μmol/L, and 29.22 ± 10.10, respectively, in the healthy dogs; and 40.16 ± 12.11, 8.27 ± 3.94, 411.11 ± 199.60 μmol/L, and 205.92 ± 154.20, respectively, in the dogs with pyometra. Tryptophan and KYN levels had normalized on suture removal (10 days after surgery) though IDO activity and KYNA concentrations remained elevated during the postoperative period compared with presurgery values in both study groups. Our results suggest that KYNA concentrations and IDO activity could be useful indicators of the inflammation induced by pyometra and could be also used to monitor recovery following ovariohysterectomy in both healthy dogs and dogs with pyometra.

  14. Blood transcriptomic biomarkers in adult primary care patients with major depressive disorder undergoing cognitive behavioral therapy.

    PubMed

    Redei, E E; Andrus, B M; Kwasny, M J; Seok, J; Cai, X; Ho, J; Mohr, D C

    2014-09-16

    An objective, laboratory-based diagnostic tool could increase the diagnostic accuracy of major depressive disorders (MDDs), identify factors that characterize patients and promote individualized therapy. The goal of this study was to assess a blood-based biomarker panel, which showed promise in adolescents with MDD, in adult primary care patients with MDD and age-, gender- and race-matched nondepressed (ND) controls. Patients with MDD received cognitive behavioral therapy (CBT) and clinical assessment using self-reported depression with the Patient Health Questionnaire-9 (PHQ-9). The measures, including blood RNA collection, were obtained before and after 18 weeks of CBT. Blood transcript levels of nine markers of ADCY3, DGKA, FAM46A, IGSF4A/CADM1, KIAA1539, MARCKS, PSME1, RAPH1 and TLR7, differed significantly between participants with MDD (N=32) and ND controls (N=32) at baseline (q< 0.05). Abundance of the DGKA, KIAA1539 and RAPH1 transcripts remained significantly different between subjects with MDD and ND controls even after post-CBT remission (defined as PHQ-9 <5). The ROC area under the curve for these transcripts demonstrated high discriminative ability between MDD and ND participants, regardless of their current clinical status. Before CBT, significant co-expression network of specific transcripts existed in MDD subjects who subsequently remitted in response to CBT, but not in those who remained depressed. Thus, blood levels of different transcript panels may identify the depressed from the nondepressed among primary care patients, during a depressive episode or in remission, or follow and predict response to CBT in depressed individuals.

  15. The Effectiveness of Intravenous Dexmedetomidine on Perioperative Hemodynamics, Analgesic Requirement, and Side Effects Profile in Patients Undergoing Laparoscopic Surgery Under General Anesthesia

    PubMed Central

    Panchgar, Vinayak; Shetti, Akshaya N.; Sunitha, H. B.; Dhulkhed, Vithal K.; Nadkarni, A. V.

    2017-01-01

    Background: There is an upward surge in the use of laparoscopic surgeries due to various advantages when compared to open surgeries. Major advantages are, due to small incisions which are cosmetically acceptable and most of them are now daycare procedures. Problem of economic burden and hospital bed occupancy has been overcome with laparoscopic surgeries. All these advantages are not free from disadvantages, as hemodynamic changes such as hypertension; tachycardia and other surgical-related complications are commonly observed intraoperatively. Dexmedetomidine is one of the α2 agonist drugs which acts at both supraspinal and spinal level and modulate the transmission of nociceptive signals in the central nervous system. The basic effect of dexmedetomidine on the cardiovascular system is to decrease the heart rate and systemic vascular resistance with additional feature of opioid sparing effect. This drug has become an ideal adjuvant during general anesthesia, especially when stress is expected. Hence, the drug was studied in laparoscopic surgeries. Aims and Objectives: (a) To study the effect of dexmedetomidine on hemodynamic parameters during perioperative period in patients undergoing laparoscopic surgery. (b) To study the postoperative sedation score and analgesic requirement. (c) To study the side effect profile of dexmedetomidine. Settings and Design: Randomized double blind controlled trial. Subjects and Methods: After obtaining the Institutional Ethical Clearance, the study was conducted. Forty patients of American Society of Anesthesiologists Class I and II were enrolled in this randomized study. The patients were randomly divided into two groups; group normal saline (NS) and group dexmedetomidine. Patient received either NS or dexmedetomidine in group NS and group dexmedetomidine, respectively, depending upon the allocation. The infusion rate was adjusted according to; loading dose (1 μg/kg) over 10 min and maintenance dose (0.5 μg/kg/h) and

  16. Pharmacokinetics of epidurally administered nicomorphine with its metabolites and glucuronide conjugates in patients undergoing pulmonary surgery during combined epidural local anaesthetic block and general anaesthesia.

    PubMed

    Koopman-Kimenai, P M; Vree, T B; Booij, L H; Hasenbos, M A

    1995-08-01

    After epidural administration of 15 mg 3, 6-dinicotinoylmorphine (nicomorphine) in 10 patients undergoing pulmonary surgery, the parent compound was quickly metabolized into the metabolites 6-mononicotinoylmorphine and morphine. The mean apparent half-lives (+/- SD) of elimination were 10 min (0.165 h +/- 0.053 h) for 3,6-dinicotinoylmorphine and 1.77 h +/- 1.23 h for 6-mononicotinoylmorphine. Morphine is subsequently metabolized into morphine-3-glucuronide and morphine-6-glucuronide. The apparent half-lives of morphine, morphine-3-glucuronide, and morphine-6-glucuronide are similar: 3.63 h +/- 1.63 h, 4.10 h +/- 0.57 h, and 4.20 h +/- 1.64 h respectively. The possible glucuronide conjugate of 6-mononicotinoylmorphine was not detected. The prodrug 3,6-dinicotinoylmorphine was biotransformed into three active compounds: 6-mononicotinoylmorphine, morphine, and morphine-6-glucuronide.

