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Intensive care/postoperative care

Jae Young Kwack, Yong-Soon Kwon
OBJECTIVE: Although laparoscopic hysterectomy, a worldwide popular surgery, ensures faster recovery and less postoperative pain than with laparotomic hysterectomy, immediate pain control still improving postoperative care. We introduce an effective method, intraoperative injection of ropivacaine into both uterosacral ligaments, to control immediate postoperative pain. MATERIALS AND METHODS: We performed a prospective, double-blind, and randomized study. We analyzed 40 cases of laparoscopic vaginal hysterectomy performed between July 2015 and November 2016 by a single surgeon (Y...
October 2018: Taiwanese Journal of Obstetrics & Gynecology
Oh Tak Kyu, Eunjeong Ji, Soyeon Ahn, Dong Jung Kim, In-Ae Song
BACKGROUND: This study aimed to investigate the association between postoperative surgical Intensive Care Unit (ICU) admission during a time when there was intensivist coverage and 30-day mortality after ICU admission. METHODS: This was a retrospective observational study in a tertiary care academic hospital ICU, with daytime intensivist coverage. We collected the electronic medical records for all patients who were admitted to the postoperative ICU after undergoing a surgery between January 1, 2007 and December 31, 2016...
October 17, 2018: Anaesthesia, Critical Care & Pain Medicine
Vivien Berthoud, Omar Ellouze, Maxime Nguyen, Maria Konstantinou, Serge Aho, Ghislain Malapert, Claude Girard, Pierre-Gregoire Guinot, Olivier Bouchot, Belaid Bouhemad
BACKGROUND: Minimal invasive heart surgery (MIHS) presents several benefits, but provides intense and prolonged post-operative pain. Our objective was to compare efficacy of serratus anterior plane block (SAPB) with continuous wound infiltration (CWI) for management of post-operative pain following MIHS. METHODS: It's retrospective, monocentric study between November 2016 to April 2017. The study was performed at the University hospital of Dijon, Burgundy, France...
October 20, 2018: BMC Anesthesiology
B Chan, A Aneman
This aim of this prospective observational cohort study was to evaluate any association between postoperatively impaired cerebrovascular autoregulation and the onset of delirium following cardiac surgery. Previous studies have shown that impaired intra-operative cerebrovascular autoregulation during cardiopulmonary bypass is associated with delirium. However, postoperative changes in cerebrovascular autoregulation and its association with delirium have not been investigated. One-hundred and eight consecutive adult cardiac surgical patients without baseline cognitive dysfunction or aphasia were included in the study...
October 18, 2018: Anaesthesia
Darko Aleksa Golic, Dragan Svraka, Nataša Keleman, Snjezana Petrovic
Flail chest, often defined as the fracture of three or more ribs in two or more places, represents the most severe form of rib fractures. Conservative treatment, consisting of respiratory assistance with endotracheal intubation and mechanical ventilation (internal pneumatic stabilization) and pain control, are the current treatments of choice in the majority of patients with multiple rib fractures. However, the use of mechanical ventilation may create complications. In selected patients, operative fixation of fractured ribs within 72 h post injury may lead to better outcomes...
2018: Frontiers in Medicine
Jamie Mann-Farrar, Elizabeth Egan, Andrew Higgins, Leigh Wysocki, Amanda Vaux, Elise Arndell, Elizabeth A Burmeister
PURPOSE: To compare clinical outcomes of patients who required a prolonged length of stay in the postanesthesia care unit (PACU) with a control group. DESIGN: A single-center purposive-sampled retrospective medical record and database audit. METHODS: Patients with prolonged PACU stays were compared to a group of patients whose stay was less than median for outcome measures: rapid response team (RRT) activation, cardiac arrest, unanticipated intensive care unit admissions, and survival to discharge...
October 15, 2018: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
Mohammad S Diab, Rajdeep Bilkhu, Gopal Soppa, Mark Edsell, Nick Fletcher, Johan Heiberg, Colin Royse, Marjan Jahangiri
OBJECTIVE: To examine the influence of prolonged intensive care unit (ICU) stay on quality of life and recovery following cardiac surgery. METHODS: Quality of life was assessed using the Short Form 36 Health Survey (SF36). The Postoperative Quality of Recovery Scale was used to assess quality of recovery, disability, and cognition after ICU discharge over 12 months' follow-up. Prolonged ICU stay was defined as ≥3 postoperative days. Mortality and major adverse cardiac and cerebrovascular events were recorded up to 12 months...
