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Intraoperative fluid management

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https://www.readbyqxmd.com/read/29650133/contemporary-preoperative-and-intraoperative-management-of-the-radical-cystectomy-patient
#1
REVIEW
Jack Griffin Campbell, Woodson Wade Smelser, Eugene K Lee
Radical cystectomy is a morbid procedure performed on an aging and often frail population. Nonetheless, advances in preoperative and intraoperative management have significantly improved patient outcomes. Preoperative optimization includes a focus on patient education, risk factor reduction, risk stratification, nutritional optimization, and bowel motility enhancement. Intraoperative optimization focuses on maintaining normothermia, restrictive fluid administration, minimization of blood transfusions, and nonopioid pain management...
May 2018: Urologic Clinics of North America
https://www.readbyqxmd.com/read/29649026/evidence-review-conducted-for-the-agency-for-healthcare-research-and-quality-safety-program-for-improving-surgical-care-and-recovery-focus-on-anesthesiology-for-colorectal-surgery
#2
Kristen A Ban, Melinda M Gibbons, Clifford Y Ko, Elizabeth C Wick, Maxime Cannesson, Michael J Scott, Michael C Grant, Christopher L Wu
The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, has developed the Safety Program for Improving Surgical Care and Recovery (ISCR), which is a national effort to disseminate best practices in perioperative care to more than 750 hospitals across multiple procedures in the next 5 years. The program will integrate evidence-based processes central to enhanced recovery and prevention of surgical site infection, venous thromboembolic events, catheter-associated urinary tract infections with socioadaptive interventions to improve surgical outcomes, patient experience, and perioperative safety culture...
April 11, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29643552/anaesthetic-management-and-perioperative-outcomes-of-cytoreductive-surgery-with-hyperthermic-intraperitoneal-chemotherapy-a-retrospective-analysis
#3
Kalpana P Balakrishnan, Sreedevi Survesan
Background and Aims: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is becoming the standard treatment option for peritoneal carcinomatosis but is associated with high rates of morbidity and mortality. Our aim was to retrospectively analyse and evaluate intra-operative factors associated with morbidity and mortality of CRS and HIPEC. Methods: Intra-operative data were collected for cases done over 1 year (24 cases) and analysed for the primary outcome of post-operative ventilation >24 h, and secondary outcome of length of the Intensive Care Unit (ICU) stay >5 days...
March 2018: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/29642696/periprocedural-and-perioperatory-management-of-patients-with-tricuspid-valve-disease
#4
Fabrizio Monaco, Ambra L DI Prima, Monica DE Luca, Gaia Barucco, Alberto Zangrillo
Tricuspid regurgitation (TR) is a common valvular lesion which may affect morbidity and mortality. It can be related to an intrinsic abnormality of the tricuspid valve leaflets (organic) or secondary to annular dilatation (functional). Often organic and functional TR coexist in the same patient. A long standing TR is associated with ascites, congestive hepatopathy, peripheral edema, renal failure, and abdominal fullness which significantly affect the outcome. In particular, the perioperative course may be complicated due to both the presence of comorbidities and the development of a severe postoperative right ventricle (RV) dysfunction...
April 11, 2018: Minerva Cardioangiologica
https://www.readbyqxmd.com/read/29629201/anesthesia-and-fast-track-in-video-assisted-thoracic-surgery-vats-from-evidence-to-practice
#5
REVIEW
Marzia Umari, Stefano Falini, Matteo Segat, Michele Zuliani, Marco Crisman, Lucia Comuzzi, Francesco Pagos, Stefano Lovadina, Umberto Lucangelo
In thoracic surgery, the introduction of video-assisted thoracoscopic techniques has allowed the development of fast-track protocols, with shorter hospital lengths of stay and improved outcomes. The perioperative management needs to be optimized accordingly, with the goal of reducing postoperative complications and speeding recovery times. Premedication performed in the operative room should be wisely administered because often linked to late discharge from the post-anesthesia care unit (PACU). Inhalatory anesthesia, when possible, should be preferred based on protective effects on postoperative lung inflammation...
