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Postoperative care of cardiac surgery patient

Emily R W Davidson, Katherine Woodburn, Mariam AlHilli, Cecile A Ferrando
INTRODUCTION AND HYPOTHESIS: This study's objectives were to compare the incidence of adverse events after concurrent urogynecologic and gynecologic oncology surgery to gynecologic oncology surgery alone and to describe the frequency of modification in planned urogynecologic procedures. The authors hypothesized there would be no difference in major complications. METHODS: This was a retrospective matched cohort study of women who underwent concurrent surgery at a large tertiary care center between January 2004 and June 2017...
October 2, 2018: International Urogynecology Journal
Karam Nam, Yoon Sang Park, Won Ho Kim
BACKGROUND: The elevated preoperative ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e') as an echocardiographic index of left ventricular filling pressure is known to be associated with poor postoperative outcomes. We investigated the association between pre- and postoperative E/e' elevation and clinical outcomes after cardiac surgery. METHODS: 1353 patients who underwent cardiac surgery were divided into four groups (pre- and postoperative E/e' ≤15 [low-low], preoperative E/e' ≤15 but postoperative E/e' >15 [low-high], preoperative E/e' >15 but postoperative E/e' ≤15 [high-low], and pre- and postoperative E/e' >15 [high-high])...
September 28, 2018: Annals of Thoracic Surgery
E T D Souwer, E Bastiaannet, S de Bruijn, A J Breugom, F van den Bos, J E A Portielje, J W T Dekker
BACKGROUND: We implemented a multidisciplinary pre- and rehabilitation program for elderly patients (≥75 years of age) in a single center consisting of prehabilitation, laparoscopic surgery and early rehabilitation with the intention to lower 1-year overall mortality. METHODS: In this study we compared all patients that underwent elective surgery for stage I-III colorectal cancer before and during development and after implementation of the program (2010-2011, 2012-2013 and 2014-2015)...
September 8, 2018: European Journal of Surgical Oncology
Mustafa Serkan Durdu, Mehmet Cakici, Fatih Gumus, Gunseli Cubukcuoglu Deniz, Sinem Civriz Bozdag, Evren Ozcinar, Nur Dikmen Yaman, Osman Ilhan, Kemalettin Ucanok
OBJECTIVE: Apheresis is performed for treatment of numerous diseases by removing auto-antibodies, antigen-antibody complexes, allo-antibodies, paraproteins, non-Ig proteins, toxins, exogenous poisons. In current study, we present our experience of using therapeutic plasma exchange (TPE) in patients with different types of clinical scenarios. METHODS: Between January 2013 and May 2016, we retrospectively presented the results of 64 patients in whom postoperative TPE was performed in ICU setting after cardiac surgery...
September 18, 2018: Transfusion and Apheresis Science
Michael A Fierro, Eric I Ehieli, Mary Cooter, Austin Traylor, Mark Stafford-Smith, Madhav Swaminathan
OBJECTIVES: Acute kidney injury (AKI) is a common complication of cardiac surgery, and early detection is difficult. This study was performed to determine the sensitivity, specificity, positive predictive value, negative predictive value, and statistical performance of renal angina (RA) as an early predictor of AKI in an adult cardiac surgical patient population. DESIGN: Retrospective, nonrandomized, observational study. SETTING: A single, university-affiliated, quaternary medical center...
August 11, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Thomas Langer, Alessandro Santini, Francesco Zadek, Manuela Chiodi, Paola Pugni, Valentina Cordolcini, Barbara Bonanomi, Francesca Rosini, Maura Marcucci, Franco Valenza, Cristina Marenghi, Silvia Inglese, Antonio Pesenti, Luciano Gattinoni
STUDY OBJECTIVE: To assess the effect of different intraoperative blood pressure targets on the development of POCD and test the feasibility of a larger trial. DESIGN: Randomized controlled pilot trial. SETTING: Perioperative care in a tertiary care teaching hospital with outpatient follow-up. PATIENTS: One hundred one patients aged ≥75 years with ASA physical status <4, undergoing elective, non-cardiac surgery under general anesthesia and 33 age-matched healthy controls...
September 19, 2018: Journal of Clinical Anesthesia
Katarzyna Kotfis, Marta Strzelbicka, Małgorzata Zegan-Barańska, Krzysztof Safranow, Mirosław Brykczyński, Maciej Żukowski, Eugene Wesley Ely
Patients after cardiac surgery experience significant pain, but cannot communicate effectively due to opioid analgesia and sedation. Identification of pain with validated behavioral observation tool in patients with limited abilities to self-report pain improves quality of care and prevents suffering. Aim of this study was to validate Polish version of behavioral pain scale (BPS) in intubated, mechanically ventilated patients sedated with dexmedetomidine and morphine after cardiac surgery.Prospective observational cohort study included postoperative cardiac surgery patients, both sedated with dexmedetomidine and unsedated, observed at rest, during a nociceptive procedure (position change) and 10 minutes after intervention...
