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https://www.readbyqxmd.com/read/27906721/preoperative-evaluation-and-preparation-of-the-morbidly-obese-patient
#1
Andreas B Böhmer, Frank Wappler
PURPOSE OF REVIEW: This review aims to familiarize with the most current findings regarding preoperative evaluation and preparation of morbidly obese patients prior to elective, noncardiac surgery. In the light of the increasing number of surgical patients being morbidly obese, the knowledge of evidence-based preoperative evaluation strategies is profound for a rational approach. RECENT FINDINGS: Preoperative evaluation should be carried out with sufficient time before the day of surgery to allow modification of the perioperative management...
November 30, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27906717/spectrum-of-postoperative-complications-in-pulmonary-hypertension-and-obesity-hypoventilation-syndrome
#2
Roop K Kaw
PURPOSE OF REVIEW: The purpose of this review is to identify chronic pulmonary conditions which may often not be recognized preoperatively especially before elective noncardiac surgery and which carry the highest risk of perioperative morbidity and mortality. RECENT FINDINGS: This review discusses some of the most recent studies that highlight the perioperative complications, and their prevention and management strategies. SUMMARY: Pulmonary hypertension is a well recognized risk factor for postoperative complications after cardiac surgery but the literature surrounding noncardiac surgery is sparse...
November 30, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27906705/arterial-pressure-variation-in-elective-noncardiac-surgery-identifying-reference-distributions-and-modifying-factors
#3
Michael R Mathis, Samuel A Schechtman, Milo C Engoren, Amy M Shanks, Aleda Thompson, Sachin Kheterpal, Kevin K Tremper
BACKGROUND: Assessment of need for intravascular volume resuscitation remains challenging for anesthesiologists. Dynamic waveform indices, including systolic and pulse pressure variation, are demonstrated as reliable measures of fluid responsiveness for mechanically ventilated patients. Despite widespread use, real-world reference distributions for systolic and pulse pressure variation values have not been established for euvolemic intraoperative patients. The authors sought to establish systolic and pulse pressure variation reference distributions and assess the impact of modifying factors...
December 1, 2016: Anesthesiology
https://www.readbyqxmd.com/read/27904839/noncardiac-thoracic-surgery-in-abidjan-from-1977-to-2015
#4
Yves Tanauh, Flavien Kendja, Hervé Yangni-Angate, Blaise Demine, Raphaël Ouédé, Maurice Kouacou
BACKGROUND: To report and analyze noncardiac thoracic operations performed at the Cardiology Institute of Abidjan (Institut de Cardiologie d'Abidjan) from 1977 to 2015. METHODS: This is a retrospective and descriptive study covering 39 years, from 1977 to 2015. This study period was divided into three periods of 13 years each: P1 from 1977 to 1989, P2 from 1990 to 2002 and P3 from 2003 to 2015. Medical records of 2014 operated patients were analyzed: 414 patients for P1, 464 patients for P2, 1,136 patients for P3...
October 2016: Cardiovascular Diagnosis and Therapy
https://www.readbyqxmd.com/read/27902826/association-of-a-frailty-screening-initiative-with-postoperative-survival-at-30-180-and-365-days
#5
Daniel E Hall, Shipra Arya, Kendra K Schmid, Mark A Carlson, Pierre Lavedan, Travis L Bailey, Georgia Purviance, Tammy Bockman, Thomas G Lynch, Jason M Johanning
Importance: As the US population ages, the number of operations performed on elderly patients will likely increase. Frailty predicts postoperative mortality and morbidity more than age alone, thus presenting opportunities to identify the highest-risk surgical patients and improve their outcomes. Objective: To examine the effect of the Frailty Screening Initiative (FSI) on mortality and complications by comparing the surgical outcomes of a cohort of surgical patients treated before and after implementation of the FSI...