March 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29628846/intraoperative-fluid-management-past-and-future-where-is-the-evidence
#6
REVIEW
Abdulmohsin A Al-Ghamdi
Currently, there is no consensus about the optimum intraoperative fluid therapy strategy. There is growing body of evidence supports the beneficial effects of adopting "Goal-directed therapy" over either the "liberal" or "restrictive" fluid therapy strategies. In this narrative review, we have presented the evidence to support the optimum strategy for intraoperative therapy. In conclusion, whatever the intravenous fluid replacement strategy used, the anesthesiologist must be prepared to adjust the composition and rate of the fluids administered to provide sufficient intravascular fluid volume for adequate perfusion of vital organs without overwhelming the glycocalyx function with fluid overloads...
April 2018: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/29624533/profound-intraoperative-hypotension-associated-with-transfusion-via-the-belmont-fluid-management-system
#7
Joanna Miller, Sang Kim, Dieter Adelmann, Bryan Hill, Nicolette Schlichting, Natalie Smith, Samuel DeMaria, Jeron Zerillo
This retrospective observational case series conducted at 2 large academic centers over a 4-year period consists of 15 cases of profound hypotension in surgical patients immediately after initiation of the Belmont Fluid Management System for rapid transfusion of blood products. Halting the infusion and administering vasoactive agents led to resolution of hypotension. Repeat transfusion with the Belmont system resulted in repeat hypotension unless counteracted with vasopressors. No etiology was elucidated. This represents the largest documented association of acute hypotensive transfusion reaction with any rapid infusion system in surgical patients...
April 5, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29576906/lower-complication-and-reoperation-rates-for-laminectomy-rather-than-mi-tlif-other-fusions-for-degenerative-lumbar-disease-spondylolisthesis-a-review
#8
REVIEW
Nancy E Epstein
Background: Utilizing the spine literature, we compared the complication and reoperation rates for laminectomy alone vs. instrumented fusions including minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) for the surgical management of multilevel degenerative lumbar disease with/without degenerative spondylolisthesis (DS). Methods: Epstein compared complication and reoperation rates over 2 years for 137 patients undergoing laminectomy alone undergoing 2-3 level (58 patients) and 4-6 level (79 patients) Procedures for lumbar stenosis with/without DS...
2018: Surgical Neurology International
https://www.readbyqxmd.com/read/29571640/comparison-of-clinical-outcomes-between-general-anesthesiologists-and-cardiac-anesthesiologists-in-the-management-of-left-ventricular-assist-device-patients-in-noncardiac-surgeries-and-procedures
#9
Tod A Brown, Jocelyn Kerpelman, Bethany J Wolf, Julie R McSwain
OBJECTIVE: To describe the authors' experience and comparative results after introducing noncardiac fellowship-trained anesthesiologists to a service previously managed by fellowship-trained cardiac anesthesiologists caring for left ventricular assist device (LVAD) patients undergoing low-risk noncardiac procedures with anesthesia. DESIGN: A retrospective chart review. SETTING: Single-site academic medical center in the United States. INTERVENTIONS: Anesthesia and intraoperative therapy...
February 12, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29550095/incidence-and-perioperative-risk-factors-for-early-acute-kidney-injury-after-radical-cystectomy-and-urinary-diversion
#10
Marc A Furrer, Marc P Schneider, Fiona C Burkhard, Patrick Y Wuethrich
BACKGROUND: Early postoperative acute kidney injury (AKI) is associated with increased morbidity and mortality following major surgery. Only few reports exist on postoperative AKI and specifically its risk factors after radical cystectomy (RC) and urinary diversion (UD). We aimed to identify risk factors for AKI in patients undergoing RC and UD. METHODS: In an observational single-center cohort study, 912 consecutive bladder cancer patients undergoing RC and UD from 2000 to 2016 were evaluated for risk factors for AKI...