  17. The effect of foot reflexology on physiologic parameters and mechanical ventilation weaning time in patients undergoing open-heart surgery: A clinical trial study.

    PubMed

    Ebadi, Abbas; Kavei, Parastoo; Moradian, Seyyed Tayyeb; Saeid, Yaser

    2015-08-01

    The aim of this study was to investigate the efficacy of foot reflexology on physiological parameters and mechanical ventilation weaning time in patients undergoing open-heart surgery. This was a double blind three-group randomized controlled trial. Totally, 96 patients were recruited and randomly allocated to the experimental, placebo, and the control groups. Study groups respectively received foot reflexology, simple surface touching, and the routine care of the study setting. Physiological parameters (pulse rate, respiratory rate, systolic and diastolic blood pressures, mean arterial pressure, percutaneous oxygen saturation) and weaning time were measured. The study groups did not differ significantly in terms of physiological parameters (P value > 0.05). However, the length of weaning time in the experimental group was significantly shorter than the placebo and the control groups (P value < 0.05). The study findings demonstrated the efficiency of foot reflexology in shortening the length of weaning time.

  18. Staphylococcus aureus screening and decolonization reduces the risk of surgical site infections in patients undergoing deep brain stimulation surgery.

    PubMed

    Lefebvre, J; Buffet-Bataillon, S; Henaux, P L; Riffaud, L; Morandi, X; Haegelen, C

    2017-02-01

    In a controlled before-and-after study in a single centre, it was aimed to determine whether identification of Staphylococcus aureus nasal carriers followed by nasal mupirocin ointment and chlorhexidine soap reduced surgical site infections (SSIs) among 182 patients undergoing deep brain stimulation. In all, 119 patients were included in the control group and 63 in the screening group. There was a significant SSI decrease from 10.9% to 1.6% between the two groups (P<0.04; relative risk: 0.13; 95% confidence interval: 0.003-0.922). There were eight SSIs involving S. aureus in the control group, none in the screening group. No specific risk factors for SSI were identified.

  19. Plasma IL-6 and IL-10 Concentrations Predict AKI and Long-Term Mortality in Adults after Cardiac Surgery

    PubMed Central

    Zhang, William R.; Garg, Amit X.; Coca, Steven G.; Devereaux, Philip J.; Eikelboom, John; Kavsak, Peter; McArthur, Eric; Thiessen-Philbrook, Heather; Shortt, Colleen; Shlipak, Michael; Whitlock, Richard

    2015-01-01

    Inflammation has an integral role in the pathophysiology of AKI. We investigated the associations of two biomarkers of inflammation, plasma IL-6 and IL-10, with AKI and mortality in adults undergoing cardiac surgery. Patients were enrolled at six academic centers (n=960). AKI was defined as a ≥50% or ≥0.3-mg/dl increase in serum creatinine from baseline. Pre- and postoperative IL-6 and IL-10 concentrations were categorized into tertiles and evaluated for associations with outcomes of in-hospital AKI or postdischarge all-cause mortality at a median of 3 years after surgery. Preoperative concentrations of IL-6 and IL-10 were not significantly associated with AKI or mortality. Elevated first postoperative IL-6 concentration was significantly associated with higher risk of AKI, and the risk increased in a dose-dependent manner (second tertile adjusted odds ratio [OR], 1.61 [95% confidence interval (95% CI), 1.10 to 2.36]; third tertile adjusted OR, 2.13 [95% CI, 1.45 to 3.13]). First postoperative IL-6 concentration was not associated with risk of mortality; however, the second tertile of peak IL-6 concentration was significantly associated with lower risk of mortality (adjusted hazard ratio, 0.75 [95% CI, 0.57 to 0.99]). Elevated first postoperative IL-10 concentration was significantly associated with higher risk of AKI (adjusted OR, 1.57 [95% CI, 1.04 to 2.38]) and lower risk of mortality (adjusted HR, 0.72 [95% CI, 0.56 to 0.93]). There was a significant interaction between the concentration of neutrophil gelatinase-associated lipocalin, an established AKI biomarker, and the association of IL-10 concentration with mortality (P=0.01). These findings suggest plasma IL-6 and IL-10 may serve as biomarkers for perioperative outcomes. PMID:25855775

  20. Relationship between site of myocardial infarction, left ventricular function and cytokine levels in patients undergoing coronary artery surgery

    PubMed Central

    Ilker, Kiris; Sahin, Kapan; Huseyin, Okutan,; Cuneyt, Narin; Mehmet, Ozaydın; Medine, Cumhur Cure; Recep, Sutcu