November 30, 2016: JAMA Surgery
https://www.readbyqxmd.com/read/27892891/atorvastatin-for-high-risk-statin-na%C3%A3-ve-patients-undergoing-noncardiac-surgery-the-lowering-the-risk-of-operative-complications-using-atorvastatin-loading-dose-load-randomized-trial
#6
Otavio Berwanger, Pedro G M de Barros E Silva, Roberto Ramos Barbosa, Dalton Bertolim Precoma, Estêvão Lanna Figueiredo, Ludhmila Abrahão Hajjar, Cleber Dario Pinto Kruel, Carolina Alboim, Adail Paixão Almeida, Marianna Deway Andrade Dracoulakis, Hugo Vargas Filho, Maria José Carvalho Carmona, Lília Nigro Maia, João Bosco de Oliveira Filho, Jose Francisco Kerr Saraiva, Rafael M Soares, Lucas Damiani, Denise Paisani, Alessandra A Kodama, Beatriz Gonzales, Dimas T Ikeoka, Philip J Devereaux, Renato D Lopes
: Preliminary evidence suggests that statins may prevent major perioperative vascular complications. METHODS: We randomized 648 statin-naïve patients who were scheduled for noncardiac surgery and were at risk for a major vascular complication. Patients were randomized to a loading dose of atorvastatin or placebo (80 mg anytime within 18hours before surgery), followed by a maintenance dose of 40 mg (or placebo), started at least 12hours after the surgery, and then 40 mg/d (or placebo) for 7days...
November 9, 2016: American Heart Journal
https://www.readbyqxmd.com/read/27884107/association-between-changes-in-cerebral-grey-matter-volume-and-postoperative-cognitive-dysfunction-in-elderly-patients-study-protocol-for-a-prospective-observational-cohort-study
#7
Nicolai Goettel, Panagiota Mistridis, Manfred Berres, Julia Reinhardt, Christoph Stippich, Andreas U Monsch, Luzius A Steiner
BACKGROUND: Cognitive decline is frequently observed in elderly patients after major surgery. The pathophysiology of postoperative cognitive dysfunction (POCD) remains unclear. The aim of our investigation is to identify potential associations between brain volume change and POCD in elderly patients undergoing major surgery. METHODS: This is a prospective observational cohort study approved by the regional ethics board. We intend to compare specific brain volumes (hippocampus, lateral ventricle, total grey matter volume, regional cortical thickness) on magnetic resonance imaging and cognitive functions determined by a neuropsychological assessment battery in 70 study participants aged ≥65 years before and 3 and 12 months after major noncardiac surgery...
November 25, 2016: BMC Anesthesiology
https://www.readbyqxmd.com/read/27872408/active-expiration-and-the-measurement-of-central-venous-pressure
#8
Sheldon Magder, Karim Serri, Sara Verscheure, Renée Chauvin, Peter Goldberg
PURPOSE: To obtain a point prevalence estimate of alterations in central venous pressure (CVP) produced by active expiration in a consecutive series of intensive care patients. METHODS: We evaluated CVP tracings taken by the nurses at their morning shift change in a consecutive series of 60 cardiac surgery and 59 noncardiac surgery patients. We also assessed change in values due to the change in transducer level. Three physicians and a nurse instructor independently reviewed the tracings and determined whether there was evidence of forced expiration and whether it was type A, defined by decreasing CVP during expiration, or type B, defined by increasing CVP during expiration...
November 20, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27870741/relationship-between-preoperative-anemia-and-in-hospital-mortality-in-children-undergoing-noncardiac-surgery
#9
David Faraoni, James A DiNardo, Susan M Goobie
BACKGROUND: The relationship between preoperative anemia and in-hospital mortality has not been investigated in the pediatric surgical population. We hypothesized that children with preoperative anemia undergoing noncardiac surgery may have an increased risk of in-hospital mortality. METHODS: We identified all children between 1 and 18 years of age with a recorded preoperative hematocrit (HCT) in the 2012, 2013, and 2014 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) pediatric databases...
December 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27870734/incremental-value-of-preoperative-copeptin-for-predicting-myocardial-injury
#10
Eckhard Mauermann, Daniel Bolliger, Esther Seeberger, Christian Puelacher, Sydney Corbiere, Miodrag Filipovic, Manfred Seeberger, Christian Mueller, Giovanna Lurati Buse
BACKGROUND: Copeptin, a novel marker of endogenous stress, has shown diagnostic and prognostic value in nonsurgical patients with a suspected coronary event. We aimed to assess the incremental value of copeptin in addition to established preoperative risk indices to predict the occurrence of postoperative myocardial injury. METHODS: This secondary analysis of prospectively collected data included adults undergoing noncardiac surgery with risk factors for adverse perioperative cardiac events based on preoperative risk stratification...
