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https://www.readbyqxmd.com/read/29771722/detection-of-deteriorating-patients-on-surgical-wards-outside-the-icu-by-an-automated-mews-based-early-warning-system-with-paging-functionality
#1
Axel R Heller, Sören T Mees, Benjamin Lauterwald, Christian Reeps, Thea Koch, Jürgen Weitz
BACKGROUND: The establishment of early warning systems in hospitals was strongly recommended in recent guidelines to detect deteriorating patients early and direct them to adequate care. Upon reaching predefined trigger criteria, Medical Emergency Teams (MET) should be notified and directed to these patients. The present study analyses the effect of introducing an automated multiparameter early warning score (MEWS)-based early warning system with paging functionality on 2 wards hosting patients recovering from highly complex surgical interventions...
May 16, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29764750/patient-oriented-optimal-depth-of-conscious-sedation-using-midazolam-during-flexible-bronchoscopy-a-prospective-open-labeled-single-arm-trial
#2
Yuichiro Takeda, Hibiki Udagawa, Shinji Nakamichi, Yasuto Yoneshima, Motoyasu Iikura, Satoshi Hirano, Go Naka, Haruhito Sugiyama
BACKGROUND: The British Thoracic Society guidelines for diagnostic flexible bronchoscopy (FB) in adults recommend that intravenous sedation should be offered to patients undergoing bronchoscopy. However, it is difficult to determine the adequate depth of sedation for each patient because of inter-individual variability. METHODS: This prospective, open-label, single-arm study was conducted in patients undergoing routine bronchus examination with FB. All patients underwent FB under local anesthesia and conscious sedation, with initial administration of 0...
May 6, 2018: Respiratory Investigation
https://www.readbyqxmd.com/read/29758372/percutaneous-endoscopic-lumbar-surgery-via-transfacet-approach-for-lumbar-synovial-cyst
#3
Hsuan-Han Wu, Lei Chu, Yong-Jian Zhu, Chun-Yuan Cheng, Chien-Min Chen
BACKGROUND: There are currently no high-quality studies on the optimal therapeutic approach for juxtafacet cyst as treatment guidelines have not been developed. Herein, a novel technique in which using an endoscopic transfacet approach to treat a patient with symptomatic lumbar synovial cyst was presented. . CASE DESCRIPTION: A 87-year-old man presented with severe dull pain in the right anterior thigh had developed. Lumbar magnetic resonance imaging (MRI) revealed disc extrusion over the central canal zone at the L2-3 and L4-L5 level, and an ovoid lesion with a hyperintense center plus a hypointense rim on the T2-weighted image...
May 11, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29757779/the-perioperative-care-of-the-transgender-patient
#4
Luis Etienne Tollinche, Chasity Burrows Walters, Asa Radix, Michael Long, Larissa Galante, Zil Garner Goldstein, Yvonne Kapinos, Cindy Yeoh
An estimated 25 million people identify as transgender worldwide, approximately 1 million of whom reside in the United States. The increasing visibility and acceptance of transgender people makes it likely that they will present in general surgical settings; therefore, perioperative health care providers must develop the knowledge and skills requisite for the safe management of transgender patients in the perioperative setting. Extant guidelines, such as those published by the World Professional Association for Transgender Health and the University of California San Francisco Center of Excellence for Transgender Health, serve as critical resources to those caring for transgender patients; however, they do not address their unique perioperative needs...
May 10, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29756745/controversies-in-office-based-anesthesia-obstructive-sleep-apnea-considerations
#5
Ruchir Gupta, Srinivas Pyati
As the number of procedures being performed in the office based anesthesia (OBA) setting are increasing, so are the number of patients presenting for surgery with obstructive sleep apnea (OSA). There continues to be controversy regarding whether these patients can be safely cared for in the OBA setting. To date, no national guideline has clearly addressed this issue and while some have extrapolated lessons from what has been published for OSA in the ambulatory surgery center (ASC) setting, some argue that there is a significant difference in the availability of resources in the ASC versus the OBA setting...