    2016-01-01

    Summary Background The purpose of this study was to examine the relationship between left ventricular (LV) function, cytokine levels and site of myocardial infarction (MI) in patients undergoing coronary artery bypass grafting (CABG). Methods Sixty patients undergoing CABG were divided into three groups (n = 20) according to their history of site of myocardial infarction (MI): no previous MI, anterior MI and posterior/inferior MI. In the pre-operative period, detailed analysis of LV function was done by transthoracic echocardiography.The levels of adrenomedullin, interleukin-1-beta,interleukin-6, tumour necrosis factor-alpha (TNF-α) and angiotensin-II in both peripheral blood samples and pericardial fluid were also measured. Results Echocardiographic analyses showed that the anterior MI group had significantly worse LV function than both the group with no previous MI and the posterior/inferior MI group (p < 0.05 for LV end-systolic diameter, fractional shortening, LV end-systolic volume, LV end-systolic volume index and ejection fraction). In the anterior MI group, both plasma and pericardial fluid levels of adrenomedullin and and pericardial fluid levels of interleukin-6 and interleukin- 1-beta were significantly higher than those in the group with no previous MI (p < 0.05), and pericardial fluid levels of adrenomedullin, interleukin-6 and interleukin-1-beta were significantly higher than those in the posterior/inferior MI group (p < 0.05). Conclusions The results of this study indicate that (1) patients with an anterior MI had worse LV function than patients with no previous MI and those with a posterior/inferior MI, and (2) cytokine levels in the plasma and pericardial fluid in patients with anterior MI were increased compared to patients with no previous MI. PMID:27805242

  1. AGE-RELATED DIFFERENCES IN SLEEP-WAKE SYMPTOMS OF ADULTS UNDERGOING POLYSOMNOGRAPHY

    PubMed Central

    Vaz Fragoso, Carlos A.; Van Ness, Peter H.; Araujo, Katy L.B; Iannone, Lynne P.; Yaggi, H. Klar

    2017-01-01

    OBJECTIVES To evaluate age-related differences in sleep-wake symptoms. DESIGN Cross-sectional. SETTING Technologist-attended, laboratory-based polysomnography (PSG). PARTICIPANTS 201 community-dwelling adults aged 20–89, including 52 aged 18–39, 72 aged 40–59, and 77 aged ≥60. MEASUREMENTS 1) Medical burden: Charlson Comorbidity Index, medications, and health status; 2) PSG-defined sleep disorders: sleep-disordered breathing (SDB), sleep-associated hypoxemia, and periodic limb movements in sleep (PLMS); 3) sleep-wake symptoms: Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), and fatigue (Facit-F Scale). RESULTS Medical burden increased significantly across the age groups of 18–39, 40–59 and ≥60 (p<.001 for Charlson Comorbidity Index and number of medications; p=.005 for reduced health status). In addition, the severity of sleep disorders increased significantly across the age groups of 18–39, 40–59 and ≥60 (p<.001 for SDB and hypoxemia; p=.008 for PLMS). Conversely, significant reductions were observed for sleep-wake symptoms across the age groups of 18–39, 40–59 and ≥60 (p=.020 for daytime drowsiness [ESS≥10]; p=.036 for insomnia [ISI≥8]; p<.001 for fatigue). In adjusted models, a 1-year increase in age was significantly associated with a 4% decrease in the odds of having daytime drowsiness (odds ratio: 0.96 [0.93, 0.98]). Similarly, but only in those with mild SDB, a 1-year increase in age was significantly associated with a 5% decrease in the odds of having insomnia (odds ratio: 0.95 [0.92, 0.99]). CONCLUSION In our PSG-based sample, advancing age was characterized by a decrease in sleep-wake symptoms (daytime drowsiness, insomnia and fatigue), despite an age-related increase in disease severity (medical burden and sleep disorders). Because the increase in disease severity included well-established risk factors for having sleep-wake symptoms, we posit that the age-related decrease in sleep-wake symptoms may reflect

  2. Venous thromboembolism prevention with fondaparinux 1.5 mg in renally impaired patients undergoing major orthopaedic surgery. A real-world, prospective, multicentre, cohort study.

    PubMed

    Mismetti, Patrick; Samama, Charles-Marc; Rosencher, Nadia; Vielpeau, Claude; Nguyen, Philippe; Deygas, Beatrice; Presles, Emilie; Laporte, Silvy

    2012-06-01

    Despite the need for effective and safe thromboprophylactic drugs for patients with renal impairment, clinical trial data on anticoagulant agents are limited in this population. The study aim was to assess in the real-world setting the use of the once-daily 1.5 mg reduced dosage regimen of fondaparinux available for this context. In this prospective cohort study, patients with a creatinine clearance (CrCl) of 20-50 ml/minute, undergoing total hip (THR) or knee (TKR) replacement or hip fracture surgery (HFS) received fondaparinux thromboprophylaxis. Main clinical outcomes were bleeding (major/clinically relevant non-major), symptomatic venous thromboembolism (VTE) and death. Overall, 442 patients (353 women; median age: 82 years; 39.4% in ASA class ≥3; mean ± SD CrCl: 39.0 ± 8.0 ml/minute; 78% with additional risk factors for bleeding), undergoing THR (43.7%), TKR (27.6%), or HFS (28.7%) received fondaparinux 1.5 mg for a mean ± SD duration of 16.0 ± 12.5 days. At postoperative day 10, the rates (95% confidence interval) of major bleeding, clinically relevant bleeding and symptomatic VTE were 4.5% (2.8-6.9), 0.5% (0.1-1.6) and 0.5% (0.05-1.62), respectively; no fatal bleeding, bleeding into a critical organ, pulmonary embolism or proximal deep-vein thrombosis occurred. Corresponding rates at one month were 5.2%, 0.7% and 0.7%. One-month mortality was 2.3% (0.9-3.6). This large clinical prospective study provides for the first time, under conditions reflecting "real-world" routine clinical practice, data on the bleeding and VTE risks of thromboprophylaxis with fondaparinux 1.5 mg after major orthopaedic surgery in renally impaired patients. It shows that these patients constitute a very elderly and fragile population.

