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Intensive care/postoperative care

C Vahldieck, M Lindig, C Nau, M Hüppe
BACKGROUND: The intensity of postoperative pain is characterized by large interindividual variability. Furthermore, strong postoperative pain is known to influence physical recovery after surgery. High (preoperative) pain expectation and pre-existing pain, which are associated with pain-related disability (impairing pain) are risk factors for strong postoperative pain. They can be determined with the Lübeck Pain Risk Questionnaire used for the first time in this study. The aim of this study was to explore the hypothesis that patients with a combination of the characteristics (1) preoperative impairing pain and (2) high pain expectation are more likely to have strong postoperative pain...
August 13, 2018: Der Anaesthesist
Frans van Workum, Annelijn E Slaman, Mark I van Berge Henegouwen, Suzanne S Gisbertz, Ewout A Kouwenhoven, Marc J van Det, Frits J H van den Wildenberg, Fatih Polat, Misha D P Luyer, Grard A P Nieuwenhuijzen, Camiel Rosman
INTRODUCTION: Totally minimally invasive esophagectomy (TMIE) is increasingly used in treatment of patients with esophageal carcinoma. However, it is currently unknown if McKeown TMIE or Ivor Lewis TMIE should be preferred for patients in whom both procedures are oncologically feasible. METHODS: The study was performed in 4 high-volume Dutch esophageal cancer centers between November 2009 and April 2017. Prospectively collected data from consecutive patients with esophageal cancer localized in the distal esophagus or gastroesophageal junction undergoing McKeown TMIE or Ivor Lewis TMIE were included...
August 10, 2018: Annals of Surgery
David L Penn, Kyle C Wu, Kayla R Presswood, Coleman P Riordan, R Michael Scott, Edward R Smith
Children with arteriovenous malformations (AVMs) are at cumulative, life-long risk of debilitating and fatal intracranial hemorrhage, especially with syndromes such as hereditary hemorrhagic telangiectasia. Cerebral angiography is the gold standard for diagnosis and allows simultaneous adjunctive embolization limiting radiation and contrast exposure and intraoperative blood loss, important in pediatric patients with low blood volume. Microsurgical resection of low-grade AVMs offers cure with minimal morbidity...
August 7, 2018: Operative Neurosurgery (Hagerstown, Md.)
Ian C Gibbs, Oluwole Fadahunsi, Natoya Reid, Andrea M Bonnick
Malignant hyperthermia is a rare condition that occurs in susceptible patients exposed to triggering anesthetic agents. It is associated with a high mortality rate if not recognized immediately and treated appropriately. A 52-year-old man presented to our clinic 2 days after an assault for management of jaw pain. A minimally displaced right parasymphyseal fracture and moderately displaced left body fracture of the mandible were diagnosed. There were no known drug allergies. The patient reported no previous difficulty with anesthesia, as well as no known prior adverse reactions to anesthesia in any relatives...
July 19, 2018: Journal of Oral and Maxillofacial Surgery
Benjamin Khechen, Brittany E Haws, Mundeep S Bawa, Dil V Patel, Kaitlyn L Cardinal, Jordan A Guntin, Simon P Lalehzarian, Kern Singh
STUDY DESIGN: Retrospective Cohort OBJECTIVE.: To determine if comorbidity as determined by Charlson Comorbidity Index (CCI) is associated with inpatient complication rate, length of stay (LOS), or direct hospital costs after minimally-invasive transforaminal lumbar interbody fusion (MIS-TLIF). SUMMARY OF BACKGROUND DATA: In the spine literature, comorbidity burden has been associated with an increased risk for complications, prolonged LOS, and greater hospital costs...
August 7, 2018: Spine
Sue Carol Verrillo, Maria Cvach, Krysia Warren Hudson, Bradford D Winters
BACKGROUND: Episodic vital sign collection (eVSC), as single data points, gives an incomplete picture of adult patients' postoperative physiologic status. LOCAL PROBLEM: Late detection of patient deterioration resulted in poor patient outcomes on a postsurgical unit. METHODS: Baseline demographic and outcome data were collected through retrospective chart review of all patients admitted to the surgical unit for 12 weeks prior to this quality improvement project...