November 2018: Journal of Thoracic and Cardiovascular Surgery
Viktor Szabó, András Büki, Tamás Dóczi, Attila Schwarcz
In spine surgery, minimally invasive approaches (MIS) are getting accepted and more popular worldwide during the last decades. It is due to the reduced intraoperative blood loss, decreased infection rate, less postoperative pain and earlier discharge from hospital compared to traditional approaches. The present paper puts forward a minimally invasive extrapleural approach to the thoracic spine that is not applied in Hungary. This new approach, in contrast to the standard costotransversectomy, provides direct visual control over the ventral surface of the dural sac...
September 30, 2018: Ideggyógyászati Szemle
Mohab M Sabry, Ayman A Sallam, Ahmed Said Elgebaly, Amr A Abdelwahab
Background: During decortication surgery, fibrous peel over the lung was removed to allow expansion of the lung and therefore, wide raw area was created with surface oozing. The phenomenon of fibrinolysis usually activated after such procedure, resulting in increasing the postoperative bleeding. Tranexamic acid is one of antifibrinolytic therapies that could be used topically and to targets directly the source of bleeding and reducing the local activation of the fibrinolytic process and consequently reducing the postoperative bleeding...
October 2018: Annals of Cardiac Anaesthesia
Brenda Nachiyunde, Louisa Lam
Cardiac surgery induces severe postoperative pain and impairment of pulmonary function, increases the length of stay (LOS) in hospital, and increases mortality and morbidity; therefore, evaluation of the evidence is needed to assess the comparative benefits of different techniques of pain management, to guide clinical practice, and to identify areas of further research. A systematic search of the Cochrane Central Register of Controlled Trials, DARE database, Joanna Briggs Institute, Google scholar, PUBMED, MEDLINE, EMBASE, Academic OneFile, SCOPUS, and Academic search premier was conducted retrieving 1875 articles...
October 2018: Annals of Cardiac Anaesthesia
Jason M Ali, Kate Wallwork, Narain Moorjani
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: Do patients who require return to theatre (RTT) for bleeding have inferior outcomes following cardiac surgery? Altogether, 598 papers were found using the reported search, of which 8 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated...
October 15, 2018: Interactive Cardiovascular and Thoracic Surgery
Mohamed Hichem Loghmari, Wafa Ben Mansour, Arwa Guediche, Wided Bouhlel, Mourad Gahbiche, Leila Safer
INTRODUCTION: Acute esophageal necrosis, also known as black esophagus, is a rare digestive complication, frequently manifested by an upper gastrointestinal hemorrhage and occurs in patients with comorbidities. AIM: To report the case of a patient with a black esophagus revealed by an upper gastrointestinal hemorrhage. OBSERVATION: A 72-year-old patient with a history of diabetes mellitus, hypertension and ischemic heart disease was hospitalized in surgical intensive care unit for hemorrhagic shock induced by cholecystectomy...
February 2018: La Tunisie Médicale
Xuting Li, Xuezhen Zhou, Juan Wei, Hongping Mo, Hongyu Lou, Ni Gong, Meifen Zhang
BACKGROUND: Postoperative hyperglycaemia has been shown to have adverse effects on patients after coronary artery bypass grafting surgery (CABG). However, whether glucose variability has an effect on patients' outcomes is still uncertain. The aim of this study is to explore the effects of glucose variability on short-term outcomes in non-diabetic patients undergoing coronary artery bypass grafting. METHODS: This is a retrospective observational study utilising data collected after patients had left the hospital...
September 7, 2018: Heart, Lung & Circulation
Mariano E Menendez, Sarah M Lawler, David Ring, Andrew Jawa
BACKGROUND: As reimbursement becomes increasingly tied to quality and patient experience, there is growing interest in alleviation of postoperative pain combined with optimal opioid stewardship. We characterized predictors of severe inpatient pain after elective total shoulder arthroplasty and evaluated its association with opioid use, operative time, hospital length of stay, discharge disposition, and cost. METHODS: We identified 415 patients undergoing elective primary total shoulder arthroplasty between 2016 and 2017 from our registry...