  3. Emotional Processes in Patients Undergoing Coronary Artery Bypass Graft Surgeries with Extracorporeal Circulation in View of Selected Indicators of the Inflammatory Condition

    PubMed Central

    Płotek, Włodzimierz; Pielok, Joanna; Cybulski, Marcin; Samborska, Regina

    2015-01-01

    Background The aim of this study was to describe positive and negative emotions in patients undergoing coronary artery bypass graft (CABG) surgeries with extracorporeal circulation and the correlations between emotions and basic indicators of the inflammatory condition: C-reactive protein (CRP) concentration, body temperature, and leukocyte count. Material/Methods Standardized tools were used to select 52 patients (aged 47–63 years, 6 women – 11.5% and 46 men – 88.5%) without dementia or depression. The Positive and Negative Affect Schedule (PANAS) was used to examine positive affect (PA) and negative affect (NA) and the State-Trait Anxiety Inventory (STAI X1 and X2) was used to examine the anxiety level. The patients underwent CABG surgery according to a common anesthesia protocol and for 5 consecutive days they were observed in the ward, where selected indicators of the inflammatory condition were monitored. Results A detailed description of the results of examinations of emotions was presented. The patients with low PA-trait level, high NA-trait level, and high anxiety-trait level (STAI X2) exhibited statistically significantly higher body temperatures than the other patients in the postoperative period. The patients with high NA-trait and anxiety-state levels (STAI X1) had statistically significantly lower CRP levels in the postoperative period than the patients with low NA-trait and anxiety-state levels (STAI X1). Conclusions Patients undergoing CABG operations express both positive and negative affects. The changes in the inflammatory markers are expressed mostly by CRP concentration. There exist relationships between the result of tests assessing emotions and the markers of the inflammatory condition. PMID:25573296

  4. A comparative study of dexmedetomidine and fentanyl as adjuvants to levobupivacaine for caudal analgesia in children undergoing lower limb orthopedic surgery

    PubMed Central

    Elfawal, SM; Abdelaal, WA; Hosny, MR

    2016-01-01

    Background: Levobupivacaine is an effective local anesthetic agent with less systemic toxicity than racemic bupivacaine, but it has short postoperative analgesic duration. Dexmedetomidine and fentanyl are promising adjuncts to provide excellent and prolonged postoperative caudal analgesia. This study compared the effects of caudal levobupivacaine plus dexmedetomidine and levobupivacaine plus fentanyl for postoperative analgesia and sedation in children undergoing lower limb orthopedic surgery. Patients and Methods: Ninety children, whose age ranged from 1 to 7 years, American Society of Anesthesiologists I-II, undergoing orthopedic lower limb surgery under general anesthesia received caudal block for postoperative analgesia. The children were randomly allocated into three groups: Group L (control) received 0.75 ml/kg levobupivacaine 0.25% diluted in saline; Group LD received 0.75 ml/kg levobupivacaine 0.25% with dexmedetomidine 1 μg/kg; and Group LF received 0.75 ml/kg levobupivacaine 0.25% with fentanyl 1 μg/kg. Following the administration of the drugs; hemodynamic variables, the total anesthesia time, sedation score, Face, Legs, Activity, Cry, Consolability score, duration of analgesia, and side effects were recorded. Results: Demographically, all the groups were comparable, both the baseline and the intraoperative hemodynamic profile were similar in all groups. The mean duration of analgesia and the mean sedation score in the Group LD were significantly greater as compared to both the other groups. Conclusion: Dexmedetomidine may be a better additive to levobupivacaine than fentanyl for caudal postoperative analgesia, arousable sedation with comparable hemodynamic and side effect profile in children. PMID:27833486

  5. Effect of the duration of food withholding prior to anesthesia on gastroesophageal reflux and regurgitation in healthy dogs undergoing elective orthopedic surgery.

    PubMed

    Viskjer, Sivert; Sjöström, Lennart

    2017-02-01

    OBJECTIVE To compare the incidence of and risk factors for gastroesophageal reflux (GER) and regurgitation associated with preanesthetic food withholding for periods of 18 hours (overnight) and 3 hours in healthy dogs undergoing elective orthopedic surgery. ANIMALS 82 healthy (American Society of Anesthesiologists physical status classification I or II) client-owned dogs. PROCEDURES Food was withheld for 18 hours (18-hour group [n = 41]) or each dog was allowed to consume half its daily ration of canned food approximately 3 hours (3-hour group [n = 41]) prior to induction of anesthesia. In each anesthetized dog, a pH catheter was introduced through the oropharynx into the distal portion of the esophagus; the pH was continuously recorded throughout the period of anesthesia. Gastroesophageal reflux was defined as pH < 4.0. RESULTS Gastroesophageal reflux was significantly associated with age, dorsal recumbency, and duration of preanesthetic food withholding. Regurgitation was significantly associated with duration of GER and duration of preanesthetic food withholding. During anesthesia, 25 (61%) dogs in the 3-hour group had GER and 12 (48%) of those dogs regurgitated gastric content; 18 (43.9%) dogs in the 18-hour group had GER and 2 (11.1%) of those dogs regurgitated gastric content. The mean lowest pH measured in the refluxate in the 3-hour group (2.3) was significantly greater than that in the 18-hour group (1.3). CONCLUSIONS AND CLINICAL RELEVANCE Among the study dogs undergoing orthopedic surgery, consumption of a light meal 3 hours prior to anesthesia was associated with significantly greater odds of reflux and regurgitation, compared with overnight food withholding.