December 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27865641/canadian-cardiovascular-society-guidelines-on-perioperative-cardiac-risk-assessment-and-management-for-patients-who-undergo-noncardiac-surgery
#11
Emmanuelle Duceppe, Joel Parlow, Paul MacDonald, Kristin Lyons, Michael McMullen, Sadeesh Srinathan, Michelle Graham, Vikas Tandon, Kim Styles, Amal Bessissow, Daniel I Sessler, Gregory Bryson, P J Devereaux
The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of evidence assessment for patients who undergo noncardiac surgery. Strong recommendations included: 1) measuring brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery to enhance perioperative cardiac risk estimation in patients who are 65 years of age or older, are 45-64 years of age with significant cardiovascular disease, or have a Revised Cardiac Risk Index score ≥ 1; 2) against performing preoperative resting echocardiography, coronary computed tomography angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging to enhance perioperative cardiac risk estimation; 3) against the initiation or continuation of acetylsalicylic acid for the prevention of perioperative cardiac events, except in patients with a recent coronary artery stent or who will undergo carotid endarterectomy; 4) against α2 agonist or β-blocker initiation within 24 hours before surgery; 5) withholding angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker starting 24 hours before surgery; 6) facilitating smoking cessation before surgery; 7) measuring daily troponin for 48 to 72 hours after surgery in patients with an elevated NT-proBNP/BNP measurement before surgery or if there is no NT-proBNP/BNP measurement before surgery, in those who have a Revised Cardiac Risk Index score ≥1, age 45-64 years with significant cardiovascular disease, or age 65 years or older; and 8) initiating of long-term acetylsalicylic acid and statin therapy in patients who suffer myocardial injury/infarction after surgery...
October 4, 2016: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/27849768/124-timed-resumption-of-beta-blockers-and-the-incidence-of-atrial-fibrillation-after-noncardiac-surgery
#12
Ashish Khanna, Daniel Sessler, Murtaza Diwan, Jing You, Amanda Naylor, Eric Reville, Quinton Riter, Douglas Naylor
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27816126/coexisting-cardiac-and-hematologic-disorders
#13
REVIEW
Jordan E Goldhammer, Benjamin A Kohl
Patients with concomitant cardiac and hematologic disorders presenting for noncardiac surgery are challenging. Anemic patients with cardiac disease should be approached in a methodical fashion. Transfusion triggers and target should be based on underlying symptomatology. The approach to anticoagulation management in patients with artificial heart valves, cardiac devices, or severe heart failure in the operative setting must encompass a complete understanding of the rationale of a patient's therapy as well as calculate the risk of changing this regimen...
December 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27805269/inactivity-and-its-associated-factors-in-adults-scheduled-for-noncardiac-surgery-the-pamp-phase-i-study
#14
Olga L Cortés, Karen Moreno, Paula Alvarado, Camilo Povea, Monique Lloyd, Rodolfo Dennis
PURPOSE: The aim of this study was to determine the prevalence of physical inactivity and its associated factors in adult patients admitted to hospital for noncardiac surgery. DESIGN: Cross-sectional study. METHODS: Five hundred able-bodied patients (age ≥45 years) admitted to hospital, also participants in the VISION study, were recruited before noncardiac surgery. The physical activity level (PAL) was assessed with the International Physical of Activity Questionnaire...
November 2, 2016: Rehabilitation Nursing: the Official Journal of the Association of Rehabilitation Nurses
https://www.readbyqxmd.com/read/27797892/sex-and-the-risk-of-aki-following-cardio-thoracic-surgery-a-meta-analysis
#15
Joel Neugarten, Sandipani Sandilya, Beenu Singh, Ladan Golestaneh
BACKGROUND AND OBJECTIVES: Being a woman is a well established risk factor for the development of cardiothoracic surgery-associated AKI. In striking contrast, women are less likely to develop AKI associated with noncardiac surgical procedures than men. In an attempt to ascertain why being a woman might be protective for ischemic AKI after general surgery but deleterious in patients undergoing cardiothoracic surgery, we examined cardiothoracic surgery-associated AKI in greater detail. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed a systematic review and meta-analysis of cardiothoracic surgery-associated AKI studies published between January of 1978 and December of 2015 to further explore the relationship between sex and cardiothoracic surgery-associated AKI...
October 20, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27793230/brazilian-consensus-on-perioperative-hemodynamic-therapy-goal-guided-in-patients-undergoing-noncardiac-surgery-fluid-management-strategy-produced-by-the-s%C3%A3-o-paulo-state-society-of-anesthesiology-sociedade-de-anestesiologia-do-estado-de-s%C3%A3-o-paulo-saesp
#16
Enis Donizetti Silva, Albert Carl Perrino, Alexandre Teruya, Bobbie Jean Sweitzer, Chiara Scaglioni Tessmer Gatto, Claudia Marquez Simões, Ederlon Alves Carvalho Rezende, Filomena Regina Barbosa Gomes Galas, Francisco Ricardo Lobo, João Manoel da Silva Junior, Leandro Ultino Taniguchi, Luciano Cesar Pontes de Azevedo, Ludhmila Abrahão Hajjar, Luiz Antônio Mondadori, Marcelo Gama de Abreu, Marcelo Vaz Perez, Regina El Dib, Paulo do Nascimento, Roseny Dos Reis Rodrigues, Suzana Margareth Lobo, Rogean Rodrigues Nunes, Murillo Santucci Cesar de Assunção
No abstract text is available yet for this article.
