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Perioperative fluid management

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https://www.readbyqxmd.com/read/28803771/perioperative-management-of-patients-with-end-stage-renal-disease
#1
REVIEW
Hirotsugu Kanda, Yuji Hirasaki, Takafumi Iida, Megumi Kanao-Kanda, Yuki Toyama, Takashi Chiba, Takayuki Kunisawa
End-stage renal disease (ESRD) is associated with significant alterations in cardiovascular function; homeostasis of body fluid, electrolytes, and acid-base equilibrium; bone metabolism, erythropoiesis; and blood coagulation. The prevalence of ESRD is increasing rapidly worldwide, as is the number of patients requiring surgery under general anesthesia. Patients with ESRD have significantly higher risks of perioperative morbidity and mortality due to multiple comorbidities. The perioperative management of patients with ESRD under general anesthesia therefore requires special considerations and a careful multidisciplinary approach...
April 13, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28795966/the-coagulation-profile-of-end-stage-liver-disease-and-considerations-for-intraoperative-management
#2
Katherine T Forkin, Douglas A Colquhoun, Edward C Nemergut, Julie L Huffmyer
The coagulopathy of end-stage liver disease results from a complex derangement in both anticoagulant and procoagulant processes. With even minor insults, cirrhotic patients experience either inappropriate bleeding or clotting, or even both simultaneously. The various phases of liver transplantation along with fluid and blood product administration may contribute to additional disturbances in coagulation. Thus, anesthetic management of patients undergoing liver transplantation to improve hemostasis and avoid inappropriate thrombosis in the perioperative environment can be challenging...
August 8, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28795615/international-survey-on-the-perioperative-management-of-pulmonary-endarterectomy-the-perfusion-perspective
#3
Roger D P Stanzel, Johannes Gehron, Matthias Wolff, Natalie Striegl, Peter Roth, Rolf-Hasso Boedeker, Christine Scheibelhut, Johannes Herrmann, Ingeborg Welters, Eckhard Mayer, Matthias Scheffler
INTRODUCTION: Pulmonary endarterectomy (PEA) is the most effective treatment available for chronic thromboembolic pulmonary hypertension (CTEPH). Patient selection, surgical technique and perioperative management have improved patient outcomes, which are traditionally linked to surgical and center experience. However, optimal perfusion care has not been well defined. The goal of the international survey was to better characterize the contemporary perfusion management of PEA and highlight similarities and controversies...
August 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28790281/-perioperative-management-for-prevention-of-cardiac-complications-in-general-thoracic-surgery
#4
Terumoto Koike, Masanori Tsuchida
For general thoracic surgeons, perioperative management for prevention of cardiac complications is important because patients undergoing general thoracic surgery often have risk factors for cardiac disease. Sever cardiac failure should be detected and treated prior to surgery, and coronary artery may be examined in patients with risk factors for ischemic heart disease. Pulmonary resection sometimes causes right-sided heart failure due to reducing pulmonary vascular bed. In high-risk patients for rightsided heart failure, pulmonary artery pressure monitoring by right heart catheterization should be considered in addition to blood pressure and central venous pressure monitoring, and precise fluid management is required...
July 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28774488/crystalloid-versus-colloid-fluids-for-reduction-of-postoperative-ileus-after-abdominal-operation-under-combined-general-and-epidural-anesthesia
#5
Mohammad Reza Ghodraty, Faranak Rokhtabnak, Hossein Reza Dehghan, Alireza Pournajafian, Masoud Baghaee Vaji, Zahra Sadat Koleini, Jahan Porhomayon, Nader D Nader
BACKGROUND: The main objective of this study was to compare the effect of perioperative administration of crystalloid versus colloid solutions and its impact on reversal of ileus after resection with primary anastomosis of intestine. We hypothesized that inclusion of colloids will improve the return of intestinal motility. METHODS: In a double-blinded clinical trial, 91 the American Society of Anesthesiologists I to III patients undergoing abdominal operation for resection with anastomosis of small or large intestine were randomized to receive either lactated Ringer solution crystalloid group or 6% hydroxyethyl starch colloid group to replace intraoperative fluid loss (blood loss + third space)...
