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Intraoperative fluid management

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https://www.readbyqxmd.com/read/28092334/is-enhanced-recovery-the-new-standard-of-care-in-microsurgical-breast-reconstruction
#1
Anoushka Afonso, Sabine Oskar, Kay See Tan, Joseph J Disa, Babak J Mehrara, Jihan Ceyhan, Joseph H Dayan
BACKGROUND: Enhanced recovery pathways (ERPs) have been shown to aid in patient recovery and improve outcomes in many surgical settings. At present, there is limited data available regarding the use and feasibility of ERPs for patients undergoing microsurgical breast reconstruction. We sought to assess patient outcomes before and after the introduction of an ERP that was adopted by multiple surgeons at a single cancer center. METHODS: A multidisciplinary ERP was developed for patients undergoing deep inferior epigastric perforator (DIEP) or muscle-sparing free transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction...
January 12, 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28086855/postoperative-fluid-overload-is-a-risk-factor-for-adverse-surgical-outcome-in-patients-undergoing-esophagectomy-for-esophageal-cancer-a-retrospective-study-in-335-patients
#2
Torben Glatz, Birte Kulemann, Goran Marjanovic, Svenja Bregenzer, Frank Makowiec, Jens Hoeppner
BACKGROUND: Restrictive intraoperative fluid management is increasingly recommended for patients undergoing esophagectomy. Controversy still exists about the impact of postoperative fluid management on perioperative outcome. METHODS: We retrospectively examined 335 patients who had undergone esophagectomy for esophageal cancer at the University Hospital Freiburg between 1996 and 2014 to investigate the relation between intra- and postoperative fluid management and postoperative morbidity after esophagectomy...
January 13, 2017: BMC Surgery
https://www.readbyqxmd.com/read/28078172/gastric-rupture-in-pregnancy-case-series-from-a-tertiary-institution-in-rwanda-and-review-of-the-literature
#3
David Ntirushwa, Stephen Rulisa, Febronie Muhorakeye, Lisa Bazzett-Matabele, Theogene Rurangwa, Maria Small
Background Gastric rupture is a rare, life-threatening condition during pregnancy. Case study We present three cases of gastric perforation during pregnancy and the puerperium. The first patient presented with gastric perforation 4 days following an uncomplicated cesarean delivery for obstetric indications. She initially complained of epigastric pain; however, those symptoms resolved. She later demonstrated worsening abdominal distension, intra-abdominal free fluid, and signs of peritonitis. At laparotomy, an ascariasis-associated gastric rupture was diagnosed...
October 2016: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/28062421/intraoperative-oct-assisted-descemetopexy-with-stromal-vent-incisions-and-intracameral-gas-injection-for-case-of-non-resolving-descemet-s-membrane-detachment
#4
Archita Singh, Murugesan Vanathi, Suman Sahu, Saranya Devi
Descemet's membrane detachment (DMD) though uncommon in the present day scenario of advancing surgical techniques is a significant complication that requires prompt diagnosis and management. A middle-aged man presented to our hospital with poor gain of vision following cataract surgery. There was significant corneal oedema with DMD which was confirmed on anterior segment optical coherence tomography. We describe a modified continuous intraoperative-guided approach for the management of DMD in cases with oedematous hazy corneas...
January 6, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28045814/recalcitrant-invasive-skin-cancer-of-the-scalp-combined-extirpation-and-microsurgical-reconstruction-without-cranioplasty
#5
Gerald J Cho, Frederick Wang, Steven M Garcia, Jennifer Viner, William Y Hoffman, Michael W McDermott, Jason H Pomerantz
BACKGROUND: Recurrent invasive skin cancer of the scalp and calvarium is a difficult problem for which universally accepted treatment protocols have not been established. The authors present their 10-year experience with treatment of this specific subset of scalp reconstruction patients and present a successful treatment algorithm that is well suited to this patient population. METHODS: The authors retrospectively reviewed all patients of microsurgical scalp reconstruction performed from 2005 to 2015 that involved invasive cutaneous malignancies of the scalp and calvarium...
December 30, 2016: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28045745/avoiding-complications-in-endoscopic-skull-base-surgery
#6
Jannis Constantinidis, Iordanis Konstantinidis
PURPOSE OF REVIEW: Endoscopic skull base surgery has become an established approach for the removal of tumors and cerebrospinal fluid fistulae repair. Compared with external approaches, it provides better aesthetic results and quality of life postoperatively. However, as it becomes popular and expands its indications possible complications should be reassessed in terms of incidence and variability in order to confirm its efficacy and safety. This article reviews the recent literature describing the main categories of possible complications suggesting strategies to minimize their incidence...
December 23, 2016: Current Opinion in Otolaryngology & Head and Neck Surgery
https://www.readbyqxmd.com/read/28027250/important-developments-in-burn-care
#7
Kevin J Zuo, Abelardo Medina, Edward E Tredget
LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Explain the epidemiology of severe burn injury in the context of socioeconomic status, gender, age, and burn cause. 2. Describe challenges with burn depth evaluation and novel methods of adjunctive assessment. 3. Summarize the survival and functional outcomes of severe burn injury. 4. State strategies of fluid resuscitation, endpoints to guide fluid titration, and sequelae of overresuscitation. 5. Recognize preventative measures of sepsis...