October 12, 2018: Journal of Shoulder and Elbow Surgery
Ahmet Bolukçu, Sami İlhan, Ahmet Can Topçu, Rafet Günay, İlyas Kayacıoğlu
OBJECTIVES: Postoperative dyspnea is common after cardiac surgery, even in low-risk patients. Cardiac surgeons and anesthesiologists are familiar with patients suffering from dyspnea in the early postoperative period, but in some cases, conventional treatment strategies may be ineffective, and a consultation with a pulmonologist may be required. The aim of this study is to investigate the causes of dyspnea after cardiac surgery in this particular patient group. MATERIALS AND METHODS: The hospital database was searched for non-emergency cardiac surgery for the period January 2014-October 2015...
September 13, 2018: Turkish Thoracic Journal
Néstor F Sandoval, Catalina Vargas Acevedo, Juan Bernardo Umaña, Ivonne Pineda, Albert Guerrero, Carlos Obando, Juan P Umaña, Jaime Camacho
BACKGROUND: The approach to coarctation of the aorta with hypoplastic aortic arch is controversial. We evaluated the outcomes in patients with coarctation of the aorta with or without hypoplastic aortic arch operated through a posterior left lateral thoracotomy. METHODS: A retrospective cohort of patients with aortic coarctation, who underwent repair between January 2009 and October 2017, was analyzed. Preoperative, postoperative, and echocardiographic characteristics were reviewed...
November 2018: World Journal for Pediatric & Congenital Heart Surgery
Arda Kucukguven, Mert Calis, Haluk Topaloglu, Figen Ozgur
Accompanying neurologic disorders directly affect psychosocial development of cleft lip and/or cleft palate (CLP) patients and make it difficult for their family to look after them properly. The aim of this study was to investigate the diversity and the incidence of additional neurologic malformations in children with CLP and to evaluate their effects on cleft care. All patients who applied to our Cleft and Craniofacial Center between July 2014 and July 2017 were included in the study. Demographic and perioperative data such as gender, cleft type, syndromic status of the patient, associated neurologic anomalies, timing and duration of operation, hospitalization period, and follow-up period in the intensive care unit are all recorded...
October 12, 2018: Journal of Craniofacial Surgery
Mehernoor F Watcha, Andrew D Lee, Eduardo Medellin, M Toni Felberg, Sudha A Bidani
BACKGROUND: Because nausea is difficult to evaluate in children, vomiting is used as the objective clinical end point in managing pediatric postoperative nausea and vomiting and postdischarge nausea and vomiting (PDNV). The recently developed pictorial Baxter Retching Faces (BARF) scale has content, construct, and convergent validity in quantifying pediatric nausea intensity. We determined its clinical usefulness in assessing pediatric postoperative nausea and vomiting and PDNV, establishing the lowest age associated with consistently reliable use, the score at which patients identify a need for therapy, and the minimum clinically relevant change in scores, and examined its test-retest reliability...
October 12, 2018: Anesthesia and Analgesia
Vicente Muedra, Lucrecia Moreno, Vicente Rodilla, Cristina Arce, Fermi Montó, Águeda Blázquez, Paloma Pérez, Pilar D'Ocón
Introduction: Decreased antithrombin (AT) activity in patients scheduled for cardiovascular surgery under cardiopulmonary bypass (CPB) is related to increased postoperative complications and hospitalization time. Indirect evidence suggests that glucocorticoids mitigate this decreased AT activity. To better understand the beneficial effects of AT we have analyzed: (i) the clinical relevance of acute dexamethasone (DX) administration before cardiac surgery on AT activity, (ii) the modulation by DX of AT expression in human endothelial cells (hECs), (iii) the activity of AT on migration and angiogenesis of hECs, or on angiogenesis of rat aorta...
2018: Frontiers in Pharmacology
Shaun R Yockelson, Stephen B Heitner, Sarah Click, Gemechu Geleto, Miriam M Treggiari, Michael P Hutchens
OBJECTIVE: An association between central venous pressure and acute kidney injury (AKI) has been observed following cardiac surgery, but it is unknown whether this reflects intravascular volume status or impaired right ventricular (RV) myocardial performance. This study was performed to test the hypothesis that decreased RV peak longitudinal strain (PLSS), as measured by 2-dimensional speckle-tracking echocardiography, is associated with AKI following cardiac surgery. DESIGN: Retrospective observational cohort study...
September 12, 2018: Journal of Cardiothoracic and Vascular Anesthesia
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