September 2018: Medicine (Baltimore)
Paul J Chestovich, Christopher F McNicoll, Douglas R Fraser, Purvi P Patel, Deborah A Kuhls, Esmeralda Clark, John J Fildes
Background: Penetrating cardiac injuries (PCIs) are highly lethal, and a sternotomy is considered mandatory for suspected PCI. Recent literature suggests pericardial window (PCW) may be sufficient for superficial cardiac injuries to drain hemopericardium and assess for continued bleeding and instability. This study objective is to review patients with PCI managed with sternotomy and PCW and compare outcomes. Methods: All patients with penetrating chest trauma from 2000 to 2016 requiring PCW or sternotomy were reviewed...
2018: Trauma surgery & acute care open
Jamie Furlong-Dillard, Alaina Neary, Jennifer Marietta, Courtney Jones, Grace Jeffers, Lindsey Gakenheimer, Michael Puchalski, Aaron Eckauser, Claudia Delgado-Corcoran
Introduction: Feeding difficulties and malnutrition are important challenges when caring for newborns with critical congenital heart disease (CCHD) without clear available guidelines for providers. This study describes the utilization of a feeding protocol with the focus on standardization, feeding modality, and total parenteral nutrition (TPN) utilization postoperatively. Methods: Patients included neonates with CCHD undergoing complex biventricular repair using cardiopulmonary bypass...
May 2018: Pediatric quality & safety
Stephanie A Bodily, Claudia Delgado-Corcoran, Katherine Wolpert, Kathryn Lucas, Angela P Presson, Susan L Bratton
Introduction: Frequent blood testing increases risk of iatrogenic anemia, infection, and blood transfusion. This study describes 3 years of sustained blood testing reduction from a quality improvement (QI) initiative which began in 2011. Methods: The cohort consisted of postop children whose surgery had a Risk Adjustment for Congenital Heart Surgery (RACHS) classification consecutively admitted to a tertiary Cardiac Intensive Care Unit. Data were collected for a 2010 preintervention, 2011 intervention, and 2012-13 postintervention periods, tabulating common laboratory studies per patient (labs/pt) and adjusted for length of stay (labs/pt/d)...
November 2017: Pediatric Quality & Safety
Nathan Belkin, Benjamin M Jackson, Paul J Foley, Scott M Damrauer, Venkat Kalapatapu, Michael A Golden, Ronald M Fairman, Rachel R Kelz, Grace J Wang
BACKGROUND: Length of stay (LOS) is a commonly used metric to optimize value in medical care. While pathways have been developed for some procedures in vascular surgery to reduce length of stay (LOS), they do not yet exist for TEVAR. The purpose of this study is to identify and define the risk factors for prolonged LOS in patients undergoing TEVAR to facilitate pathway development. METHODS: We included TEVAR patients in the National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005-2015...
September 11, 2018: Annals of Vascular Surgery
Tim Montrief, Alex Koyfman, Brit Long
INTRODUCTION: Coronary artery bypass graft (CABG) surgery remains a high-risk procedure, and many patients require emergency department (ED) management for complications after surgery. OBJECTIVE: This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of post-CABG surgery complications. DISCUSSION: While there has been a recent decline in all cardiac revascularization procedures, there remains over 200,000 CABG surgeries performed in the United States annually, with up to 14% of these patients presenting to the ED within 30 days of discharge with post-operative complications...
September 8, 2018: American Journal of Emergency Medicine
Sjoerd de Hoogd, Abraham J Valkenburg, Eric P A van Dongen, Edgar J Daeter, Joost van Rosmalen, Albert Dahan, Dick Tibboel, Catherijne A J Knibbe
BACKGROUND: The clinical relevance of the suggested hyperalgesic effects of remifentanil is still unclear, especially in the long term. OBJECTIVE: The current study evaluated the impact of remifentanil on thermal thresholds 3 days and 12 months after surgery, measured with Quantitative Sensory Testing. DESIGN: A prospective, single-blind, randomised controlled trial. SETTING: A tertiary care teaching hospital in The Netherlands, from 2014 to 2016...
September 11, 2018: European Journal of Anaesthesiology
Max Lacour, Claudio Caviezel, Walter Weder, Didier Schneiter
The aim of lung volume reduction surgery (LVRS) for patients suffering from severe emphysema is to improve lung function and palliate dyspnea. Careful patient selection in a multidisciplinary approach in a high-volume center is mandatory for a successful outcome. Pulmonary complications including air leak and pneumonia as well as cardiac complications are the most common complications after LVRS. The following article will focus on most common complications observed after LVRS and review the management strategies to improve surgical outcome...