January 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28027059/avoiding-complications-in-endoscopic-skull-base-surgery
#8
Jannis Constantinidis, Iordanis Konstantinidis
PURPOSE OF REVIEW: Endoscopic skull base surgery has become an established approach for the removal of tumors and cerebrospinal fluid fistulae repair. Compared with external approaches, it provides better aesthetic results and quality of life postoperatively. However, as it becomes popular and expands its indications possible complications should be reassessed in terms of incidence and variability in order to confirm its efficacy and safety. This article reviews the recent literature describing the main categories of possible complications suggesting strategies to minimize their incidence...
February 2017: Current Opinion in Otolaryngology & Head and Neck Surgery
https://www.readbyqxmd.com/read/28012532/management-of-surgical-difficulties-during-cochlear-implant-with-inner-ear-anomalies
#9
Ahmad M Aldhafeeri, Abdulrahman A Alsanosi
OBJECTIVE: To review the difficulties that can occur during cochlear implant surgery in patients with inner ear abnormalities and the management thereof. METHODS: A retrospective chart review of 316 patients who received cochlear implants was conducted. The data collected included the types of inner ear anomalies, intraoperative findings, and the clinical management strategies. A review of the literature was also performed. RESULTS: A total of 24 patients with inner ear malformations who underwent 28 total cochlear implant procedures were identified...
January 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/27999663/implementation-of-goal-directed-fluid-therapy-during-hip-revision-arthroplasty-a-matched-cohort-study
#10
Marit Habicher, Felix Balzer, Viktor Mezger, Jennifer Niclas, Michael Müller, Carsten Perka, Michael Krämer, Michael Sander
BACKGROUND: Several randomized controlled trials (RCTs) have demonstrated that intraoperative goal-directed fluid therapy (GDFT) can decrease postsurgical complications in patients undergoing major abdominal surgery. However, very few studies have demonstrated the value of goal-directed therapy (GDT) in patients undergoing orthopaedic surgery and confirmed it is as useful in real-life conditions. Therefore, we initiated a GDFT implementation programme in patients undergoing hip revision arthroplasty in order to assess its effects on postoperative complications (e...
2016: Perioperative Medicine
https://www.readbyqxmd.com/read/27990642/anemia-tolerance-during-normo-hypo-and-hypervolemia
#11
Malte Krömker, Patrick Lauscher, Harry Kertscho, Kai Zacharowski, Peter Rosenberger, Jens Meier
BACKGROUND: Restrictive intraoperative fluid management has been demonstrated to improve outcome of visceral and lung surgery in several studies. However, subsequent hypovolemia (HOV) may be accompanied by a decrease of anemia tolerance, resulting in increased transfusion needs. We therefore investigated the effect of volume status on anemia tolerance. STUDY DESIGN AND METHODS: Eighteen domestic pigs of either sex (mean weight, 23.5 ± 4.8 kg) were anesthetized, ventilated, and randomized into three experimental groups: normovolemia (no intervention), HOV (blood loss of 40% of blood volume), and hypervolemia (HEV; volume infusion of 40% of blood volume)...
December 19, 2016: Transfusion
https://www.readbyqxmd.com/read/27977657/delayed-recovery-of-adipsic-diabetes-insipidus-adi-caused-by-elective-clipping-of-anterior-communicating-artery-and-left-middle-cerebral-artery-aneurysms
#12
Jeffrey Tan, Samuel Ndoro, Uchenna Okafo, Aoife Garrahy, Amar Agha, Danny Rawluk
Adipsic diabetes insipidus (ADI) is an extremely rare complication following microsurgical clipping of anterior communicating artery aneurysm (ACoA) and left middle cerebral artery (MCA) aneurysm. It poses a significant challenge to manage due to an absent thirst response and the co-existence of cognitive impairment in our patient. Recovery from adipsic DI has hitherto been reported only once. A 52-year-old man with previous history of clipping of left posterior communicating artery aneurysm 20 years prior underwent microsurgical clipping of ACoA and left MCA aneurysms without any intraoperative complications...
December 16, 2016: New Zealand Medical Journal
https://www.readbyqxmd.com/read/27972360/when-cost-saving-technologies-are-not-adopted-despite-evidence-and-payer-recommendations-intraoperative-fluid-management-iofm-in-the-uk
#13
J Murphy, G Goodall
No abstract text is available yet for this article.
November 2016: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/27906705/arterial-pressure-variation-in-elective-noncardiac-surgery-identifying-reference-distributions-and-modifying-factors
#14
Michael R Mathis, Samuel A Schechtman, Milo C Engoren, Amy M Shanks, Aleda Thompson, Sachin Kheterpal, Kevin K Tremper
BACKGROUND: Assessment of need for intravascular volume resuscitation remains challenging for anesthesiologists. Dynamic waveform indices, including systolic and pulse pressure variation, are demonstrated as reliable measures of fluid responsiveness for mechanically ventilated patients. Despite widespread use, real-world reference distributions for systolic and pulse pressure variation values have not been established for euvolemic intraoperative patients. The authors sought to establish systolic and pulse pressure variation reference distributions and assess the impact of modifying factors...
