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Perioperative Medicine

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https://www.readbyqxmd.com/read/29988696/the-rising-tide-of-opioid-use-and-abuse-the-role-of-the-anesthesiologist
#1
REVIEW
Elena J Koepke, Erin L Manning, Timothy E Miller, Arun Ganesh, David G A Williams, Michael W Manning
Opioid use has risen dramatically in the past three decades. In the USA, opioid overdose has become a leading cause of unintentional death, surpassing motor vehicle accidents. A patient's first exposure to opioids may be during the perioperative period, a time where anesthesiologists have a significant role in pain management. Almost all patients in the USA receive opioids during a surgical encounter. Opioids have many undesirable side effects, including potential for misuse, or opioid use disorder. Anesthesiologists and surgeons employ several methods to decrease unnecessary opioid use, opioid-related adverse events, and side effects in the perioperative period...
2018: Perioperative Medicine
https://www.readbyqxmd.com/read/29983928/comparing-the-experience-of-enhanced-recovery-programme-for-gynaecological-patients-undergoing-laparoscopic-versus-open-gynaecological-surgery-a-prospective-study
#2
Joanne Lee, Viren Asher, Arun Nair, Victoria White, Catherine Brocklehurst, Martyn Traves, Anish Bali
Background: Enhanced recovery has been shown to improve patients' experience after surgery. There are no previous studies comparing patients' experience between those undergoing laparoscopic and open gynaecological surgery. Therefore, the aim of this prospective study is to compare patients' functional recovery based on milestones set by the enhanced recovery programme and patients' satisfaction between the two groups. Methods: All eligible patients undergoing gynaecological surgery within an enhanced recovery after surgery (ERAS) programme from March to August 2014 were involved in this study...
2018: Perioperative Medicine
https://www.readbyqxmd.com/read/29983927/the-relationship-between-cardiopulmonary-exercise-test-variables-the-systemic-inflammatory-response-and-complications-following-surgery-for-colorectal-cancer
#3
Stephen T McSorley, Campbell S D Roxburgh, Paul G Horgan, Donald C McMillan
Background: Both preoperative cardiopulmonary exercise test (CPET)-derived measures of fitness and postoperative C-reactive protein (CRP) concentrations are associated with complications following surgery for colorectal cancer. The aim of the present pilot study was to examine the relationship between CPET and postoperative CRP concentrations in this patient group. Methods: Patients who had undergone CPET prior to elective surgery for histologically confirmed colorectal cancer in a single centre between September 2008 and April 2017 were included...
2018: Perioperative Medicine
https://www.readbyqxmd.com/read/29977522/perioperative-corticosteroid-administration-a-systematic-review-and-descriptive-analysis
#4
REVIEW
C Groleau, S N Morin, L Vautour, A Amar-Zifkin, A Bessissow
Background: Perioperative administration of corticosteroid is common and variable. Guidelines for perioperative corticosteroid administration before non-cardiac non-transplant surgery in patients with current or previous corticosteroid use to reduce the risk of adrenal insufficiency are lacking. Perioperative use of corticosteroid may be associated with serious adverse events, namely hyperglycemia, infection, and poor wound healing. Objective: To determine whether perioperative administration of corticosteroids, compared to placebo or no intervention, reduces the incidence of adrenal insufficiency in adult patients undergoing non-cardiac surgery who were or are exposed to corticosteroids...
2018: Perioperative Medicine
https://www.readbyqxmd.com/read/29951203/anesthesiologists-as-perioperative-hospitalists-and-outcomes-in-patients-undergoing-major-urologic-surgery-a-historical-prospective-comparative-effectiveness-study
#5
Gary Stier, Davinder Ramsingh, Ronak Raval, Gary Shih, Bryan Halverson, Briahnna Austin, Joseph Soo, Herbert Ruckle, Robert Martin
Background: Perioperative care has been identified as an area of wide variability in quality, with conflicting models, and involving multiple specialties. In 2014, the Loma Linda University Departments of Anesthesiology and Urology implemented a perioperative hospitalist service (PHS), consisting of anesthesiology-trained physicians, to co-manage patients for the entirety of their perioperative period. We hypothesized that implementation of this PHS model would result in an improvement in patient recovery...
2018: Perioperative Medicine
https://www.readbyqxmd.com/read/29951202/self-reported-mobility-as-a-preoperative-risk-assessment-tool-in-older-surgical-patients-compared-to-the-american-college-of-surgeons-national-surgical-quality-improvement-program
#6
Sunghye Kim, Rebecca Neiberg, W Jack Rejeski, Anthony P Marsh, Stephen B Kritchevsky, Xiaoyan I Leng, Leanne Groban
Background: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP®) developed a surgical risk calculator using data from 1.4 million patients and including 1557 unique Current Procedural Terminology (CPT) codes. Although this calculator demonstrated excellent performance in predicting postoperative mortality, morbidity, and six surgical complications, it was not developed specifically for use in older surgical patients who have worse surgical outcomes and additional unique risk factors compared to younger adults...
