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Intraoperative fluid management

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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
#1
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...
July 4, 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
#2
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/28659243/the-impact-of-using-an-intraoperative-goal-directed-fluid-therapy-protocol-on-clinical-outcomes-in-patients-undergoing-total-pancreatectomy-and-islet-cell-autotransplantation
#3
Matthew K Wagar, Josh Magnuson, Patty T Liu, Varvara Kirchner, Joshua J Wilhelm, Martin L Freeman, Melena D Bellin, Timothy L Pruett, Gregory J Beilman, Ty B Dunn
BACKGROUND: Patients undergoing total pancreatectomy and islet cell autotransplant (TPIAT) for treatment of pancreatitis are at risk for complications of over and under resuscitation. We hypothesized that using a goal directed fluid therapy (GDFT) protocol might impact clinical outcomes. MATERIALS AND METHODS: A consecutive series of adult patients undergoing TPIAT were managed intraoperatively using either standard fluid therapy (SFT, n = 44) or GDFT (n = 23) as part of a pilot study between January 2013 and May 2015...
June 23, 2017: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
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
#4
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/28618979/complications-and-post-operative-sequelae-of-temporomandibular-joint-arthrocentesis
#5
Luigi Angelo Vaira, Maria Teresa Raho, Damiano Soma, Giovanni Salzano, Giovanni Dell'aversana Orabona, Pasquale Piombino, Giacomo De Riu
OBJECTIVE:  To evaluate intraoperative complications and postsurgical sequelae associated with arthrocentesis of the TMJ, including injection of Sodium Hyaluronate. METHODS: This retrospective study evaluated 433 arthrocentesis procedures performed in 315 patients between January 2009 and August 2016. The authors reviewed the complications identified during the procedure and the follow-up period. RESULTS: Temporary swelling of the periarticular tissues (95...
June 15, 2017: Cranio: the Journal of Craniomandibular Practice
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
#6
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/28604404/perioperative-care-of-head-and-neck-free-flap-patients
#7
Michael R Kinzinger, Arnaud F Bewley
PURPOSE OF REVIEW: This article reviews the recent literature on the perioperative care of head and neck surgical patients undergoing free tissue transfer. RECENT FINDINGS: As the overall success of head and neck free flaps has plateaued above 95%, recent literature on perioperative flap management has focused on minimizing complications, length of stay, and cost of treatment. Current areas of research include preoperative risk stratification, preoperative and postoperative nutrition, intraoperative fluid management, postoperative level of care, postoperative antibiotic prophylaxis, defining the impact of comorbidities, and developing comprehensive evidence-based perioperative care protocols...
June 9, 2017: Current Opinion in Otolaryngology & Head and Neck Surgery
https://www.readbyqxmd.com/read/28598916/protective-lung-ventilation-and-morbidity-after-pulmonary-resection-a-propensity-score-matched-analysis
#8
David Amar, Hao Zhang, Alessia Pedoto, Dawn P Desiderio, Weiji Shi, Kay See Tan
BACKGROUND: Protective lung ventilation (PLV) during one-lung ventilation (OLV) for thoracic surgery is frequently recommended to reduce pulmonary complications. However, limited outcome data exist on whether PLV use during OLV is associated with less clinically relevant pulmonary morbidity after lung resection. METHODS: Intraoperative data were prospectively collected in 1080 patients undergoing pulmonary resection with OLV, intentional crystalloid restriction, and mechanical ventilation to maintain inspiratory peak airway pressure <30 cm H2O...
July 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28593554/hydrocephalus-and-mucopolysaccharidoses-what-do-we-know-and-what-do-we-not-know
#9
REVIEW
Amauri Dalla Corte, Carolina F M de Souza, Maurício Anés, Roberto Giugliani
INTRODUCTION: The precise incidence of hydrocephalus in patients with mucopolysaccharidoses (MPS) is hard to determine, because the condition lacks a formal, consensus-based definition. The diagnosis of hydrocephalus depends on symptom profile, presence of neuroimaging features, and the outcome of diagnostic tests. Although numerous techniques are used to identify MPS patients who are most likely to have hydrocephalus and respond to treatment, no definitive method exists to prove diagnosis...
