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Perioperative volume management

Navid Alem, Joseph Rinehart, Brian Lee, Doug Merrill, Safa Sobhanie, Kyle Ahn, Ran Schwarzkopf, Maxime Cannesson, Zeev Kain
BACKGROUND: Efforts to mitigate costs while improving surgical care quality have received much scrutiny. This includes the challenging issue of readmission subsequent to hospital discharge. Initiatives attempting to preclude readmission after surgery require planned and unified efforts extending throughout the perioperative continuum. Patient optimization prior to discharge, enhanced disease monitoring, and seamless coordination of care between hospitals and community providers is integral to this process...
2016: Perioperative Medicine
David Altschul, Andrew Kobets, Jonathan Nakhla, Ajit Jada, Rani Nasser, Merritt D Kinon, Reza Yassari, John Houten
OBJECTIVE Postoperative urinary retention (POUR) is a common problem leading to morbidity and an increased hospital stay. There are limited data regarding its baseline incidence in patients undergoing spinal surgery and the risk factors with which it may be associated. The purpose of this study was to evaluate the incidence of POUR in elective spine surgery patients and determine the factors associated with its occurrence. METHODS The authors retrospectively reviewed the records of patients who had undergone elective spine surgery and had been prospectively monitored for POUR during an 18-month period...
October 21, 2016: Journal of Neurosurgery. Spine
Sanna L Lahtinen, Janne H Liisanantti, Meri M Poukkanen, Päivi A Laurila
BACKGROUND: Goal-directed fluid management using stroke volume variation (SVV) analysis is not well studied in free flap reconstruction surgery in patients with head and neck cancer. METHODS: Patients operated due to cancer of the head and neck with free flap reconstruction during 2008-2010 and 2012-2014 in Oulu University Hospital were retrospectively evaluated to determine the impact of SVV-guided fluid management on perioperative fluid balance, postoperative complications and hospital length of stay (LOS)...
October 19, 2016: Minerva Anestesiologica
C Raspé, L Flöther, R Schneider, M Bucher, P Piso
Due to the significantly improved outcome and quality of life of patients with different tumor entities after cytoreductive surgery (CRS) and HIPEC, there is an increasing number of centers performing CRS and HIPEC procedures. As this procedure is technically challenging with potential high morbidity and mortality, respectively, institutional experience also in the anesthetic and intensive care departments is essential for optimal treatment and prevention of adverse events. Clinical pathways have to be developed to achieve also good results in more comorbid patients with border line indications and extensive surgical procedures...
September 28, 2016: European Journal of Surgical Oncology
Anthony M Roche, Michael Fm James
PURPOSE OF REVIEW: Fluid management remains a controversial subject in perioperative medicine and organ transplantation. Various case series, anecdotes and tradition guide many fluid choices, especially when good evidence is lacking. Recent advances in the understanding of pharmacokinetic and pharmodynamic profiles of fluids, as well as transplantation physiology and pathophysiology, can guide us in new approaches to common problems. RECENT FINDINGS: This review is intended to describe some of the latest thinking on subjects like saline-induced hyperchloraemic metabolic acidosis, the use of goal-directed approaches to volume resuscitation in perioperative medicine, the relative lack of evidence for low central venous pressure techniques in liver transplantation, some of the drug effects of intravenous fluids, as well as the complex issue of different crystalloids and colloids in renal transplantation...
June 2007: Current Opinion in Organ Transplantation
Betty Jo Rocchio
The reimbursement structure of the US health care system is shifting from a volume-based system to a value-based system. Adopting a comprehensive data analytics platform has become important to health care facilities, in part to navigate this shift. Hospitals generate plenty of data, but actionable analytics are necessary to help personnel interpret and apply data to improve practice. Perioperative services is an important revenue-generating department for hospitals, and each perioperative service line requires a tailored approach to be successful in managing outcomes and controlling costs...
October 2016: AORN Journal
Takashi Kido, Hiroyuki Nishi, Koichi Toda, Takayoshi Ueno, Toru Kuratani, Masayuki Sakaki, Toshiki Takahashi, Yoshiki Sawa
OBJECTIVE: To identify the predictive factors for responders to tolvaptan, a novel vasopressin type 2 receptor antagonist for fluid management after cardiovascular surgery. METHODS: Between January 2013 and May 2014, 113 patients were treated with tolvaptan for fluid management after cardiovascular surgery. As indicators for the effects of tolvaptan, change in bodyweight during the tolvaptan administration period and correlations with perioperative factors were assessed...
