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fluid therapy perioperative

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https://www.readbyqxmd.com/read/29792232/effect-of-postoperative-goal-directed-therapy-in-cancer-patients-undergoing-high-risk-surgery-a-randomized-clinical-trial-and-meta-analysis
#1
Aline Rejane Muller Gerent, Juliano Pinheiro Almeida, Evgeny Fominskiy, Giovanni Landoni, Gisele Queiroz de Oliveira, Stephanie Itala Rizk, Julia Tizue Fukushima, Claudia Marques Simoes, Ulysses Ribeiro, Clarice Lee Park, Rosana Ely Nakamura, Rafael Alves Franco, Patricia Inês Cândido, Cintia Rosa Tavares, Ligia Camara, Graziela Dos Santos Rocha Ferreira, Elisangela Pinto Marinho de Almeida, Roberto Kalil Filho, Filomena Regina Barbosa Gomes Galas, Ludhmila Abrahão Hajjar
BACKGROUND: Perioperative goal-directed hemodynamic therapy (GDHT) has been advocated in high-risk patients undergoing noncardiac surgery to reduce postoperative morbidity and mortality. We hypothesized that using cardiac index (CI)-guided GDHT in the postoperative period for patients undergoing high-risk surgery for cancer treatment would reduce 30-day mortality and postoperative complications. METHODS: A randomized, parallel-group, superiority trial was performed in a tertiary oncology hospital...
May 23, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29789877/-meta-analyses-on-measurement-precision-of-non-invasive-hemodynamic-monitoring-technologies-in-adults
#2
G Pestel, K Fukui, M Higashi, I Schmidtmann, C Werner
An ideal non-invasive monitoring system should provide accurate and reproducible measurements of clinically relevant variables that enables clinicians to guide therapy accordingly. The monitor should be rapid, easy to use, readily available at the bedside, operator-independent, cost-effective and should have a minimal risk and side effect profile for patients. An example is the introduction of pulse oximetry, which has become established for non-invasive monitoring of oxygenation worldwide. A corresponding non-invasive monitoring of hemodynamics and perfusion could optimize the anesthesiological treatment to the needs in individual cases...
May 22, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29772591/-monitoring-and-modern-hemodynamic-concepts-in-cardiac-anesthesia
#3
Matthias Heringlake, Christian Schmidt, Sebastian Brandt
Patients undergoing cardiac surgery are growing older, present with more comorbidities, and are frequently scheduled for more complex and prolonged surgical procedures. Routine application of neurological as well as extended hemodynamic monitoring combined with goal-directed perioperative hemodynamic optimization, targeting optimization of systemic and cerebral oxygen balance, show promise to reduce postoperative complications and to improve mortality in this high risk population. Expert recommendations suggest to avoid synthetic colloids for fluid optimization...
May 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29767451/feline-ureteral-obstructions-part-1-medical-management
#4
REVIEW
D L Clarke
Feline ureteral obstructions are an increasingly recognised and challenging diagnostic and management problem. Many cats with ureteral obstructions are critically ill at the time of diagnosis, especially if there is dysfunction of the contralateral kidney. They may present with varying severities of acute kidney injury, electrolyte disturbances, and may have comorbidities such as heart disease that complicate perioperative and long-term management. Medical management, which may consist of rehydration and restoration of intravascular volume with intravenous fluid therapy, osmotic diuresis, ureteral muscle relaxation, and antimicrobials for infection, is important in feline ureteral obstruction patients...
May 16, 2018: Journal of Small Animal Practice
https://www.readbyqxmd.com/read/29756693/multi-parametric-functional-hemodynamic-optimization-improves-postsurgical-outcome-after-intermediate-risk-open-gastrointestinal-surgery-a-randomized-controlled-trial
#5
Pavel Szturz, Pavel Folwarczny, Roman Kula, Jan Neiser, Pavel Ševčík, Jan Benes
BACKGROUND: Perioperative goal directed therapy (pGDT) using flow monitoring has been associated with improved outcomes. However, its protocols are often based on stroke volume only: as a target for fluid loading, inotropic support and vasopresors (via mathematical coupling of systemic vascular resistance). In this trial, we have tested the multi- parametric pGDT protocol based on esophageal Doppler variables (corrected flow time, peak velocity) in intermediate-to-high risk patients undergoing gastrointestinal surgery...