  6. Perioperative supplementation with bifidobacteria improves postoperative nutritional recovery, inflammatory response, and fecal microbiota in patients undergoing colorectal surgery: a prospective, randomized clinical trial

    PubMed Central

    MIZUTA, Minoru; ENDO, Izuru; YAMAMOTO, Sumiharu; INOKAWA, Hidetoshi; KUBO, Masatoshi; UDAKA, Tetsunobu; SOGABE, Osanori; MAEDA, Hiroya; SHIRAKAWA, Kazutoyo; OKAZAKI, Eriko; ODAMAKI, Toshitaka; ABE, Fumiaki; XIAO, Jin-zhong

    2015-01-01

    The use of probiotics has been widely documented to benefit human health, but their clinical value in surgical patients remains unclear. The present study investigated the effect of perioperative oral administration of probiotic bifidobacteria to patients undergoing colorectal surgery. Sixty patients undergoing colorectal resection were randomized to two groups prior to resection. One group (n=31) received a probiotic supplement, Bifidobacterium longum BB536, preoperatively for 7–14 days and postoperatively for 14 days, while the other group (n=29) received no intervention as a control. The occurrences of postoperative infectious complications were recorded. Blood and fecal samples were collected before and after surgery. No significant difference was found in the incidence of postoperative infectious complications and duration of hospital stay between the two groups. In comparison to the control group, the probiotic group tended to have higher postoperative levels of erythrocytes, hemoglobin, lymphocytes, total protein, and albumin and lower levels of high sensitive C-reactive proteins. Postoperatively, the proportions of fecal bacteria changed significantly; Actinobacteria increased in the probiotic group, Bacteroidetes and Proteobacteria increased in the control group, and Firmicutes decreased in both groups. Significant correlations were found between the proportions of fecal bacteria and blood parameters; Actinobacteria correlated negatively with blood inflammatory parameters, while Bacteroidetes and Proteobacteria correlated positively with blood inflammatory parameters. In the subgroup of patients who received preoperative chemoradiotherapy treatment, the duration of hospital stay was significantly shortened upon probiotic intervention. These results suggest that perioperative oral administration of bifidobacteria may contribute to a balanced intestinal microbiota and attenuated postoperative inflammatory responses, which may subsequently promote a healthy

  7. The effect of music with and without binaural beat audio on operative anxiety in patients undergoing cataract surgery: a randomized controlled trial.

    PubMed

    Wiwatwongwana, D; Vichitvejpaisal, P; Thaikruea, L; Klaphajone, J; Tantong, A; Wiwatwongwana, A

    2016-11-01

    PurposeTo investigate the anxiolytic effects of binaural beat embedded audio in patients undergoing cataract surgery under local anesthesia.MethodsThis prospective RCT included 141 patients undergoing cataract surgery under local anesthesia. The patients were randomized into three groups; the Binaural beat music group (BB), the plain music intervention group (MI), and a control group (ear phones with no music). Blood pressure (BP) and heart rate were measured on admission, at the beginning of and 20 min after the start of the operation. Peri-operative anxiety level was assessed using the State-Trait Anxiety Inventory questionnaire (STAI).ResultsThe BB and MI groups comprised 44 patients each and the control group 47. Patients in the MI group and BB group showed significant reduction of STAI state scores after music intervention compared with the control group (P<0.001) but the difference was not significant between the MI and BB group (STAI-S score MI group -7.0, BB group -9.0, P=0.085). Systolic BP was significantly lower in both MI (P=0.043) and BB (0.040) groups although there was no difference between the two groups (P=1.000). A significant reduction in heart rate was seen only in the BB group (BB vs control P=0.004, BB vs MI P=0.050, MI vs control P=0.303).ConclusionMusic, both with and without binaural beat, was proven to decrease anxiety level and lower systolic BP. Patients who received binaural beat audio showed additional decrease in heart rate. Binaural beat embedded musical intervention may have benefit over musical intervention alone in decreasing operative anxiety.

  8. Psychological state in patients undergoing coronary artery bypass grafting surgery or percutaneous coronary intervention and their spouses.

    PubMed

    Roohafza, Hamidreza; Sadeghi, Masoumeh; Khani, Azam; Andalib, Elham; Alikhasi, Hasan; Rafiei, Mohammadali

    2015-04-01

    Percutaneous coronary intervention (PCI) and the coronary artery bypass grafting surgery (CABG) are well accepted treatments for coronary artery disease. Many patients and their spouses experience increased level of stress, anxiety and depression before and after going under the procedure. One hundred and ninety-six cardiac patients who were candidate for CABG or PCI procedures and their spouses were asked to complete Hospital Anxiety and Depression Scale and General Health Questionnaire-12 before and 1 month after procedures. Anxiety, depression and stress level in patients and their spouses going under the procedures significantly reduced over time. Scores of anxiety, depression and stress in patients and their spouses were correlated. There was no difference in the level of anxiety, depression and stress between CABG and PCI groups before to after procedures. We suggest providing information about the procedures to both patients and their spouses to deal better with their own psychological state.