2018: Perioperative Medicine
https://www.readbyqxmd.com/read/29946447/clinical-agreement-in-the-american-society-of-anesthesiologists-physical-status-classification
#7
Kayla M Knuf, Christopher V Maani, Adrienne K Cummings
Background: The American Society of Anesthesiologists physical status (ASA-PS) classification is not intended to predict risk, but increasing ASA-PS class has been associated with increased perioperative mortality. The ASA-PS class is being used by many institutions to identify patients that may require further workup or exams preoperatively. Studies regarding the ASA-PS classification system show significant variability in class assignment by anesthesiologists as well as providers of different specialties when provided with short clinical scenarios...
2018: Perioperative Medicine
https://www.readbyqxmd.com/read/29757298/correction-to-cardiopulmonary-exercise-testing-cpet-in-the-united-kingdom-a-national-survey-of-the-structure-conduct-interpretation-and-funding
#8
T Reeves, S Bates, T Sharp, K Richardson, S Bali, J Plumb, H Anderson, J Prentis, M Swart, D Z H Levett
[This corrects the article DOI: 10.1186/s13741-017-0082-3.].
2018: Perioperative Medicine
https://www.readbyqxmd.com/read/29755736/surgical-specialty-and-preoperative-medical-consultation-based-on-commercial-health-insurance-claims
#9
Stephan R Thilen, Alex L Woersching, Anda M Cornea, Elliott Lowy, Edward M Weaver, Miriam M Treggiari
Background: Surgical patients are sometimes referred for preoperative evaluations by consultants in other medical specialties, although consultations are unnecessary for many patients, particularly for healthy patients undergoing low-risk surgeries. Surgical specialty has been shown to predict usage of preoperative consultations. However, evidence is generally limited regarding factors associated with preoperative consultations. This study evaluates surgical specialty and other predictors of preoperative consultations...
2018: Perioperative Medicine
https://www.readbyqxmd.com/read/29692886/what-are-the-optimum-components-in-a-care-bundle-aimed-at-reducing-post-operative-pulmonary-complications-in-high-risk-patients
#10
Sophie V Griffiths, Daniel H Conway, Michael Sander, Ib Jammer, Michael P W Grocott, Ben C Creagh-Brown
Background: Post-operative pulmonary complications (POPC) are common, predictable and associated with increased morbidity and mortality, independent of pre-operative risk. Interventions to reduce the incidence of POPC have been studied individually, but the use of a care bundle has not been widely investigated. The purpose of our work was to use Delphi consensus methodology and an independently chosen expert panel to formulate a care bundle for patients identified as being at high of POPC, as preparation towards an evaluation of its effectiveness at reducing POPC...
2018: Perioperative Medicine
https://www.readbyqxmd.com/read/29651334/the-evaluation-of-risk-prediction-models-in-predicting-outcomes-after-bariatric-surgery-a-prospective-observational-cohort-pilot-study
#11
David Andrew Gilhooly, Michelle Cole, Suneetha Ramani Moonesinghe
Background: As the prevalence of obesity is increasing, the number of patients requiring surgical intervention for obesity-related illness is also rising. The aim of this pilot study was to explore predictors of short-term morbidity and longer-term poor weight loss after bariatric surgery. Methods: This was a single-centre prospective observational cohort pilot study in patients undergoing bariatric surgery. We assessed the accuracy (discrimination and calibration) of two previously validated risk prediction models (the Physiological and Operative Severity Score for the enumeration of Morbidity and Mortality, POSSUM score, and the Obesity Surgical Mortality Risk Score, OS-MS) for postoperative outcome (postoperative morbidity defined using the Post Operative Morbidity Survey)...
2018: Perioperative Medicine
https://www.readbyqxmd.com/read/29644051/correction-to-american-society-for-enhanced-recovery-aser-and-perioperative-quality-initiative-poqi-joint-consensus-statement-on-perioperative-fluid-management-within-an-enhanced-recovery-pathway-for-colorectal-surgery
#12
Robert H Thiele, Karthik Raghunathan, C S Brudney, Dileep N Lobo, Daniel Martin, Anthony Senagore, Maxime Cannesson, Tong Joo Gan, Michael Monty G Mythen, Andrew D Shaw, Timothy E Miller
[This corrects the article DOI: 10.1186/s13741-016-0049-9.].
2018: Perioperative Medicine
https://www.readbyqxmd.com/read/29644050/correction-to-american-society-for-enhanced-recovery-aser-and-perioperative-quality-initiative-poqi-joint-consensus-statement-on-optimal-analgesia-within-an-enhanced-recovery-pathway-for-colorectal-surgery-part-2-from-pacu-to-the-transition-home
#13
Michael J Scott, Matthew D McEvoy, Debra B Gordon, Stuart A Grant, Julie K M Thacker, Christopher L Wu, Tong J Gan, Monty G Mythen, Andrew D Shaw, Timothy E Miller
[This corrects the article DOI: 10.1186/s13741-017-0063-6.].