March 14, 2018: Urologic Oncology
https://www.readbyqxmd.com/read/29526051/central-venous-pressure-monitoring-in-living-donor-kidney-recipients-does-not-affect-immediate-graft-function-a-propensity-score-analysis
#11
Dieter Adelmann, Leonie Bicknell, Claus U Niemann, John Feiner, Garrett R Roll, Lyle Burdine, Elizabeth L Whitlock
BACKGROUND: During kidney transplantation, intraoperative fluid management can affect post-transplant graft function. It is unclear whether or not central venous pressure (CVP) monitoring is required to guide fluid therapy during kidney transplantation. METHODS: We compared post-transplant graft function in recipients of living donor kidney transplants between August 2006 and March 2009 based on the use or absence of intraoperative CVP monitoring. Graft function, assessed using the creatinine reduction ratio on postoperative day 2 (CCR2), was evaluated by multivariable linear regression analysis and in a propensity-matched cohort...
March 11, 2018: Clinical Transplantation
https://www.readbyqxmd.com/read/29521264/application-of-eras-enhanced-recovery-after-surgery-and-laparoscopic-surgery-in-the-management-of-patients-with-bladder-cancer
#12
Rafael Uña Orejón, Estrella Mateo Torres, Iván Huercio Martínez, Cristina Jofré Escudero, Juan Gómez Rivas, Jesús Díez Sebastián, Maria Prado Ureta Tolsada
OBJECTIVE: The enhanced recovery after surgery program (ERAS) has become the base of perioperative management in various surgical specialties. However, limited data are available for radical cystectomy. METHODS: We have analyzed 124 patients undergoing radical cystectomy. For retrospective analysis, the patients were divided into two groups:Group A (n=72) included patients whose surgery was performed before the introduction of the ERAS protocol; and Group B (n=52) included patients who were treated following the items included in the ERAS protocol...
March 2018: Archivos Españoles de Urología
https://www.readbyqxmd.com/read/29464346/systematic-review-and-meta-analysis-of-restrictive-perioperative-fluid-management-in-pancreaticoduodenectomy
#13
REVIEW
Brian P Chen, Marian Chen, Sean Bennett, Kristina Lemon, Kimberly A Bertens, Fady K Balaa, Guillaume Martel
BACKGROUND: There is significant interest and controversy surrounding the effect of restrictive fluid management on outcomes in major gastrointestinal surgery. This has been most studied in colorectal surgery, although the literature relating to pancreaticoduodenectomy (PD) patients is growing. The aim of this paper was to generate a comprehensive review of the available evidence for restrictive perioperative fluid management strategies and outcomes in PD. METHODS: MEDLINE/PubMed, Embase, and the Cochrane Library were searched from inception to April 2017...
February 20, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29460796/effects-of-goal-directed-fluid-therapy-on-enhanced-postoperative-recovery-an-interventional-comparative-observational-study-with-a-historical-control-group-on-oesophagectomy-combined-with-eras-program
#14
Hideki Taniguchi, Toshio Sasaki, Hisae Fujita, Hiroko Kobayashi, Rieko Kawasaki, Takashi Ogata, Haruhiko Cho, Takaki Yoshikawa, Keiko Ushigome, Akemi Tanaka, Osami Takano
BACKGROUND AND AIMS: The Enhanced Recovery after Surgery (ERAS) program has been proposed as a postoperative recovery-enhancing strategy. We frequently apply the Modified-ERAS program following oesophagectomy. This study aims to elucidate the impact of goal-directed fluid therapy (GDT) for the perioperative management of oesophageal cancer on the postoperative recovery of patients undergoing oesophagectomy. METHODS: This is an interventional before-after comparative observational study conducted at Kanagawa Cancer Centre, Japan...
February 2018: Clinical Nutrition ESPEN
https://www.readbyqxmd.com/read/29457117/goal-directed-therapy-reduces-fluid-balance-while-maintaining-hemodynamic-stability-in-intraoperative-management-of-pancreaticoduodenectomy-a-retrospective-comparative-study
#15
Satoshi Ishihara, Takeshi Yokoyama, Katsuyuki Katayama
Background: Goal-directed therapy (GDT) is beneficial for surgical patients, especially for those undergoing high-risk surgery. However, little has been reported on the hemodynamic effects of GDT in extensive surgery. We conducted a study to determine the impact of GDT on intraoperative management of extensive surgery. Findings: We retrospectively collected data from 90 patients who underwent pancreaticoduodenectomy: 44 who received intraoperative GDT (GDT group) and 46 who received conventional hemodynamic management (control group)...