August 7, 2018: Journal of Nursing Care Quality
Mahmoud Abdelaziz, Saib Khogali, James M Cotton, Antonella Meralgia, Maciej Matuszewski, Heyman Luckraz
Objective: Severe decompensated aortic valve stenosis is associated with noticeable reduction in survival. Until recently the options for such patients were either high-risk surgery or percutaneous balloon valvuloplasty and medical therapy which does not add any survival benefits and associated with high rate of complications. We present our experience in the use of transcatheter aortic valve implantation (TAVI) in patients with decompensated severe aortic stenosis requiring urgent intervention in the same hospital admission...
2018: Open Heart
Bao Zhao, Yuhua Ni, Xingsong Tian
BACKGROUND: Postoperative delirium (POD) commonly occurs in elderly patients after noncardiac surgery, resulting in increased morbidity and greater risk of death. However, its pathophysiology is currently unknown. Cholinergic dysfunction has been implicated in delirium pathophysiology, and low plasma cholinesterase activity has been reported as a risk marker of POD. Therefore, the aim of this study was to investigate the link between plasma cholinesterase activity and POD in elderly Han Chinese patients after noncardiac surgery...
July 8, 2018: Psychosomatics
A Desole, A Ferrari, F Tosato, D Milite
INTRODUCTION: The recent technological evolution has also allowed for the treatment of juxtarenal abdominal aortic aneurysms (JAA) with an endovascular technique but short and long-term results must be compared with the results of open treatment that is the gold standard. In this study we analyzed the short and long term results of open surgical treatment (OR) in patients with JAA in our series. METHODS: From January 2006 to December 2016, 155 patients were treated for JAA with open repair; the data were analyzed retrospectively...
August 6, 2018: Annals of Vascular Surgery
Kiyoshi Tamura, Toshiyuki Maruyama, Syogo Sakurai
OBJECTIVE: Suvorexant is an orexin receptor antagonist and is effective in inducing sleep. We hypothesized that Suvorexant would reduce the incidence of postoperative delirium (POD) after coronary artery bypass grafting (CABG). METHODS: We reviewed 88 patients (12 women, mean age: 69.3 ± 2.5 years) who were undergone CABG alone. Patients were divided into two groups; patients received Suvorexant (S group, n = 36), patients not received Suvorexant (N group, n = 52), and the following data were analyzed and compared between two groups...
August 9, 2018: Annals of Thoracic and Cardiovascular Surgery
Neha Kumta, Fiona Coyer, Michael David
OBJECTIVE: To identify variables during surgery that may contribute to the development of pressure ulcers (PUs) in postoperative, intensive care unit (ICU) patients within 72 hours of admission, as well as over their entire ICU admission. Furthermore, to investigate how these variables may impact on the number of PUs acquired. METHOD: In a three-year retrospective audit, from 1 January 2014 to 31 December 2016, data from the electronic medical records of 3484 postoperative ICU patients in a major Australian metropolitan public hospital were retrieved and analysed to investigate associations between perioperative variables and PU occurrence...
August 2, 2018: Journal of Wound Care
Pedro N M P Coelho, Luís M R P C Miranda, Pedro M P Barros, José I G Fragata
OBJECTIVES: Cardiac surgery has little effect on life expectancy in elderly patients. Thus, improving the quality of life should be the main factor affecting therapeutic decisions. Most studies on quality of life in elderly patients undergoing cardiac surgery report improvement but have limitations. Consequently, we assessed improvements in the quality of life of elderly patients undergoing elective cardiac surgery, identified influencing variables and established patterns of mental and physical health variations in the first year postoperatively...
July 31, 2018: Interactive Cardiovascular and Thoracic Surgery
Cristina Barbero, Simon Messer, Ayyaz Ali, David P Jenkins, John Dunning, Steven Tsui, Jasvir Parmar
OBJECTIVES: Donor organ utilization and shortage remain the major limitations to the opportunity of a lung transplantation (LTx). Donation after circulatory determined death (DCD) has been adopted as a source of additional organs worldwide. However, concerns about organ quality and ischaemia-reperfusion injury have limited its application. The aim of this study was to retrospectively analyse a single-centre experience in the DCD LTx and compare early and mid-term outcomes with those from a standard donation after brain death (DBD)...
August 1, 2018: European Journal of Cardio-thoracic Surgery
Yugo Okabe, Takehiko Asaga, Sayuri Bekku, Hiromi Suzuki, Kanae Kanda, Takeshi Yoda, Tomohiro Hirao, Gotaro Shirakami
Background: Extubation failure is associated with mortality and morbidity in the intensive care unit. Ventilator weaning protocols have been introduced, and extubation is conducted based on the results of a spontaneous breathing trial. Room for improvement still exists in extubation management, and additional objective indices may improve the safety of the weaning and extubation process. Static lung-thorax compliance reflects lung expansion difficulty that is caused by several conditions, such as atelectasis, fibrosis, and pleural effusion...