July 31, 2017: Surgery
https://www.readbyqxmd.com/read/28770553/perioperative-technical-complications-in-deep-brain-stimulation-surgeries
#6
Onur Alptekin, Ersoy Kocabicak, Felix S Gubler, Linda Ackermans, Pieter L Kubben, Yasin Temel
AIM: Deep brain stimulation (DBS) surgeries are multi-faceted and the various steps are interconnected. Since its first implementation, the method of DBS surgery has undergone changes. We have encountered several expected and also non-expected perioperative technical complications in the past seventeen years. Here, we describe the stereotactic frame, stereotactic localizer and planning station related complications and how we have managed them as much as possible. MATERIAL AND METHODS: This study is a retrospective qualitative analysis of the documented technical events encountered during DBS surgeries from 1999 onwards...
June 14, 2017: Turkish Neurosurgery
https://www.readbyqxmd.com/read/28766056/-anesthesia-management-in-microsurgical-reconstructions
#7
A Rand, M Ayoub, C H Meyer-Frießem, P K Zahn, M Bauer
Microsurgical procedures for construction of anastomoses present new challenges for anesthetists in the perioperative setting. Despite their increasing importance, so far no perioperative management guidelines for these patients existed. Anesthetists can influence the success of surgery (e. g. successful perfusion of a flap) via an optimal preoperative, intraoperative and postoperative approach. Patients should be carefully evaluated preoperatively for increased risks to avoid poor postoperative outcomes...
August 1, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28762024/risk-factors-for-prolonged-length-of-hospital-stay-and-readmissions-after-laparoscopic-sleeve-gastrectomy-and-laparoscopic-roux-en-y-gastric-bypass
#8
Piotr Major, Michał Wysocki, Grzegorz Torbicz, Natalia Gajewska, Alicja Dudek, Piotr Małczak, Michał Pędziwiatr, Magdalena Pisarska, Dorota Radkowiak, Andrzej Budzyński
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LRYGB) are most commonly performed bariatric procedures. Laparoscopic approach and enhanced recovery after surgery (ERAS) protocols managed to decrease length of hospital and morbidity. However, there are patients in whom, despite adherence to the protocol, the length of stay (LOS) remains longer than targeted. This study aimed to assess potential risk factors for prolonged LOS and readmissions. METHODS: The study was a prospective observation with a post-hoc analysis of bariatric patients in a tertiary referral university teaching hospital...
July 31, 2017: Obesity Surgery
https://www.readbyqxmd.com/read/28762023/efficacy-of-goal-directed-fluid-therapy-via-pleth-variability-index-during-laparoscopic-roux-en-y-gastric-bypass-surgery-in-morbidly-obese-patients
#9
İsmail Demirel, Esef Bolat, Aysun Yıldız Altun, Mustafa Özdemir, Azize Beştaş
BACKGROUND: There is no well-recognized guideline for intraoperative fluid management in bariatric surgery. Goal-directed fluid therapy (GDFT) is a new concept of perioperative fluid management which was shown to improve patients' prognoses. Dynamic indicators may better predict fluid response compared to static indicators. In this study, we aimed to assess effects of administering GDFT protocol via Pleth Variability Index (PVI) in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) surgery...
July 31, 2017: Obesity Surgery
https://www.readbyqxmd.com/read/28755968/surgical-and-medical-approach-to-patients-requiring-total-small-bowel-resection-managing-the-no-gut-syndrome
#10
Ruy J Cruz, Laurie Butera, Kristine Poloyac, Jenee McGurgan, William Stein, David Binion, Abhinav Humar
BACKGROUND: Total resection of the jejunum and ileum, a rarely performed procedure, is indicated after mesenteric vascular events, trauma, or resection of abdominal neoplasms. We describe our recent experience with the operative and medical management of patients with "no gut syndrome." METHODS: We retrospectively reviewed 341 adult patients who were referred to our center between January 2013 and December 2016. RESULTS: Thirteen patients with a mean age of 42...