May 14, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29754874/preoperative-screening-for-obstructive-sleep-apnea-and-outcomes-in-pacu
#6
Jill Setaro, Ruth Reinsel, Dana Brun
PURPOSE: Practice guidelines from the perianesthesia community suggest that preoperative identification of patients with obstructive sleep apnea (OSA) and standardized longer observation in postanesthesia care unit (PACU) promotes safety after general anesthesia. The purpose of this study was to determine if longer monitoring of patients with OSA in the PACU improves patient outcomes after general anesthesia. DESIGN: Evidence-based best practices literature review...
May 10, 2018: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/29750692/trainability-of-cricoid-pressure-force-application-a-simulation-based-study
#7
Eric Noll, Shivam Shodhan, Arnavi Varshney, Christopher Gallagher, Pierre Diemunsch, F Barry Florence, Jamie Romeiser, Elliott Bennett-Guerrero
BACKGROUND: Aspiration of gastric contents is a leading cause of airway management-related mortality during anesthesia practice. Cricoid pressure (CP) is widely used during rapid sequence induction to prevent aspiration. National guidelines for CP suggest a target force of 10 N before and 30 N after loss of consciousness. However, few studies have rigorously assessed whether clinicians can be trained to consistently achieve these levels of force. We hypothesized that clinicians can be trained effectively to deliver 10-30 N during application of CP...
May 9, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29725865/post-operative-weaning-of-opioids-after-ambulatory-surgery-the-importance-of-physician-stewardship
#8
REVIEW
Brandon Roth, Adjoa Boateng, Allison Berken, Daniel Carlyle, Nalini Vadivelu
PURPOSE OF REVIEW: We performed a systematic review to elucidate the current guidelines on weaning patients from opioids in the post-operative ambulatory surgery setting, and how pain management intraoperatively can impact this process. DESIGN: The review highlights the most up-to-date research from clinical trials, patient reports, and retrospective studies regarding both the current guidelines and weaning of opioid analgesia in ambulatory surgery setting. RECENT FINDINGS: A striking paucity of convincing evidence exists on ambulatory postoperative pain management discontinuation or weaning of pain medications...
May 3, 2018: Current Pain and Headache Reports
https://www.readbyqxmd.com/read/29719742/toxic-myelitis-and-arachnoiditis-after-intrathecal-delivery-of-bupivacaine-via-an-implanted-drug-delivery-system-case-report-and-review-of-the-literature
#9
Meng Huang, Brian Dalm, Richard K Simpson
The off-label usage of amino-amide anesthetics in intrathecal drug delivery systems (IDDS) for the treatment of chronic non-malignant and malignant pain is supported in the polyanalgesic consensus guidelines as a second-line adjunctive therapy. Although strong evidence for its clinical efficacy is lacking, its clinical safety profile has been well established within established dosing parameters. Despite the rarity of neurological adverse reactions to intrathecal bupivacaine, whether given as regional anesthesia or intrathecal therapy, neurologic morbidity associated with its administration is well documented...
February 27, 2018: Curēus
https://www.readbyqxmd.com/read/29719401/a-restrictive-dose-of-crystalloids-in-patients-during-laparoscopic-cholecystectomy-is-safe-and-cost-effective-prospective-two-arm-parallel-randomized-controlled-trial
#10
Matija Belavić, Vlatka Sotošek Tokmadžić, Antonija Brozović Krijan, Ines Kvaternik, Kristina Matijaš, Nedjeljko Strikić, Josip Žunić
Purpose: There are no evidence-based guidelines for volume replacement during surgical procedures such as laparoscopic cholecystectomy. However, the administration of a restrictive volume of crystalloids could be more cost-effective and safe. This trial aimed to determine the effectiveness and safety of a restrictive regimen of crystalloids in patients during laparoscopic cholecystectomy by analyzing its cost-effectiveness and 1-year morbidity rate. Patients and methods: In this randomized, prospective study, patients were assigned to one of three groups based on the volume of fluid administered: the restrictive group received 1 mL/kg/hr, the low liberal group received 5 mL/kg/hr, and the high liberal group received 15 mL/kg/hr of Ringer's solution intraoperatively...