2018: Journal of Intensive Care
José López-Menéndez, Javier Miguelena, Carlos Morales, Francisco Callejo, Jacobo Silva
BACKGROUND: We analyzed the adequacy of the myocardial protection achieved with a single dose of retrograde crystalloid Celsior®, compared with an accepted standard (microplegia), in on-pump coronary artery bypass grafting surgery (CABG). METHODS: This was a retrospective comparative clinical study conducted in a single institution that included all the patients operated on who had elective isolated on-pump CABG, from March 2006 to June 2014. We evaluated maximum postoperative troponin T (TnT) as a marker of myocardial damage, adjusted for possible confounders using propensity score matching...
August 7, 2018: Therapeutic Advances in Cardiovascular Disease
Amer Harky, Jeffrey Shi Kai Chan, Chris Ho Ming Wong, Rafal Al Nasiri, Mohamad Bashir
OBJECTIVE: The purpose of this study was to determine whether thoracic endovascular aortic repair reduces death and morbidity compared with open surgical repair for descending thoracic aortic disease. METHODS: A comprehensive search was undertaken among the four major databases (PubMed, Embase, Scopus and Ovid) to identify all randomized and nonrandomized controlled trials comparing open versus endovascular repair in thoracic aortic aneurysm. Databases where evaluated and assessed to July 2017...
August 3, 2018: Annals of Vascular Surgery
Johan M Berghmans, Marten J Poley, Jan van der Ende, Francis Veyckemans, Stephanie Poels, Frank Weber, Bert Schmelzer, Dirk Himpe, Frank C Verhulst, Elisabeth Utens
BACKGROUND: Children undergoing adenotonsillectomy are at risk of severe postoperative pain and sleep problems. Little is known about the specific child risk factors for these problems. AIMS: The aim of this study was to assess the occurrence of postoperative pain, sleep problems, and medication adherence, and assess the influence of internalizing and externalizing problems on postoperative pain. METHODS: This prospective cohort study included 160 children, aged 1...
August 5, 2018: Paediatric Anaesthesia
O Moreno, A Ochagavía, A Artigas, C Espinal, R Tomás, M D Bosque, C Fortià, F Baigorri
BACKGROUND: Transthoracic echocardiography can significantly change the management of many critical patients, and is being incorporated into many Intensive Care Units (ICU). Very few studies have examined the feasibility and impact of intensivists performing basic transthoracic echocardiography upon the management of critical patients after cardiac surgery. The present study therefore evaluates the quality of acquisition and accuracy of intensivist interpretation of basic transthoracic echocardiograms in the postoperative period of heart surgery...
July 30, 2018: Medicina Intensiva
Brin Freund, John C Probasco, Eva K Ritzl
OBJECTIVE Delay in diagnosis and subsequent treatment of nonconvulsive seizures can lead to worsened outcomes. The gold standard in detecting nonconvulsive seizures is continuous video-electroencephalography (cEEG). Compared to routine, 30-minute EEG, the use of cEEG increases the likelihood of capturing intermittent nonconvulsive seizures. Studies of critically ill patients in intensive care units demonstrate a particularly high rate of nonconvulsive seizures. Some of these studies included postneurosurgical patients, but often subanalyses of specific populations were not done...
June 1, 2018: Journal of Neurosurgery
Taylor Chuich, Christopher Lewis Cropsey, Yaping Shi, Daniel Johnson, Matthew S Shotwell, Christopher Patrick Henson
BACKGROUND: Sedative agents used during cardiac surgery can influence the patient's time to extubation, intensive care unit (ICU) and hospital length of stay, and incidence of delirium. OBJECTIVE: This study evaluates the effects of the intraoperative and postoperative use of dexmedetomidine versus propofol infusions. METHODS: This 19-month retrospective observational study at an academic medical center included 278 patients 18 years of age or older who underwent coronary artery bypass grafting (CABG), valve replacement surgery, or combined CABG plus valve surgery, who received either a dexmedetomidine or propofol infusion in addition to general anesthesia intraoperatively...
August 1, 2018: Annals of Pharmacotherapy
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