July 26, 2017: Surgery
https://www.readbyqxmd.com/read/28746899/hypertonic-saline-in-critical-illness-a-systematic-review
#11
REVIEW
Carmen Andrea Pfortmueller, Joerg C Schefold
INTRODUCTION: The optimal approach to fluid management in critically ill patients is highly debated. Fluid resuscitation using hypertonic saline was used in the past for more than thirty years, but has recently disappeared from clinical practice. Here we provide an overview on the currently available literature on effects of hypertonic saline infusion for fluid resuscitation in the critically ill. METHODS: Systematic analysis of reports of clinical trials comparing effects of hypertonic saline as resuscitation fluid to other available crystalloid solutions...
June 19, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28731875/management-of-complex-spine-surgery
#12
Massimo Lamperti, Boris Tufegdzic, Rafi Avitsian
PURPOSE OF REVIEW: The main objective of this article is to present the updated data regarding the perioperative management of patients undergoing major spine surgery in an era where the surgical techniques are changing and there is a high demand for these surgeries in older and high-risk patients. RECENT FINDINGS: Preoperative assessment and stabilization is now more structured protocol and it is based on a multidisciplinary approach to the patient. The Enhanced Recovery After Surgery (ERAS) programs and the Perioperative Surgical Home on major spine surgery are not yet fully evidence based but it seems that the use of a perioperative optimization of patients and use of a drugs' bundle is more effective than using single drugs or interventions on the postoperative pain reduction and faster recovery from surgery...
July 20, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28719432/perioperative-fluid-management
#13
Brenton Alexander, Alexandre Joosten
No abstract text is available yet for this article.
July 14, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28710563/an-observational-study-examining-the-effects-of-a-surgically-induced-inflammatory-response-on-the-distribution-of-morphine-and-its-metabolites-into-cerebrospinal-fluid
#14
Yan Wang, Kerry B Goralski, Derek J Roberts, Kathryn Landry, Mark E Issa, Lekha Sleno, Lisa C Julien, Jeremy Wood, Richard I Hall
PURPOSE: Morphine is administered intravenously for pain management in the perioperative period. The effect of the inflammatory response to surgery on morphine distribution across the blood-brain barrier (BBB) in humans was investigated. We hypothesized that a graded surgically induced, systemic inflammatory response alters cerebrospinal fluid (CSF) levels of morphine, morphine-3-glucuronide (M3G), and morphine-6-glucuronide (M6G) through a temporary reduction in BBB drug efflux transporter function...
July 14, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28682955/ringer-s-lactate-versus-normal-saline-in-urgent-cesarean-delivery-in-a-resource-limited-setting-a-pragmatic-clinical-trial
#15
Emmanuel Timarwa Ayebale, Arthur Kwizera, Cephas Mijumbi, Samuel Kizito, Anthony Michael Roche
BACKGROUND: Crystalloids are used routinely for perioperative fluid management in cesarean delivery. Few studies have determined the crystalloid of choice in obstetric anesthesia. We compared the effects of Ringer's lactate (RL) versus 0.9% normal saline (NS) on maternal and neonatal blood pH and 24-hour postoperative morbidity in urgent cesarean delivery in a low-resource setting. Our hypothesis was that RL would result in 30% less acidosis than NS. METHODS: This was a pragmatic prospective double-blind randomized controlled trial in the Mulago National Referral Hospital Labor Ward Theater from September 2011 to May 2012...