2018: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/29713886/comparison-of-narrow-band-imaging-and-the-storz-professional-image-enhancement-system-for-detection-of-laryngeal-and-hypopharyngeal-pathologies
#11
L Staníková, R Walderová, D Jančatová, M Formánek, K Zeleník, Pavel Komínek
OBJECTIVE: The aim of this study was to compare narrow band imaging (NBI) endoscopy and Storz Professional Image Enhancement System (SPIES) in observing epithelial and/or subepithelial microvascular irregularities and pathologies. METHODS: A total of 73 patients with laryngeal or hypopharyngeal lesions were investigated using high-definition NBI endoscopy preoperatively in local anesthesia and using SPIES system intraoperatively in general anesthesia from August 2016 to October 2017...
April 30, 2018: European Archives of Oto-rhino-laryngology
https://www.readbyqxmd.com/read/29700894/consensus-statement-on-clear-fluids-fasting-for-elective-pediatirc-general-anesthesia
#12
Mark Thomas, Christa Morrison, Richard Newton, Ehrenfried Schindler
Pediatric anesthetic guidelines for the management of preoperative fasting of clear fluids are currently 2 hours. The traditional 2 hours clear fluid fasting time was recommended to decrease the risk of pulmonary aspiration and is not in keeping with current literature. It appears that a liberalized clear fluid fasting regime does not affect the incidence of pulmonary aspiration and in those who do aspirate, the sequelae are not usually severe or long-lasting. With a 2-hour clear fasting policy, the literature suggests that this translates into 6-7 hours actual duration of fasting with several studies up to 15 hours...
April 27, 2018: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29700892/prevention-of-perioperative-venous-thromboembolism-in-pediatric-patients-guidelines-from-the-association-of-paediatric-anaesthetists-of-great-britain-and-ireland-apagbi
#13
Judith Morgan, Matthew Checketts, Amaia Arana, Elizabeth Chalmers, Jamie Maclean, Mark Powis, Neil Morton
The Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) Guidelines Working Group on Thromboprophylaxis in Children has reviewed the literature and where possible provided advice on the care of children in the perioperative period. Areas reviewed include the incidence of perioperative venous thromboembolism (VTE), risk factors, evidence for mechanical and chemical prophylaxis, and complications. Safe practice of regional anesthesia with anticoagulant prophylaxis is detailed. In summary, there are few areas of strong evidence...
April 27, 2018: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29688925/interdisciplinary-dialogue-is-needed-when-defining-perioperative-recommendations-conflicting-guidelines-for-anesthetizing-patients-for-pilonidal-surgery
#14
Roland E Andersson, Dietrich Doll, Verena K Stauffer, Andreas P Vogt, Steven D Boggs, Markus M Luedi
National or international guidelines can help surgeons and anesthesiologists make treatment decisions, but the existence of conflicting recommendations can hinder treatment rather than helping. A case in point is the treatment of pilonidal sinus disease, a chronic subcutaneous infection located in the sacrococcygeal area. Its incidence is rising, reaching almost 100/100,000 inhabitants. Three surgical societies have proposed guidelines for treating the disease, but these guidelines vary greatly in their approach to anesthesia...
April 23, 2018: A&A practice
https://www.readbyqxmd.com/read/29686989/enhanced-recovery-after-surgery-protocols-in-major-urologic-surgery
#15
REVIEW
Natalija Vukovic, Ljubomir Dinic
The purpose of the review: The analysis of the components of enhanced recovery after surgery (ERAS) protocols in urologic surgery. Recent findings: ERAS protocols has been studied for over 20 years in different surgical procedures, mostly in colorectal surgery. The concept of improving patient care and reducing postoperative complications was also applied to major urologic surgery and especially procedure of radical cystectomy. This procedure is technically challenging, due to a major surgical resection and high postoperative complication rate that may reach 65%...