June 7, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28559002/assessment-of-the-automated-multiplex-pcr-unyvero-i60-iti-%C3%A2-cartridge-system-to-diagnose-prosthetic-joint-infection-a-multicenter-study
#10
D Malandain, P Bémer, A G Leroy, J Léger, C Plouzeau, A S Valentin, A Jolivet-Gougeon, D Tandé, G Héry-Arnaud, C Lemarié, M Kempf, L Bret, C Burucoa, S Corvec
OBJECTIVES: Prosthetic joint infections (PJI) are responsible for significant morbidity and mortality and their number continues to rise. Their management remains complex, especially the microbiological diagnosis. Besides "homemade" tests developed by several teams, new molecular biology methods are now available with different analytical performance and usability. METHODS: We studied the performances of one of these tests: ITI(®) multiplex PCR (mPCR) by the Curetis(®) company and compared it either to "optimized" culture or to 16S rRNA PCR...
May 27, 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/28558654/a-pragmatic-multi-center-trial-of-goal-directed-fluid-management-based-on-pulse-pressure-variation-monitoring-during-high-risk-surgery
#11
Luiz Marcelo Sá Malbouisson, João Manoel Silva, Maria José Carvalho Carmona, Marcel Rezende Lopes, Murilo Santucci Assunção, Jorge Luís Dos Santos Valiatti, Claudia Marques Simões, José Otavio Costa Auler
BACKGROUND: Intraoperative fluid therapy guided by mechanical ventilation-induced pulse-pressure variation (PPV) may improve outcomes after major surgery. We tested this hypothesis in a multi-center study. METHODS: The patients were included in two periods: a first control period (control group; n = 147) in which intraoperative fluids were given according to clinical judgment. After a training period, intraoperative fluid management was titrated to maintain PPV < 10% in 109 surgical patients (PPV group)...
May 30, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28552297/comparison-between-2-strategies-of-fluid-management-on-blood-loss-and-transfusion-requirements-during-liver-transplantation
#12
Nirmeen A Fayed, Khaled A Yassen, Ayat R Abdulla
OBJECTIVE: To compare the effects of low central venous pressure (LCVP) and transesophageal Doppler (TED)-guided fluid management on blood loss and blood transfusion during liver transplantation (LTx). DESIGN: Retrospective study. SETTING: Single institution, university hospital. PARTICIPANTS: Adult recipients of LTx. INTERVENTIONS: Two groups: control (LCVP G), n=45 with CVP maintained 40% lower than the preoperative value during the preanhepatic phase...
February 22, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28529913/critical-care-management-and-intensive-care-unit-outcomes-following-cytoreductive-surgery-with-hyperthermic-intraperitoneal-chemotherapy
#13
Sumit Kapoor, Adel Bassily-Marcus, Rafael Alba Yunen, Parissa Tabrizian, Sabrine Semoin, Joseph Blankush, Daniel Labow, John Oropello, Anthony Manasia, Roopa Kohli-Seth
AIM: To study the early postoperative intensive care unit (ICU) management and complications in the first 2 wk of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS: Our study is a retrospective, observational study performed at Icahn School of Medicine at Mount Sinai, quaternary care hospital in New York City. All adult patients who underwent CRS and HIPEC between January 1, 2007 and December 31, 2012 and admitted to ICU postoperatively were studied...
May 4, 2017: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28526144/pulmonary-vasodilators-and-anesthesia-considerations
#14
REVIEW
Jeremy B Green, Brendon Hart, Elyse M Cornett, Alan D Kaye, Ali Salehi, Charles J Fox
Pulmonary hypertension (PH) is a complex disease process of the pulmonary vasculature system characterized by elevated pulmonary arterial pressures. Patients with PH are at increased risk for morbidity and mortality, including intraoperatively and postoperatively. Appreciation by the clinical anesthesiologist of the pathophysiology of PH is warranted. Careful and meticulous strategy using appropriate anesthetic medications, pulmonary vasodilator and inotropic agents, and careful fluid management all increase the likelihood of the best possible outcome in this challenging patient population...
June 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28516158/a-management-algorithm-for-mitomycin-c-induced-cystitis
#15
Amy N Luckenbaugh, Rory M Marks, David C Miller, Alon Z Weizer, John T Stoffel, Jeffrey S Montgomery
Background/Objective: A post-bladder tumor resection dose of MMC can reduce non-invasive papillary (pTa) bladder cancer recurrences by up to 40%; this treatment is recommended in both the AUA and EUA non-muscle-invasive bladder cancer guidelines. A common complication of this treatment is eosinophilic cystitis. Symptoms range from mild urinary frequency and urgency to debilitating pain and dysuria. Currently, there is no established treatment algorithm for MMC-induced cystitis. Methods: Members of the Urologic Surgery Quality Collaborative (USQC), a group composed of over 160 private and academic urologists, met to discuss the management of patients with cystitis following MMC therapy...