November 2016: Brazilian Journal of Anesthesiology
https://www.readbyqxmd.com/read/27792044/relationship-between-intraoperative-hypotension-defined-by-either-reduction-from-baseline-or-absolute-thresholds-and-acute-kidney-and-myocardial-injury-after-noncardiac-surgery-a-retrospective-cohort-analysis
#17
Vafi Salmasi, Kamal Maheshwari, Dongsheng Yang, Edward J Mascha, Asha Singh, Daniel I Sessler, Andrea Kurz
BACKGROUND: How best to characterize intraoperative hypotension remains unclear. Thus, the authors assessed the relationship between myocardial and kidney injury and intraoperative absolute (intraoperative mean arterial pressure [MAP]) and relative (reduction from preoperative pressure) MAP thresholds. METHODS: The authors characterized hypotension by the lowest MAP below various absolute and relative thresholds for cumulative 1, 3, 5, or 10 min and also time-weighted average below various absolute or relative MAP thresholds...
October 28, 2016: Anesthesiology
https://www.readbyqxmd.com/read/27775997/withholding-versus-continuing-angiotensin-converting-enzyme-inhibitors-or-angiotensin-ii-receptor-blockers-before-noncardiac-surgery-an-analysis-of-the-vascular-events-in-noncardiac-surgery-patients-cohort-evaluation-prospective-cohort
#18
Pavel S Roshanov, Bram Rochwerg, Ameen Patel, Omid Salehian, Emmanuelle Duceppe, Emilie P Belley-Côté, Gordon H Guyatt, Daniel I Sessler, Yannick Le Manach, Flavia K Borges, Vikas Tandon, Andrew Worster, Alexandra Thompson, Mithin Koshy, Breagh Devereaux, Frederick A Spencer, Robert D Sanders, Erin N Sloan, Erin E Morley, James Paul, Karen E Raymer, Zubin Punthakee, P J Devereaux
BACKGROUND: The effect on cardiovascular outcomes of withholding angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in chronic users before noncardiac surgery is unknown. METHODS: In this international prospective cohort study, the authors analyzed data from 14,687 patients (including 4,802 angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker users) at least 45 yr old who had in-patient noncardiac surgery from 2007 to 2011...
October 24, 2016: Anesthesiology
https://www.readbyqxmd.com/read/27775995/effectiveness-of-an-electronic-alert-for-hypotension-and-low-bispectral-index-on-90-day-postoperative-mortality-a-prospective-randomized-trial
#19
Patrick J McCormick, Matthew A Levin, Hung-Mo Lin, Daniel I Sessler, David L Reich
BACKGROUND: We tested the hypothesis that an electronic alert for a "double low" of mean arterial pressure less than 75 mmHg and a bispectral index less than 45 reduces the primary outcome of 90-day mortality. METHODS: Adults having noncardiac surgery were randomized to receive either intraoperative alerts for double-low events or no alerts. Anesthesiologists were not blinded and not required to alter care based upon the alerts. The primary outcome was all-cause 90-day mortality...
October 24, 2016: Anesthesiology
https://www.readbyqxmd.com/read/27755054/relationship-between-preoperative-evaluation-blood-pressure-and-preinduction-blood-pressure-a-cohort-study-in-patients-undergoing-general-anesthesia
#20
Wilton A van Klei, Judith A R van Waes, Wietze Pasma, Teus H Kappen, Leo van Wolfswinkel, Linda M Peelen, Cor J Kalkman
BACKGROUND: For outcomes research where changes in intraoperative blood pressure are a possible causative factor, it is important to determine an appropriate source for a reference value. We studied to what extent preinduction blood pressure values in the operating room differ from those obtained during preoperative evaluation outside the operating room. METHODS: Cohort study including 4408 patients aged 60 years or older undergoing noncardiac surgery. The outcome was the difference between the preinduction mean blood pressure (MBP) and the MBP obtained during preoperative evaluation...
October 11, 2016: Anesthesia and Analgesia
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