2018: Frontiers in Medicine
https://www.readbyqxmd.com/read/29685887/cardiopulmonary-resuscitation-in-infants-and-children-with-cardiac-disease-a-scientific-statement-from-the-american-heart-association
#16
REVIEW
Bradley S Marino, Sarah Tabbutt, Graeme MacLaren, Mary Fran Hazinski, Ian Adatia, Dianne L Atkins, Paul A Checchia, Allan DeCaen, Ericka L Fink, George M Hoffman, John L Jefferies, Monica Kleinman, Catherine D Krawczeski, Daniel J Licht, Duncan Macrae, Chitra Ravishankar, Ricardo A Samson, Ravi R Thiagarajan, Rune Toms, James Tweddell, Peter C Laussen
Cardiac arrest occurs at a higher rate in children with heart disease than in healthy children. Pediatric basic life support and advanced life support guidelines focus on delivering high-quality resuscitation in children with normal hearts. The complexity and variability in pediatric heart disease pose unique challenges during resuscitation. A writing group appointed by the American Heart Association reviewed the literature addressing resuscitation in children with heart disease. MEDLINE and Google Scholar databases were searched from 1966 to 2015, cross-referencing pediatric heart disease with pertinent resuscitation search terms...
April 23, 2018: Circulation
https://www.readbyqxmd.com/read/29680176/perianesthesia-nurses-survey-of-their-knowledge-and-practice-with-obstructive-sleep-apnea
#17
Andrea M Erwin, Kim A Noble, June Marshall, Susan Cooper
PURPOSE: Anesthesia, sedation, and analgesia can negatively impact adult patients with obstructive sleep apnea (OSA). Despite known risks, current evidence, and practice guidelines, insufficient evidence exists that standardization and clinical application of OSA screening tools, problem identification, and perioperative nursing intervention and management strategies are consistently implemented for OSA patients across perianesthesia settings. The purpose of this study was to conduct a knowledge and practice assessment of perianesthesia nurses who care for adult patients with diagnosed or undiagnosed OSA...
April 18, 2018: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/29679839/xenon-detection-in-human-blood-analytical-validation-by-accuracy-profile-and-identification-of-critical-storage-parameters
#18
Cécile Frampas, Julia Ney, Mark Coburn, Marc Augsburger, Vincent Varlet
Xenon is a rare, mostly inert, noble gas that has applications in a wide range of fields, including medicine. Xenon acts on the human body as a useful organ-protective and anesthetic agent and has also been previously studied for potential applications in fields such as optics, aerospace and medical imaging. Recently, it was discovered that xenon can boost erythropoietin production, and it has been used as a performance-enhancing agent in international sports competitions such as the Sochi Olympic Games. Therefore, screening methods to detect the misuse of xenon by analysis of biological samples and to monitor anesthesia kinetics and efficiency are being investigated...
April 13, 2018: Journal of Forensic and Legal Medicine
https://www.readbyqxmd.com/read/29669523/central-retinal-artery-occlusion-rethinking-retinal-survival-time
#19
Stephan Tobalem, James S Schutz, Argyrios Chronopoulos
BACKGROUND: The critical time from onset of complete occlusion of the central retinal artery (CRA) to functionally significant inner retinal infarction represents a window of opportunity for treatment and also has medical-legal implications, particularly when central retinal artery occlusion (CRAO) complicates therapeutic interventions. Here, we review the evidence for time to infarction from complete CRAO and discuss the implications of our findings. METHODS: A Medline search was performed using each of the terms "central retinal artery occlusion", "retinal infarction", "retinal ischemia", and "cherry red spot" from 1970 to the present including articles in French and German...
April 18, 2018: BMC Ophthalmology
https://www.readbyqxmd.com/read/29669351/bronchial-thermoplasty-in-severe-asthma-best-practice-recommendations-from-an-expert-panel
#20
Peter I Bonta, Pascal Chanez, Jouke T Annema, Pallav L Shah, Robert Niven
Bronchial thermoplasty (BT) is a bronchoscopic treatment for patients with severe asthma who remain symptomatic despite optimal medical therapy. In this "expert best practice" paper, the background and practical aspects of BT are highlighted. Randomized, controlled clinical trials have shown BT to be safe and effective in reducing severe exacerbations, improving quality of life, and decreasing emergency department visits. Five-year follow-up studies have provided evidence of the functional stability of BT-treated patients with persistence of a clinical benefit...
2018: Respiration; International Review of Thoracic Diseases
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