September 19, 2016: General Thoracic and Cardiovascular Surgery
David Ae Imber, Massimiliano Pirrone, Changsheng Zhang, Daniel F Fisher, Robert M Kacmarek, Lorenzo Berra
With a rising incidence of obesity in the United States, anesthesiologists are faced with a larger volume of obese patients coming to the operating room as well as obese patients with ever-larger body mass indices (BMIs). While there are many cardiovascular and endocrine issues that clinicians must take into account when caring for the obese patient, one of the most prominent concerns of the anesthesiologist in the perioperative setting should be the status of the lung. Because the pathophysiology of reduced lung volumes in the obese patient differs from that of the ARDS patient, the best approach to keeping the obese patient's lung open and adequately ventilated during mechanical ventilation is unique...
September 13, 2016: Respiratory Care
P Sargos, E Stoeckle, B Henriques de Figueiredo, M Antoine, M Delannes, A Mervoyer, G Kantor
The management of retroperitoneal sarcoma can be very challenging, and the quality of initial treatment strategy appears to be a crucial prognostic factor. En bloc surgery is currently the standard of care for these rare tumours and perioperative treatments such as chemotherapy or radiotherapy have not been validated yet. However, local-regional relapse constitutes the most common disease course. While adjuvant radiotherapy is less and less common due to gastrointestinal toxicities, preoperative radiation therapy offers numerous advantages and is being evaluated as part of a national multicentre phase II study (TOMOREP trial) and is the subject of a European randomized phase III study (STRASS trial)...
October 2016: Cancer Radiothérapie: Journal de la Société Française de Radiothérapie Oncologique
Mitsutomo Yamada, Hiroyuki Nishi, Naosumi Sekiya, Kohei Horikawa, Toshiki Takahashi, Yoshiki Sawa
PURPOSE: The perioperative management of chronic kidney disease (CKD) patients undergoing open-heart surgery is challenging. In this study, we evaluated the effects of tolvaptan in CKD patients after open-heart surgery. METHODS: Between 2010 to 2015, 731 patients underwent open-heart surgery in our hospital. We consecutively selected 71 patients with stage IIIa-IV CKD and divided them into two groups. Those who received tolvaptan postoperatively were defined as the "Tolvaptan group" (n = 25) and those who did not were defined as the "Non-tolvaptan group" (n = 46)...
August 23, 2016: Surgery Today
Katherine Taylor, Wooheon Thomas Kim, Malak Maharramova, Victor Figueroa, Smruthi Ramesh, Armando Lorenzo
INTRODUCTION: Smaller children are presenting for renal transplantation as the treatment of choice for end-stage renal disease. Adult donor organs are more successful than pediatric deceased donor organs. An adult kidney may sequester ~75% of the circulating volume of a 5 year-old child and requires significantly increased cardiac output to maintain renal perfusion. Treatment includes volume, inotropic or vasopressor agents, or central neuroaxial blockade for sympatholysis. We describe the perioperative anesthestic management as a guide to clinical outcomes...
October 2016: Paediatric Anaesthesia
B Duncan X Lascelles, Lesley C Rausch-Derra, Jessica A Wofford, Margie Huebner
BACKGROUND: Local anesthetics are an important component of perioperative pain management, but the duration of action of available products is limited. We hypothesized that a single local infiltration of a novel bupivacaine liposome injectable suspension (AT-003) would provide clinically effective analgesia over a 72-h period. In a masked, randomized, placebo-controlled, multi-center pilot field study, dogs undergoing lateral retinacular suture placement for cranial cruciate insufficiency were randomly assigned to surgical site infiltration with AT-003 (5...
2016: BMC Veterinary Research
Teiji Sawa, Mao Kinoshita, Atsushi Kainuma, Koichi Akiyama, Yoshifumi Naito, Hideya Kato, Fumimasa Amaya, Keiji Shigemi
Arterial pulse waveform analysis (APWA) with a semi-invasive cardiac output monitoring device is popular in perioperative hemodynamic and fluid management. However, in APWA, evaluation of hemodynamic data is not well discussed. In this study, we analyzed how we visually interpret hemodynamic data, including stroke volume variation (SVV) and stroke volume (SV) derived from APWA. We performed arithmetic estimation of the SVV-SV relationship and applied measured values to this estimation. We then collected measured values in six anesthesia cases, including three liver transplantations and three other types of surgeries, to apply them to this SVV-SVI (stroke volume variation index) plot...
August 4, 2016: Journal of Clinical Monitoring and Computing
David Martin, Didier Roulin, Yamaguchi Takamune, Nicolas Demartines, Nermin Halkic
The number of major hepatectomy performed for the treatment of primary or secondary liver cancer has increased over the past two decades. By definition, a major hepatectomy includes the resection of at least three liversegments. Advances in anesthesiology, surgical and radiological techniques and perioperative management allowed a broad patient selection with increased security. Every case must be discussed in multidisciplinary tumor board, and preoperative assessment should include biological, volumetric and functional hepatic parameters...