  9. Nursing Approach Based on Roy Adaptation Model in a Patient Undergoing Breast Conserving Surgery for Breast Cancer

    PubMed Central

    Ursavaş, Figen Erol; Karayurt, Özgül; İşeri, Özge

    2014-01-01

    The use of models in nursing provides nurses to focus on the role of nursing and its applications rather than medical practice. In addition, it helps patient care to be systematic, purposeful, controlled and effective. One of the commonly used models in nursing is Roy Adaptation Model. According to Roy adaptation model, the aim of nursing is to increase compliance and life expectancy. Roy Adaptation Model evaluates the patient in physiologic mode, self-concept mode, role function mode and interdependence mode aiming to provide holistic care. This article describes the use of Roy Adaptation Model in the care of a patient who has been diagnosed with breast cancer and had breast-conserving surgery. Patient data was evaluated in the four modes of Roy adaptation model (physiologic, self-concept, role function, and interdependence modes) and the nursing process was applied.

  10. Role of Suppressive Oral Antibiotics in Orthopedic Hardware Infections for Those Not Undergoing Two-Stage Replacement Surgery

    PubMed Central

    Keller, Sara C.; Cosgrove, Sara E.; Higgins, Yvonne; Piggott, Damani A.; Osgood, Greg; Auwaerter, Paul G.

    2016-01-01

    Background. The use of suppressive antibiotics in treatment of orthopedic hardware infections (OHIs), including spinal hardware infections, prosthetic joint infections, and infections of internal fixation devices, is controversial. Methods. Over a 4-year period at 2 academic medical centers, patients with OHI who were treated with debridement and retention of hardware components, with single-stage exchange, or without surgery were studied to determine whether use of oral antibiotics for at least 6 months after diagnosis impacts successful treatment of the infection at 1 year after diagnosis. Results. Of 89 patients in the study, 42 (47.2%) were free of clinical infection 1 year after initial diagnosis. Suppressive antibiotics used for at least 6 months after diagnosis was not associated with being free of clinical infection (adjusted odds ratio [aOR], 5.29; 95% confidence interval [CI], .74–37.80), but being on suppressive antibiotics at least 3 months after diagnosis was associated with being free of clinical infection (OR, 3.50; 95% CI, 1.30–9.43). Causative organisms impacted the likelihood of success; patients with methicillin-resistant Staphylococcus aureus as well as with Gram-negative rods were both less likely to have achieved clinical success at 1 year after surgery (aOR = 0.018, 95% CI = .0017–.19 and aOR = 0.20, 95% CI = .039–.99, respectively). Conclusions. Oral suppressive antibiotic therapy in treatment of OHI with retention of hardware for 3 months, but not 6 months, postdiagnosis increases the likelihood of treatment success. The organisms implicated in the infection directly impact the likelihood of treatment success. PMID:27747252

  11. A Comparative Study of Intravenous Dexmedetomidine and Intravenous Clonidine for Postspinal Shivering in Patients Undergoing Lower Limb Orthopedic Surgeries

    PubMed Central

    Panneer, Manohar; Murugaiyan, Prakash; Rao, Sufala Viswas

    2017-01-01

    Background: Dexmedetomidine and clonidine have been used for the prevention and treatment of shivering following spinal blockade. A prospective randomized, double-blinded study was conducted to compare the efficacy and safety of dexmedetomidine and clonidine in controlling postspinal shivering. Methods: A total of sixty participants of equal sex, aged between 18 and 60 years of American Society of Anesthesiologists (ASA) I/II Class, who underwent orthopedic lower limb surgeries under spinal anesthesia with ≥Grade III shivering were randomly divided into two groups, Group D (n = 30) received injection dexmedetomidine 0.5 μg/kg and Group C (n = 30) received injection clonidine 1 μg/kg when they experienced shivering. Time taken to control shivering, response rate, recurrence rate, and side effects such as nausea, vomiting, dry mouth, respiratory depression, and deep sedation were observed. Results: The demographic profile, ASA Class, duration of surgery, duration of anesthesia, temperature, onset and grade of shivering were all comparable between the two groups. Time taken to control shivering and recurrence rate were significantly lower in Group D when compared with Group C. Level of sedation was adequate with Group D, and the incidence of hypotension and bradycardia were significantly higher in Group C. The other side effects profiles were comparable between the two groups. Conclusion: Dexmedetomidine 0.5 μg/kg is more efficient than clonidine 1 μg/kg in controlling postspinal blockade shivering. Dexmedetomidine has early onset of effect, high response rate, and less recurrence rate with added advantage of good sedation and stable cardiorespiratory parameters. PMID:28298775

  12. Mesenteric near-infrared spectroscopy and risk of gastrointestinal complications in infants undergoing surgery for congenital heart disease.

    PubMed

    Iliopoulos, Ilias; Branco, Ricardo G; Brinkhuis, Nadine; Furck, Anke; LaRovere, Joan; Cooper, David S; Pathan, Nazima

    2016-04-01

    We hypothesised that lower mesenteric near-infrared spectroscopy values would be associated with a greater incidence of gastrointestinal complications in children weighing <10 kg who were recovering from cardiac surgery. We evaluated mesenteric near-infrared spectroscopy, central venous oxygen saturation, and arterial blood gases for 48 hours post-operatively. Enteral feeding intake, gastrointestinal complications, and markers of organ dysfunction were monitored for 7 days. A total of 50 children, with median age of 16.7 (3.2-31.6) weeks, were studied. On admission, the average mesenteric near-infrared spectroscopy value was 71±18%, and the systemic oxygen saturation was 93±7.5%. Lower admission mesenteric near-infrared spectroscopy correlated with longer time to establish enteral feeds (r=-0.58, p<0.01) and shorter duration of feeds at 7 days (r=0.48, p<0.01). Children with gastrointestinal complications had significantly lower admission mesenteric near-infrared spectroscopy (58±18% versus 73±17%, p=0.01) and higher mesenteric arteriovenous difference of oxygen at admission [39 (23-47) % versus 19 (4-27) %, p=0.02]. Based on multiple logistic regression, admission mesenteric near-infrared spectroscopy was independently associated with gastrointestinal complications (Odds ratio, 0.95; 95% confidence interval, 0.93-0.97; p=0.03). Admission mesenteric near-infrared spectroscopy showed an area under the receiver operating characteristic curve of 0.76 to identify children who developed gastrointestinal complications, with a suggested cut-off value of 72% (78% sensitivity, 68% specificity). In this pilot study, we conclude that admission mesenteric near-infrared spectroscopy is associated with gastrointestinal complications and enteral feeding tolerance in children after cardiac surgery.