April 27, 2017: Bladder Cancer
https://www.readbyqxmd.com/read/28500653/blood-transfusion-in-the-surgical-treatment-of-adolescent-idiopathic-scoliosis-a-single-center-experience-of-patient-blood-management-in-210-cases
#16
Søren Ohrt-Nissen, Naeem Bukhari, Casper Dragsted, Martin Gehrchen, Pär I Johansson, Jesper Dirks, Jakob Stensballe, Benny Dahl
BACKGROUND: The surgical treatment of adolescent idiopathic scoliosis can be associated with substantial blood loss, requiring allogeneic red blood cell (RBC) transfusion. This study describes the use of RBC and the effect of a standardized perioperative patient blood management program. STUDY DESIGN AND METHODS: Patients treated with posterior instrumented fusion were consecutively enrolled over a 6-year period. Patient blood management strategies were implemented in 2011, including prophylactic tranexamic acid, intraoperative permissive hypotension, restrictive fluid therapy (including avoidance of synthetic colloids), restrictive RBC trigger according to institutional standardized protocol, the use of cell savage, and goal-directed therapy according to thrombelastography...
May 12, 2017: Transfusion
https://www.readbyqxmd.com/read/28497021/understanding-rare-adverse-sequelae-of-breast-implants-anaplastic-large-cell-lymphoma-late-seromas-and-double-capsules
#17
REVIEW
Mark W Clemens, Maurizio Bruno Nava, Nicola Rocco, Roberto N Miranda
Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) is a distinct type of T-cell lymphoma arising around breast implants. The United States FDA recently updated the 2011 safety communication, warning that women with breast implants may have a very low risk of developing ALCL adjacent to a breast implant. According to the World Health Organization, BI-LCL is not a breast cancer or cancer of the breast tissue; it is a lymphoma, a cancer of immune cells. BI-ALCL is highly curable in the majority of patients...
April 2017: Gland Surgery
https://www.readbyqxmd.com/read/28495088/fluorescence-guided-resection-with-5-aminolevulinic-acid-of-a-pilomyxoid-astrocytoma-of-the-third-ventricle
#18
Luis Miguel Bernal García, Jose Manuel Cabezudo Artero, Rafael García Moreno, Maria Bella Marcelo Zamorano, Carlos Mayoral Guisado
Fluorescence-guided resection with 5-aminolevulinic acid has been shown to be useful in the resection of certain brain tumors other than high grade gliomas, facilitating the intraoperative differentiation of neoplastic tissue. The technique enables the surgeon to ensure that no tumor fragments remain, thereby achieving higher rates of complete resection. Tihan first described pilomyxoid astrocytomas in 1999. They are currently classified as grade II astrocytoma according to the WHO classification system and, because of their tendency to recur and their dissemination through the cerebrospinal fluid pathways, they are considered to be more aggressive than pilocytic astrocytoma...
May 8, 2017: Neurocirugía
https://www.readbyqxmd.com/read/28490156/multiloculated-hydrocephalus-open-craniotomy-or-endoscopy
#19
REVIEW
Yun Ho Lee, Young Sub Kwon, Kook Hee Yang
Multiloculated hydrocephalus (MLH) is a condition in which patients have multiple, separate abnormal cerebrospinal fluid collections with no communication between them. Despite technical advancements in pediatric neurosurgery, neurological outcomes are poor in these patients and the approach to this pathology remains problematic especially given individual anatomic complexity and cerebrospinal fluid (CSF) hydrodynamics. A uniform surgical strategy has not yet been developed. Current treatment options for MLH are microsurgical fenestration of separate compartments by open craniotomy or endoscopy, shunt surgery in which multiple catheters are placed in the compartments, and combinations of these modalities...
May 2017: Journal of Korean Neurosurgical Society
https://www.readbyqxmd.com/read/28484814/contemporary-approaches-to-perioperative-iv-fluid-therapy
#20
REVIEW
Paul S Myles, Sam Andrews, Jonathan Nicholson, Dileep N Lobo, Monty Mythen
BACKGROUND: Intravenous fluid therapy is required for most surgical patients, but inappropriate regimens are commonly prescribed. The aim of this narrative review was to provide evidence-based guidance on appropriate perioperative fluid management. METHOD: We did a systematic literature search of the literature to identify relevant studies and meta-analyses to develop recommendations. RESULTS: Of 275 retrieved articles, we identified 25 articles to inform this review...
May 8, 2017: World Journal of Surgery
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