May 11, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29743101/individualized-perioperative-hemodynamic-goal-directed-therapy-in-major-abdominal-surgery-ipegasus-trial-study-protocol-for-a-randomized-controlled-trial
#6
Sandra Funcke, Bernd Saugel, Christian Koch, Dagmar Schulte, Thomas Zajonz, Michael Sander, Angelo Gratarola, Lorenzo Ball, Paolo Pelosi, Savino Spadaro, Riccardo Ragazzi, Carlo Alberto Volta, Thomas Mencke, Amelie Zitzmann, Benedikt Neukirch, Gonzalo Azparren, Marta Giné, Vicky Moral, Hans Otto Pinnschmidt, Oscar Díaz-Cambronero, Maria Jose Alberola Estelles, Marisol Echeverri Velez, Maria Vila Montañes, Javier Belda, Marina Soro, Jaume Puig, Daniel Arnulf Reuter, Sebastian Alois Haas
BACKGROUND: Postoperative morbidity and mortality in patients undergoing surgery is high, especially in patients who are at risk of complications and undergoing major surgery. We hypothesize that perioperative, algorithm-driven, hemodynamic therapy based on individualized fluid status and cardiac output optimization is able to reduce mortality and postoperative moderate and severe complications as a major determinant of the patients' postoperative quality of life, as well as health care costs...
May 9, 2018: Trials
https://www.readbyqxmd.com/read/29736359/clinical-significance-of-candida-in-an-intraoperative-peritoneal-specimen-with-perforation-peritonitis-an-institutional-perspective
#7
Jagannath Pramod, Chellappa Vijayakumar, Krishnamachari Srinivasan, Nanda Kishore Maroju, Nagarajan Raj Kumar, Gopal Balasubramaniyan
Introduction Fungal infection of the peritoneum has become more common in recent years, the most common cause of which is Candida. Candida peritonitis is considered as a severe disease and is regarded as an independent risk factor for mortality in postoperative peritonitis. This study was planned to find out the clinical significance of Candida isolation on the outcome of the patients with peritonitis in terms of morbidity and mortality. Methods This prospective study included consecutive patients admitted and operated for secondary peritonitis over a two-year period in a tertiary care hospital in South India...
March 5, 2018: Curēus
https://www.readbyqxmd.com/read/29719906/totally-laparoscopic-versus-open-gastrectomy-for-gastric-cancer-a-matched-pair-analysis
#8
Kaja Ludwig, Sylke Schneider-Koriath, Uwe Scharlau, Holger Steffen, Daniela Möller, Jörn Bernhardt
BACKGROUND: Laparoscopic gastrectomy has been established for treatment of early gastric cancer (EGC) especially in Eastern Asian countries. Currently, it still needs evaluation for advanced gastric cancer (AGC, T ≥ 2). Difficulty is how far Asian study data are valid for western conditions. METHODS: Out of 502 patients who underwent gastric cancer surgery between 2003 and 2016 at Klinikum Suedstadt Rostock 90 patients were selected for a retrospective study to compare totally laparoscopic D2-gastrectomy (LG, n = 45) with open D2-gastrectomy (OG, n = 45)...
April 2018: Zentralblatt Für Chirurgie
https://www.readbyqxmd.com/read/29707319/perioperative-management-and-outcomes-of-minimally-invasive-esophagectomy-case-study-of-a-high-volume-tertiary-center-in-taiwan
#9
Tzu Chang, Po-Ni Hsiao, Man-Yin Tsai, Pei-Ming Huang, Ya-Jung Cheng
Background: Mortality and complication rates for surgical esophagectomy remain high despite progress in surgical techniques and perioperative care. Minimally invasive surgery and intraoperative goal-directed fluid management are gaining popularity in Taiwan; however, perioperative complications and short-term outcomes have been rarely reported. In this retrospective study, we analyzed the surgical procedures performed as well as the perioperative outcomes and treatments after esophagectomy in a high-volume medical center in Taiwan...
March 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29696105/cumulative-positive-fluid-balance-is-a-risk-factor-for-acute-kidney-injury-and-requirement-for-renal-replacement-therapy-after-liver-transplantation
#10
Liana Codes, Ygor Gomes de Souza, Ricardo Azevedo Cruz D'Oliveira, Jorge Luiz Andrade Bastos, Paulo Lisboa Bittencourt
AIM: To analyze whether fluid overload is an independent risk factor of adverse outcomes after liver transplantation (LT). METHODS: One hundred and twenty-one patients submitted to LT were retrospectively evaluated. Data regarding perioperative and postoperative variables previously associated with adverse outcomes after LT were reviewed. Cumulative fluid balance (FB) in the first 12 h and 4 d after surgery were compared with major adverse outcomes after LT. RESULTS: Most of the patients were submitted to a liberal approach of fluid administration with a mean cumulative FB over 5 L and 10 L, respectively, in the first 12 h and 4 d after LT...
April 24, 2018: World Journal of Transplantation
https://www.readbyqxmd.com/read/29688821/risk-of-postoperative-complications-in-patients-with-obstructive-sleep-apnea-following-skull-base-surgery
#11
Phillip Huyett, Ryan J Soose, Amy E Schell, Juan C Fernandez-Miranda, Paul A Gardner, Carl H Snyderman, Eric W Wang
Objectives Obstructive sleep apnea (OSA) presents several challenges in skull base surgery, including increased intracranial pressure, worsened OSA with nasal packing, and avoidance of positive airway pressure (PAP) therapy postoperatively. The objective of this study was to examine the risk of postoperative complications in a skull base population with OSA in which PAP therapy is withheld. Study Design Retrospective cohort study. Setting Tertiary care hospital. Subjects and Methods Medical records of 414 adult patients undergoing anterior skull base procedures between January 1, 2014, and January 7, 2017, were retrospectively reviewed...