  13. SU-E-J-122: Detecting Treatment-Induced Metabolic Abnormalities in Craniopharyngioma Patients Undergoing Surgery and Proton Therapy

    SciTech Connect

    Hua, C; Shulkin, B; Li, Y; LI, X; Merchant, T; Indelicato, D; Boop, F

    2014-06-01

    Purpose: To identify treatment-induced defects in the brain of children with craniopharyngioma receiving surgery and proton therapy using fluorodeoxyglucose positron emission tomography (FDG PET). Methods: Forty seven patients were enrolled on a clinical trial for craniopharyngioma with serial imaging and functional evaluations. Proton therapy was delivered using the double-scattered beams with a prescribed dose of 54 Cobalt Gray Equivalent. FDG tracer uptake in each of 63 anatomical regions was computed after warping PET images to a 3D reference template in Talairach coordinates. Regional uptake was deemed significantly low or high if exceeding two standard deviations of normal population from the mean. For establishing the normal ranges, 132 children aged 1–20 years with noncentral nervous system related diseases and normal-appearing cerebral PET scans were analyzed. Age- and gender-dependent regional uptake models were developed by linear regression and confidence intervals were calculated. Results: Most common PET abnormality before proton therapy was significantly low uptake in the frontal lobe, the occipital lobe (particularly in cuneus), the medial and ventral temporal lobe, cingulate gyrus, caudate nuclei, and thalamus. They were related to injury from surgical corridors, tumor mass effect, insertion of a ventricular catheter, and the placement of an Ommaya reservoir. Surprisingly a significantly high uptake was observed in temporal gyri and the parietal lobe. In 13 patients who already completed 18-month PET scans, metabolic abnormalities improved in 11 patients from baseline. One patient had persistent abnormalities. Only one revealed new uptake abnormalities in thalamus, brainstem, cerebellum, and insula. Conclusion: Postoperative FDG PET of craniopharyngioma patients revealed metabolic abnormalities in specific regions of the brain. Proton therapy did not appear to exacerbate these surgery- and tumor-induced defects. In patients with persistent and

  14. Mobile phone-based telemedicine system for the home follow-up of patients undergoing ambulatory surgery.

    PubMed

    Martínez-Ramos, Carlos; Cerdán, María Teresa; López, Rodrigo S

    2009-01-01

    A pilot study was done to address the efficacy of a General Packet Radio Service mobile phone-based telemedicine system used to improve follow-up after ambulatory surgery. The method involves sending images of surgical wounds or other areas from the patient's home, to assess local complications and avoid unnecessary hospital visits. Ninety-six (N = 96) patients were enrolled in the study. The phone used was a Nokia 6600, which provides images in Joint Photographic Experts Group format. These images were sent via e-mail and visualized on a standard 17-inch screen of a personal computer. After the follow-up period, self-reported patient satisfaction was assessed by analyzing the replies to a 9-item questionnaire. Thirty of the 96 patients (31.3%) reported local problems including: hematoma in 20 (66.7%) patients, surgical bandage blood-stained in 7 (23.3%), exudates in 1 (3.3%), allergic skin reactions in 1 (3.3%), and bandage too tight in 1 (3.3%). In total, 225 photographs were evaluated by 3 physicians. In all cases, it was possible to identify and assess the postoperative problem with consensus among the 3 physicians. Images served to resolve patients' concerns in 20 individuals (66.7%). In 10 patients (33.3%), concerns were satisfied but it was suggested that follow-up images be sent in the following days. Only 1 patient (3.3%) was asked to visit the hospital. The telemedicine system proposed increases the efficiency of home follow-up to ambulatory surgery, avoids unnecessary hospital visits, and clearly improves patient satisfaction.

  15. Efficacy of intermittent pneumatic compression for venous thromboembolism prophylaxis in patients undergoing gynecologic surgery: A systematic review and meta-analysis.

    PubMed

    Feng, Jian-Ping; Xiong, Yu-Ting; Fan, Zi-Qi; Yan, Li-Jie; Wang, Jing-Yun; Gu, Ze-Juan

    2016-11-25

    We sought to comprehensively assess the efficacy of Intermittent Pneumatic Compression (IPC) in patients undergoing gynecologic surgery. A computerized literature search was conducted in Pubmed, Embase and Cochrane Library databases. Seven randomized controlled trials involving 1001 participants were included. Compared with control, IPC significantly lowered the deep vein thrombosis (DVT) risk [risk ratio (RR) = 0.33, 95% confidence interval (CI): 0.16 - 0.66]. The incidence of DVT in IPC and drugs group was similar (4.5% versus. 3.99%, RR = 1.19, 95% CI: 0.42 - 3.44). With regards to pulmonary embolism risk, no significant difference was observed in IPC versus control or IPC versus drugs. IPC had a lower postoperative transfusion rate than heparin (RR = 0.53, 95% CI: 0.32 - 0.89), but had a similar transfusion rate in operating room to low molecular weight heparin (RR = 1.06, 95% CI: 0.69 - 1.63). Combined use of IPC and graduated compression stockings (GCS) had a marginally lower risk of DVT than GCS alone (RR = 0.38, 95% CI: 0.14 - 1.03). In summary, IPC is effective in reducing DVT complications in gynecologic surgery. IPC is neither superior nor inferior to pharmacological thromboprophylaxis. However, whether combination of IPC and chemoprophylaxis is more effective than IPC or chemoprophylaxis alone remains unknown in this patient population.