2018: JA Clinical Reports
https://www.readbyqxmd.com/read/29455120/amyand-s-hernia-with-acute-gangrenous-appendicitis-and-cecal-perforation-a-case-report-and-review-of-the-literature
#16
William Kromka, Aline S Rau, Charles J Fox
INTRODUCTION: An Amyand's hernia is a heterogeneous clinical condition defined by the presence of the vermiform appendix within an inguinal hernia sac, which may or may not contain other abdominal contents or pathologic inflammatory changes. Herein we present an exceptionally rare case of an Amyand's hernia containing acute appendicitis and a perforated cecum. PRESENTATION OF CASE: A 46-year-old male with a right inguinal hernia of 2-3 year duration presented to our Emergency Department complaining of acute onset abdominal and groin pain...
2018: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/29451938/the-management-of-cerebrospinal-fluid-leak-after-anterior-cervical-decompression-surgery
#17
Jiliang Zhai, Ripul R Panchal, Ye Tian, Shujie Wang, Lijuan Zhao
Cerebrospinal fluid (CSF) leak is a rare but potentially troublesome and occasionally catastrophic complication after anterior cervical decompression surgery. There is limited literature describing this complication, and the management of CSF leak varies. The aim of this study was to retrospectively review the treatment of cases with CSF leak and develop a management algorithm. A series of 14 patients with CSF leak from January 2011 to May 2016 were included in this study. Their characteristics, management of CSF leak, and outcomes were documented...
February 16, 2018: Orthopedics
https://www.readbyqxmd.com/read/29436139/incidence-and-factors-contributing-to-postdischarge-nausea-and-vomiting-in-pediatric-ambulatory-surgical-cases
#18
Proshad N Efune, Abu Minhajuddin, Peter Szmuk
BACKGROUND: Little is known regarding the incidence and contributing factors of postdischarge nausea and vomiting in children. AIMS: The aim of this study was to determine the incidence of postdischarge nausea and vomiting in day surgery patients and to identify demographic, intraoperative, and postoperative variables that influence the risk. METHODS: In this prospective observational study, a postdischarge questionnaire was administered to parents of ambulatory patients who received anesthesia and the electronic records were reviewed...
March 2018: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29424819/temporal-bone-meningo-encephalic-herniation-etiological-categorization-and-surgical-strategy
#19
Golda Grinblat, Manjunath Dandinarasaiah, Sampath Chandra Prasad, Gianluca Piras, Enrico Piccirillo, Andrea Fulcheri, Mario Sanna
OBJECTIVE: To study the clinical presentation, intraoperative findings and surgical management in meningo-encephalic-herniation (MEH) based on the etiology. STUDY DESIGN: A retrospective clinical study and is a follow-up on the previously published report in 2009. SETTING: A quaternary referral otology and skull base center PATIENTS AND METHODS:: The inclusion criteria were intraoperatively verified MEH in patients with a minimum follow-up of 12 months, which yielded 262 operated ears...
March 2018: Otology & Neurotology
https://www.readbyqxmd.com/read/29424017/perioperative-blood-management-strategies-for-total-knee-arthroplasty
#20
REVIEW
Qiang Lu, Hao Peng, Guan-Jin Zhou, Dong Yin
Total knee arthroplasty (TKA) often causes a significant amount of blood loss with an accompanying decline in hemoglobin and may increase the frequency of allogeneic blood transfusion rates. Unfortunately, allogeneic blood transfusions have associated risks including postoperative confusion, infection, cardiac arrhythmia, fluid overload, increased length of hospital stay, and increased mortality. Other than reducing the need for blood transfusions, reducing perioperative blood loss in TKA may also minimize intra-articular hemorrhage, limb swelling, and postoperative pain, and increase the range of motion during the early postoperative period...
February 9, 2018: Orthopaedic Surgery
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