August 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28673220/anaesthetic-management-of-patients-undergoing-cytoreductive-surgery-with-hyperthermic-intraperitoneal-chemotherapy-for-pseudomyxoma-peritonei-a-retrospective-audit
#16
S P Shiralkar, P Kerr, J Scott, P Sivalingam
Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to improve quality of life and survival rates in patients suffering from pseudomyxoma peritonei. The procedure is long and associated with significant intraoperative blood loss. As such, the anaesthetic management of patients undergoing this procedure can be challenging. The aim of this paper is to describe our perioperative management of pseudomyxoma peritonei patients who received CRS and to report a retrospective audit of our outcomes and complications over a six-year period at a large tertiary centre...
July 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/28648412/renal-outcome-after-radical-cystectomy-and-urinary-diversion-performed-with-restrictive-hydration-and-vasopressor-administration-in-the-frame-of-an-enhanced-recovery-program-a-follow-up-study-of-a-randomized-clinical-trial
#17
Fiona Mei Wen Wu, Fiona Burkhard, Filippo Turri, Marc Furrer, Lukas Loeffel, George Thalmann, Patrick Wuethrich
OBJECTIVE: To determine whether a restrictive perioperative fluid management in the context of an enhanced recovery after surgery program for radical cystectomy and urinary diversion affects renal function, as fluid restriction and the use of vasopressors have been linked to impaired tissue perfusion, potentially resulting in renal dysfunction. METHODS: We followed 166 patients initially included in a randomized clinical trial and equally allocated to receive a continuous norepinephrine administration combined with 1ml/kg/h initially, and after cystectomy 3ml/kg/h crystalloid infusion (intervention group, n = 83), or a standard crystalloid infusion of 6ml/kg/h throughout surgery (control group, n = 83)...
June 22, 2017: Urologic Oncology
https://www.readbyqxmd.com/read/28645586/venous-sinus-stenting-in-the-management-of-patients-with-intracranial-hypertension-manifesting-with-skull-base-cerebrospinal-fluid-leaks
#18
Rajiv R Iyer, David Solomon, Abhay Moghekar, C Rory Goodwin, Charles M Stewart, Masaru Ishii, Philippe Gailloud, Gary L Gallia
BACKGROUND: A subset of patients with skull base cerebrospinal fluid (CSF) leaks are found to have elevated intracranial pressure (ICP). In these patients, elevated ICP is thought to contribute to both the pathophysiology of the leak as well as postoperative leak recurrences. Current strategies for post-operative ICP control include medical therapy and shunting procedures. The aim of this study is to report the use of venous sinus stenting (VSS) in the management of patients with skull base CSF leaks due to elevated ICP...
June 20, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28616213/postoperative-goal-directed-therapy-and-development-of-acute-kidney-injury-following-major-elective-noncardiac-surgery-post-hoc-analysis-of-pom-o-randomized-controlled-trial
#19
Amour Patel, John R Prowle, Gareth L Ackland
Background: The role of goal-directed therapy (GDT) in preventing creatinine rise following noncardiac surgery is unclear. We performed a post-hoc analysis of a randomized controlled trial to assess the relationship between postoperative optimization of oxygen delivery and development of acute kidney injury (AKI)/creatinine rise following noncardiac surgery. Methods: Patients were randomly assigned immediately postoperatively to receive either fluid and/or dobutamine therapy to maintain/restore their preoperative oxygen delivery, or protocolized standard care (oxygen delivery only recorded)...
June 2017: Clinical Kidney Journal
https://www.readbyqxmd.com/read/28605474/digital-innovations-and-emerging-technologies-for-enhanced-recovery-programmes
#20
F Michard, T J Gan, H Kehlet
Enhanced recovery programmes (ERPs) are increasingly used to improve post-surgical recovery. However, compliance to various components of ERPs-a key determinant of success-remains sub-optimal. Emerging technologies have the potential to help patients and caregivers to improve compliance with ERPs.Preoperative physical condition, a major determinant of postoperative outcome, could be optimized with the use of text messages (SMS) or digital applications (Apps) designed to facilitate smoking cessation, modify physical activity, and better manage hypertension and diabetes...
June 9, 2017: British Journal of Anaesthesia
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