2018: Perioperative Medicine
https://www.readbyqxmd.com/read/29484172/apnoeic-oxygenation-by-nasal-cannula-during-airway-management-in-children-undergoing-general-anaesthesia-a-pilot-randomised-controlled-trial
#14
Lafi Olayan, Abdulaleem Alatassi, Jaimin Patel, Sherran Milton
Background: Airway management is a core clinical skill in anaesthesia. Pre-oxygenation prior to induction of anaesthesia is a standard practice to prevent desaturation. Apnoeic oxygenation in adults is effective and prolongs the time to desaturation. The effectiveness of apnoeic oxygenation in the adult is well documented; however, evidence in the paediatric is lacking. Therefore, the aim of this study was to investigate the effectiveness of apnoeic oxygenation during airway management in children...
2018: Perioperative Medicine
https://www.readbyqxmd.com/read/29423173/cardiopulmonary-exercise-testing-cpet-in-the-united-kingdom-a-national-survey-of-the-structure-conduct-interpretation-and-funding
#15
T Reeves, S Bates, T Sharp, K Richardson, S Bali, J Plumb, H Anderson, J Prentis, M Swart, D Z H Levett
Background: Cardiopulmonary exercise testing (CPET) is an exercise stress test with concomitant expired gas analysis that provides an objective, non-invasive measure of functional capacity under stress. CPET-derived variables predict postoperative morbidity and mortality after major abdominal and thoracic surgery. Two previous surveys have reported increasing utilisation of CPET preoperatively in England. We aimed to evaluate current CPET practice in the UK, to identify who performs CPET, how it is performed, how the data generated are used and the funding models...
2018: Perioperative Medicine
https://www.readbyqxmd.com/read/29344350/the-sensitivity-of-the-human-thirst-response-to-changes-in-plasma-osmolality-a-systematic-review
#16
REVIEW
Fintan Hughes, Monty Mythen, Hugh Montgomery
Background: Dehydration is highly prevalent and is associated with adverse cardiovascular and renal events. Clinical assessment of dehydration lacks sensitivity. Perhaps a patient's thirst can provide an accurate guide to fluid therapy. This systematic review examines the sensitivity of thirst in responding to changes in plasma osmolality in participants of any age with no condition directly effecting their sense of thirst. Methods: Medline and EMBASE were searched up to June 2017...
2018: Perioperative Medicine
https://www.readbyqxmd.com/read/29238571/immunonutrition-within-enhanced-recovery-after-surgery-eras-an-unresolved-matter
#17
EDITORIAL
Ruchir Gupta, Anthony Senagore
Preoperative malnutrition because of poor oral intake significantly increases the risk of adverse events after surgery and leads to increased length of stay. While immunonutrition has been utilized in the non-ERAS setting, its utility in both minimally invasive surgery and ERAS pathway procedures remain poorly defined. There are at least ten meta-analyses regarding the assessment of immunonutrition, but virtually, all of these were performed in an era prior to minimally invasive surgery, adoption of enhanced recovery protocols, and an understanding of the assessment and physiology of sarcopenia...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/29238570/impact-of-asa-score-misclassification-on-nsqip-predicted-mortality-a-retrospective-analysis
#18
Alex Helkin, Sumeet V Jain, Angelika Gruessner, Maureen Fleming, Leslie Kohman, Michael Costanza, Robert N Cooney
Background: The ASA physical classification score has a major impact on the observed/expected (O/E) mortality ratio in the NSQIP General Vascular Mortality Model. The difference in predicted mortality is greatest between ASAs 3 and 4. We hypothesized under-classified ASA scores significantly affect the O/E mortality. Methods: We conducted a retrospective review of NSQIP essential surgery cases from January 2014 to December 2014 ( n  = 1264) with mortality sub-analysis ( n  = 33) at our institution...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/29204270/comparison-of-risk-scoring-systems-in-the-prediction-of-outcome-after-liver-resection
#19
S Ulyett, G Shahtahmassebi, S Aroori, M J Bowles, C D Briggs, M G Wiggans, G Minto, D A Stell
Background: Risk prediction techniques commonly used in liver surgery include the American Society of Anesthesiologists (ASA) grading, Charlson Comorbidity Index (CCI) and cardiopulmonary exercise tests (CPET). This study compares the utility of these techniques along with the number of segments resected as predictive tools in liver surgery. Methods: A review of a unit database of patients undergoing liver resection between February 2008 and January 2015 was undertaken...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/29204269/a-systematic-review-and-overview-of-health-economic-evaluations-of-emergency-laparotomy
#20
Sohail Bampoe, Peter M Odor, S Ramani Moonesinghe, Matthew Dickinson
Background: Little is known about the economic impact of emergency laparotomy (EL) surgery in healthcare systems around the world. The aim of this systematic review is to describe the primary resource utilisation, healthcare economic and societal costs of EL in adults in different countries. Methods: MEDLINE, EMBASE, ISI Web of Knowledge, Cochrane Central Register Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL were searched for full and partial economic analyses of EL published between 1 January 1991 and 31 December 2015...
2017: Perioperative Medicine
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