April 1, 2018: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/29678619/effect-of-goal-directed-fluid-therapy-on-early-cognitive-function-in-elderly-patients-with-spinal-stenosis
#12
Na Zhang, Min Liang, Dan-Dan Zhang, Yi-Rong Xiao, Yan-Zhen Li, You-Guang Gao, Hong-da Cai, Xian-Zhong Lin, Cai-Zhu Lin, Kai Zeng, Xiao-Dan Wu
PURPOSE: To explore effect of goal-directed fluid therapy (GDFT) on early cognitive function in elderly patients with spinal stenosis. METHODS: 83 elderly patients with spinal stenosis were randomly classified into two groups: control group (n = 40) and GDFT group (n = 43). The Montreal Cognitive Assessment (MoCA) score, IL-6 and S100β levels, hemodynamic parameters, cerebral oxygen saturation (rSO2 ), arterial lactic acid values, output of surgery, operation time and cases of hypotension, intraoperative complications within 7 days were recorded for all patients...
April 17, 2018: International Journal of Surgery
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
#13
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/29642696/periprocedural-and-perioperatory-management-of-patients-with-tricuspid-valve-disease
#14
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
#15
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/29600670/-prospective-cases-control-study-on-arthroscopic-for-the-treatment-of-ischial-tuberosity-cyst
#16
Ying-Chun Zhu, Xue-Wen Jia, Zhe-Yang Wang, Cui Wang, Zhan-Ping Jin
OBJECTIVE: To compare technique and clinical effect of arthroscopic and conventional sectional therapy for the treatment of ischial tuberosity cyst. METHODS: From May 2014 and September 2016, 49 patients with symptomatic ischial tuberosity cyst were randomized divided into arthroscopic group and conventional section group by envelope method. There were 24 patients in arthroscopic group, including 16 males and 8 females aged from 42 to 81years old with an average age of (64...
March 25, 2018: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
https://www.readbyqxmd.com/read/29574429/placenta-accreta-complicated-with-peripartum-cardiomyopathy
#17
Yuditiya Purwosunu, Agrifa Hasiholan Haloho
A 33-year-old G2P1 was referred to our hospital due to placenta accreta. During perioperative preparations, the patient was diagnosed with having a peripartum cardiomyopathy. The patient underwent caesarean hysterectomy at 36 weeks with an associated 2 L blood loss. Haemodynamic maintenance and stabilisation during the operation were challenging, with the combinations of fluid therapy, blood transfusions as well as vasoactive, antifibrinolytic and haemostatic drug. Postoperatively, the patient was managed in the intensive care unit and was subsequently transferred to intermediate care after less than 24 hours' observation...
March 23, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29569172/a-retrospective-evaluation-of-the-perioperative-drug-use-and-comparison-of-its-cost-in-robotic-vs-open-surgery-for-endometrial-cancer
#18
Reshu Agarwal, Anupama Rajanbabu, U G Unnikrishnan
To compare the usage and cost of analgesics (opioid and non-opioids), antiemetics, and IV fluids and its associated costs in robotic vs open staging surgery for endometrial cancer (EC). This retrospective study was performed at a single academic institution from January 2014 to June 2017 in the department of Gynecology Oncology at Amrita Institute of Medical Science, Kerala, India. The study included women with biopsy confirmed clinically early stage endometrial cancer or atypical hyperplasia, who underwent robotic-assisted or open staging surgery...
March 22, 2018: Journal of Robotic Surgery
https://www.readbyqxmd.com/read/29539628/prenatal-abo-rhd-genotyping-a-new-paradigm-to-allow-for-fresh-whole-blood-for-cardiopulmonary-bypass-in-the-immediate-newborn-period
#19
Juliet Chhay Bishop, Karin Blakemore, Luca Vricella, Priya Sekar, Katelynn Sagaser, Jude Crino, Paul Ness, Benjamin K Kogutt, Joan Boyd, Susan Aucott, Angie C Jelin, Joanne Chiu, Eric Gehrie, Kristen Nelson McMillan
Compared to standard component therapy, fresh whole blood (FWB) offers potential benefits to neonates undergoing cardiopulmonary bypass (CPB) in the context of open cardiac surgery: decreased blood loss and subsequent risk of volume overload, improved coagulation status, higher platelet counts during and following CPB, circumvention of limited vascular access, and significantly reduced donor exposures. Obtaining FWB, however, entails 2-5 days of preparation, which often precludes its availability for neonates requiring CPB in the immediate newborn period...
March 14, 2018: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/29521264/application-of-eras-enhanced-recovery-after-surgery-and-laparoscopic-surgery-in-the-management-of-patients-with-bladder-cancer
#20
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
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