August 2018: Journal of Thoracic Disease
Christoph Raspé, Maximilian Besch, Efstratios I Charitos, Lilit Flöther, Michael Bucher, Florian Rückert, Hendrik Treede
We aimed to detect alterations and deficits in hemostasis during cardiac surgery with cardiopulmonary bypass (CPB) using point-of-care-supported coagulation analysis (rotational thromboelastometry, impedance aggregometry), in addition to single factor assays for the measurement of fibrinogen (FI) and factor XIII (FXIII) levels. Forty-one patients scheduled for elective cardiac surgery with CPB were enrolled in this observational study. Perioperative measurement (pre-, postheparin, 30-minutes before the end of bypass, 1-hourpostoperatively) of standard laboratory variables, additional rotational thromboelastometry (ROTEM; International GmbH, Munich, Germany), Multiplate analysis (Roche, Switzerland), and an assay of FXIII activity were performed as well as the collection of epidemiological data and blood loss...
September 9, 2018: Clinical and Applied Thrombosis/hemostasis
Marek Zubrzycki, Andreas Liebold, Christian Skrabal, Helmut Reinelt, Mechthild Ziegler, Ewelina Perdas, Maria Zubrzycka
Analysis of the problem of surgical pain is important in view of the fact that the success of surgical treatment depends largely on proper pain management during the first few days after a cardiosurgical procedure. Postoperative pain is due to intraoperative damage to tissue. It is acute pain of high intensity proportional to the type of procedure. The pain is most intense during the first 24 hours following the surgery and decreases on subsequent days. Its intensity is higher in younger subjects than elderly and obese patients, and preoperative anxiety is also a factor that increases postoperative pain...
2018: Journal of Pain Research
Mathew P Doyle, Praveen Indraratna, Daniel T Tardo, Sheen Cs Peeceeyen, Gregory E Peoples
Background Aerobic exercise is a critical component of cardiac rehabilitation following cardiac surgery. Aerobic exercise is traditionally commenced 2-6 weeks following hospital discharge and most commonly includes stationary cycling or treadmill walking. The initiation of aerobic exercise within this early postoperative period not only introduces the benefits associated with aerobic activity sooner, but also ameliorates the negative effects of immobilization associated with the early postoperative period. Methods A systematic review identified all studies reporting safety and efficacy outcomes of aerobic exercise commenced within two weeks of cardiac surgery...
September 6, 2018: European Journal of Preventive Cardiology
Kárla M F S M Pereira, Caroline S de Assis, Haulcionne N W L Cintra, Renata Eloah L Ferretti-Rebustini, Vilanice A A Püschel, Eduesley Santana-Santos, Adriano Rogério B Rodrigues, Larissa B de Oliveira
AIMS AND OBJECTIVES: To identify factors associated with the increased bleeding in patients during the postoperative period after cardiac surgery. BACKGROUND: Bleeding is among the most frequent complications that occur in the postoperative period after cardiac surgery, representing one of the major factors in morbidity and mortality. Understanding the factors associated with the increased bleeding may allow nurses to anticipate and prioritise care, thus reducing the mortality associated with this complication...
September 5, 2018: Journal of Clinical Nursing
Syed Saleem Mujtaba, Stephen Clark
INTRODUCTION: Carcinoid heart disease most frequently involves the tricuspid or, more rarely, the pulmonary valve and presents with right heart failure as 5-HT is metabolized by the lung. Left-sided valve involvement is quite rare. We describe our experience of 3 patients presenting with heart failure secondary to carcinoid heart disease affecting all four cardiac valves. There are only four previous isolated case reports in the literature. METHODS: All three patients underwent quadruple valve replacement during a single operation...
July 2018: Brazilian Journal of Cardiovascular Surgery
Emad Mohamed Hijazi, Hayel Edwan, Nabil Al-Zoubi, Hadi Radaideh
OBJECTIVE: The aim of this study was to evaluate the incidence of postoperative nausea and vomiting (PONV) after fast-track cardiac anesthesia (FTCA) in the first 24-48 hours in the cardiac intensive care unit (CICU) after open-heart surgery, risk factors for PONV and its influence on CICU length of stay. METHODS: A prospective observational study from January 1, 2013 to the end of December 2015 was performed in the CICU of a university hospital in the north of Jordan and Queen Alia Heart Institute, Amman, Jordan...
July 2018: Brazilian Journal of Cardiovascular Surgery
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