  16. Long-Term Follow-Up of the Fellow Eye in Patients Undergoing Surgery on One Eye for Treating Myopic Traction Maculopathy

    PubMed Central

    Xia, Hui-Juan; Wang, Wei-Jun; Chen, Feng'E; Wu, Ying; Cai, Zhen-Yuan; Chen, Wei

    2016-01-01

    Objective. To observe the fellow eye in patients undergoing surgery on one eye for treating myopic traction maculopathy. Methods. 99 fellow eyes of consecutive patients who underwent unilateral surgery to treat MTM were retrospectively evaluated. All patients underwent thorough ophthalmologic examinations, including age, gender, duration of follow-up, refraction, axial length, intraocular pressure, lens status, presence/absence of a staphyloma, and best-corrected visual acuity (BCVA). Fundus photographs and SD-OCT images were obtained. When feasible, MP-1 microperimetry was performed to evaluate macular sensitivity and fixation stability. Results. At an average follow-up time of 24.7 months, 7% fellow eyes exhibited partial or complete MTM resolution, 68% stabilized, and 25% exhibited progression of MTM. Of the 38 eyes with “normal” macular structure on initial examination, 11% exhibited disease progression. The difference in progression rates in Groups 2, 3, and 4 was statistically significant. Refraction, axial length, the frequency of a posterior staphyloma, chorioretinal atrophy, initial BCVA, final BCVA, and retinal sensitivity all differed significantly among Groups 1–4. Conclusions. Long axial length, chorioretinal atrophy, a posterior staphyloma, and anterior traction contribute to MTM development. Patients with high myopia and unilateral MTM require regular OCT monitoring of the fellow eye to assess progression to myopic pre-MTM. For cases exhibiting one or more potential risk factors, early surgical intervention may maximize the visual outcomes. PMID:27478633

  17. Comparison of intrathecal clonidine and fentanyl in hyperbaric bupivacaine for spinal anesthesia and postoperative analgesia in patients undergoing lower abdominal surgeries

    PubMed Central

    Bajwa, Baljit Singh; Singh, Arwinder Pal; Rekhi, Angelina K

    2017-01-01

    Background: There are many adjuvant used along with bupivacaine for subarachnoid block, but fentanyl and clonidine are commonly used as adjuvant to intrathecal bupivacaine for prolonging both sensory and motor blockade as well as postoperative analgesia in patients undergoing lower abdominal surgeries. Objective: There is a paucity of studies comparing the efficacy of fentanyl and clonidine as adjuvant to intrathecal bupivacaine for improving intraoperative effect and postoperative analgesia in lower abdominal surgeries instigated us compare the effect of these drugs. Methods: This prospective, randomized study is conducted on 100 American Society of Anesthesiologists I or II patients between 18 and 65 years of age divided into two groups of 50 each. The patients were given 2.5 ml of 0.5% hyperbaric bupivacaine with either 50 μg of clonidine (BC Group) or 25 μg of fentanyl (BF Group) intrathecally. The onset and duration of sensory and motor block, sedation score, hemodynamic parameters, total analgesia time, and potential side effects were recorded and compared. Results: Both the groups were comparable in demographic data, onset and duration of sensory and motor blockade, hemodynamic parameters, but the duration of analgesia is significantly longer in clonidine group when compared with fentanyl group. Sedation score is more in clonidine group. Conclusion: Addition of clonidine to intrathecal bupivacaine offers longer duration of postoperative analgesia than fentanyl but with higher sedation. PMID:28217051

  18. Patient-Reported Outcome Measures (PROMS) in patients undergoing heart valve surgery: why should we measure them and which instruments should we use?

    PubMed Central

    Holmes, Charlotte; Briffa, Norman

    2016-01-01

    Objective As the population ages, the incidence of heart valve disease (HVD) is increasing. The aim of treatment is to improve prognosis and quality of life. Standard surgical treatment is being superseded by new catheter-based treatments, many of which are as yet unproven. The need for appropriate instruments to measure quality of life in patients receiving treatment for HVD has therefore never been greater. Methods In this prospective observational study, a generic instrument, Euroqol, and a disease-specific one (Minnesota Living with Heart Failure Questionnaire—MLHFQ) were, for the first time, formally tested before and after surgery in 84 patients with HVD who completed their treatment. Patients were interviewed on the night before surgery and 6–12 weeks after being discharged. Instruments were tested for validity, reliability, responsiveness, sensitivity and interpretability. Results Both Euroqol and MLHFQ registered significant improvements in patients' health. Tests for validity were significantly positive for both Euroqol and MLHFQ. Tests for reliability and responsiveness were very positive for MLHFQ, less so for EQ-5D. There was a moderate ceiling effect in the postoperative Index scores of Euroqol and a moderate floor effect in MLHFQ. Conclusions Both instruments together performed very well in assessing the health of patients undergoing surgical treatment of HVD. As the incidence of HVD increases and therapeutic options increase, measurement of