February 2017: Anesthesiology
https://www.readbyqxmd.com/read/27900630/current-delivery-of-hyperthermic-intraperitoneal-chemotherapy-with-cytoreductive-surgery-cs-hipec-and-perioperative-practices-an-international-survey-of-high-volume-surgeons
#15
Allison H Maciver, Eisar Al-Sukhni, Jesus Esquivel, Joseph J Skitzki, John M Kane, Valerie A Francescutti
BACKGROUND: Cytoreductive surgery and heated intraperitoneal chemotherapy (CS/HIPEC) is performed for selected indications at a limited number of specialized centers worldwide. Currently there is no standardized approach to the perioperative care process. We sought to capture current practices in the perioperative management of patients who undergo CS/HIPEC at high-volume centers. METHODS: Surgeon members of the American Society of Peritoneal Surface Malignancies working at high-volume CS/HIPEC centers (>10 cases/year) were invited to complete an online survey...
November 29, 2016: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/27899127/treatment-for-thoracic-ossification-of-posterior-longitudinal-ligament-with-posterior-circumferential-decompression-complications-and-managements
#16
Baohui Yang, Yi Wang, Xijing He, Haopeng Li
BACKGROUND: The complications and corresponding managements for patients with thoracic ossification of posterior longitudinal ligament (TOPLL) who were treated with posterior circumferential decompression have not been systematically summarized yet. METHODS: Twenty-one patients with TOPLL who received posterior circumferential decompression between February 2010 and December 2014 were retrospectively reviewed. The patients' basic characteristics, surgical duration, intraoperative blood loss, Japanese Orthopaedic Association (JOA) scores, and intraoperative and postoperative complications, and the adopted managements were summarized...
November 29, 2016: Journal of Orthopaedic Surgery and Research
https://www.readbyqxmd.com/read/27891427/anaesthetic-management-of-a-case-of-down-s-syndrome-with-achalasia-cardia
#17
Neeta Santha, Madhusudan Upadya, Sravanthi Vishwanatham
Achalasia cardia is a disorder of the gastrointestinal tract characterized by dilatation of the oesophagus and collection of food and fluids in the oesophagus leading to massive regurgitation and aspiration of gastric contents. Down's syndrome has multisystem effects which can also present as difficult airway. Here, we present a case of a 14-year-old girl, a case of Down's syndrome with Achalasia cardia and mitral valve prolapse posted for Heller's cardiomyotomy. Anaesthetic concerns were difficult airway due to Downs's syndrome, massive aspiration risks of Achalasia cardia and haemodynamic instability due to mitral regurgitation...
October 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/27873011/laparoscopic-resection-of-choledochal-cyst-with-roux-en-y-hepaticojejunostomy-a-case-report-and-review-of-the-literature
#18
Bestoun Ahmed, Priya Sharma, Cynthia L Leaphart
BACKGROUND: Choledochal cysts are associated with ductal strictures, stone formation, cholangitis, rupture, secondary biliary cirrhosis and increased incidence of cholangiocarcinoma. The surgical approach to choledochal cysts has evolved from the cyst-enterostomy to a complete excision with more recent use of minimally invasive approaches. We report a complete minimally invasive approach to a Type 1 choledochal cyst and summarize the literature containing large case series of similar approaches...
November 21, 2016: Surgical Endoscopy
https://www.readbyqxmd.com/read/27871544/comparison-of-anesthetic-management-and-outcomes-of-robot-assisted-vs-pure-laparoscopic-radical-prostatectomy
#19
Hiroshi Yonekura, Hiroyuki Hirate, Kazuya Sobue
STUDY OBJECTIVE: Limited data are available regarding the anesthetic management and outcome of patients undergoing pure laparoscopic radical prostatectomy (LRP) and robotic-assisted LRP (RALP). Therefore, our primary objective was to compare the anesthetic management between these 2 groups. Our secondary objective was to determine the incidence of adverse outcomes associated with RALP, which requires an extreme Trendelenburg position. DESIGN: A retrospective observational study...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27853662/postoperative-cerebrospinal-fluid-leak-rates-with-subfascial-epidural-drain-placement-after-intentional-durotomy-in-spine-surgery
#20
Tianyi Niu, Derek S Lu, Andrew Yew, Darryl Lau, Haydn Hoffman, David McArthur, Dean Chou, Daniel C Lu
Study Design Retrospective chart review. Objective Postoperative cerebrospinal fluid (CSF) leak is a known complication of intraoperative durotomy. Intraoperative placement of subfascial epidural drains following primary dural repair has been proposed as a potential management strategy to prevent formation of CSF cutaneous fistula and symptomatic pseudomeningocele. Here we describe our experience with subfascial drain after intentional durotomy. Methods Medical records of patients who underwent placement of subfascial epidural drains during spinal procedures with intentional intraoperative durotomies over a 4-year period at two institutions were retrospectively reviewed...
December 2016: Global Spine Journal
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