June 15, 2016: Revue Médicale Suisse
(no author information available yet)
<strong>Objective </strong>To identify the characteristics of anesthesia and perioperative management for ankylosing spondylitis (AS) patients undergoing total hip arthroplasty (THA). <strong>Methods </strong>Totally 63 patients scheduled for single THA in PUMC Hospital from January 1st 2013 to June 1st 2015 were included in this retrospective analysis,among whom 21 patients were diagnosed of AS. The perioperative clinical data included:demographic data,American Society of Anesthesiologists (ASA) classification,medical history,airway assessment,preoperative laboratory examinations,electrocardiogram,pulmonary function tests,intubation information,operation time,intraoperative intake and output volume,postoperative hospital stay,and postoperative complications...
June 10, 2016: Zhongguo Yi Xue Ke Xue Yuan Xue Bao. Acta Academiae Medicinae Sinicae
Shebl E Salem, Chris J Proudman, Debra C Archer
BACKGROUND: Perioperative lidocaine treatment is commonly used in horses that undergo surgical treatment of colic, to prevent or treat postoperative ileus and reduce the effects of intestinal ischaemia-reperfusion injury. However, its clinical efficacy has not been evaluated in a large population of horses undergoing small intestinal surgery. The aim of the current study was to evaluate whether systemic lidocaine administration reduced the prevalence, volume and duration of postoperative reflux and improved rates of survival following surgical treatment of small intestinal lesions...
2016: BMC Veterinary Research
Huseyin Konur, Gulay Erdogan Kayhan, Huseyin Ilksen Toprak, Nizamettin Bucak, Mustafa Said Aydogan, Saim Yologlu, Mahmut Durmus, Sezai Yılmaz
Fluid management is challenging and still remains controversial in orthotopic liver transplantation (OLT). The pleth variability index (PVI) has been shown to be a reliable predictor of fluid responsiveness of perioperative and critically ill patients; however, it has not been evaluated in OLT. This study was designed to examine whether the PVI can reliably predict fluid responsiveness in OLT and to compare PVI with other hemodynamic indexes that are measured using the PiCCO2 monitoring system. Twenty-five patients were enrolled in this study...
July 2016: Kaohsiung Journal of Medical Sciences
Akira Iyoda, Satoru Ebihara
In chest surgery, minimal invasiveness is an important topic. Video-assisted thoracic surgery and a less radical resection may be effective for decreasing postoperative complications or postoperative mortality rates. Respiratory rehabilitation is useful for preventing postoperative complications, and it is used pre- and postoperatively for patients with lung cancer and chronic obstructive pulmonary disease (COPD) in most hospitals. Although it is well adapted to patients with a lower forced expiratory volume in 1 second, higher stages of COPD, severe emphysematous changes on computed tomography, and performance status ≥2, there are no definitive criteria for rehabilitation...
July 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Thomas Kratz, Christina Simon, Volker Fendrich, Ralph Schneider, Hinnerk Wulf, Caroline Kratz, Turgay Efe, Karl F Schüttler, Martin Zoremba
BACKGROUND: Goal directed fluid management in major abdominal surgery has shown to reduce perioperative complications. The approach aims to optimize the intravascular fluid volume by use of minimally invasive devices which calculate flow-directed variables such as stroke volume (SV) and stroke volume variation (SVV). OBJECTIVE: We aimed to show the feasibility of routinely implementing this type of hemodynamic monitoring during pancreatic surgery, and to evaluate its effects in terms of perioperative fluid management and postoperative outcomes...
July 8, 2016: Technology and Health Care: Official Journal of the European Society for Engineering and Medicine
D M Manas, J Figueras, D Azoulay, J C Garcia Valdecasas, J French, E Dixon, N O'Rourke, N Grovale, V Mazzaferro
BACKGROUND: Reduction of perioperative blood loss and intraoperative transfusion are two major factors associated with improving outcomes in liver surgery. There is currently no consensus as to the best technique to achieve this. METHODS: An international Panel of Experts (EP), made up of hepatobiliary surgeons from well-known high-volume centres was assembled to share their experience with regard to the management of blood loss during liver resection surgery. The process included: a review of the current literature by the panel, a face-to-face meeting and an on-line survey completed by the EP prior to and following the face-to-face meeting, based on predetermined case scenarios...
October 2016: European Journal of Surgical Oncology
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