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Perioperative evaluation in noncardiac surgery

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https://www.readbyqxmd.com/read/28469459/cardiac-evaluation-and-monitoring-of-patients-undergoing-noncardiac-surgery
#1
REVIEW
Arsalan Rafiq, Eduard Sklyar, Jonathan N Bella
Surgical management of disease has a tremendous impact on our health system. Millions of people worldwide undergo surgeries every year. Cardiovascular complications in the perioperative period are one of the most common events leading to increased morbidity and mortality. Although such events are very small in number, they are associated with a high mortality rate making it essential for physicians to understand the importance of perioperative cardiovascular risk assessment and evaluation. Its involves a detailed process of history taking, patient's medical profile, medications being used, functional status of the patient, and knowledge about the surgical procedure and its inherent risks...
2017: Health Services Insights
https://www.readbyqxmd.com/read/28431420/generative-retrieval-improves-learning-and-retention-of-cardiac-anatomy-using-transesophageal-echocardiography
#2
Amanda M Kleiman, Katherine T Forkin, Allison J Bechtel, Stephen R Collins, Jennie Z Ma, Edward C Nemergut, Julie L Huffmyer
BACKGROUND: Transesophageal echocardiography (TEE) is a valuable monitor for patients undergoing cardiac and noncardiac surgery as it allows for evaluation of cardiovascular compromise in the perioperative period. It is challenging for anesthesiology residents and medical students to learn to use and interpret TEE in the clinical environment. A critical component of learning to use and interpret TEE is a strong grasp of normal cardiovascular ultrasound anatomy. METHODS: Fifteen fourth-year medical students and 15 post-graduate year (PGY) 1 and 2 anesthesiology residents without prior training in cardiac anesthesia or TEE viewed normal cardiovascular anatomy TEE video clips; participants were randomized to learning cardiac anatomy in generative retrieval (GR) and standard practice (SP) groups...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28366317/morbidity-and-mortality-in-elective-total-hip-arthroplasty-following-surgical-care-improvement-project-guidelines
#3
Thomas B Bemenderfer, Nigel L Rozario, Charity G Moore, Madhav A Karunakar
BACKGROUND: Following evidence questioning the safety and efficacy of perioperative beta-blocker therapy in noncardiac surgery, the Surgical Care Improvement Project (SCIP) guidelines were retired in 2015. However, perioperative myocardial infarctions and cardiac complications remain leading causes of mortality following noncardiac surgery. The impact of the SCIP guidelines on reducing cardiac complications in patients undergoing elective total hip arthroplasty (THA) has not been evaluated...
March 9, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28243856/predictors-of-intraoperative-testing-in-adults-undergoing-noncardiac-surgery-within-a-regional-hospital-system
#4
Jessica Spence, Michael Troncone, Steven Long, Velina Tzankova, Susan Tran, Joshua Peachey, Yannick LeManach, James Paul
BACKGROUND: The use of intraoperative testing is central to anesthesia practice, and point-of-care testing (POCT) is often used. Nevertheless, POCT is costly and its contribution to patient outcome is unknown. There is a lack of guidelines to describe which patients should undergo intraoperative testing or how results should be applied. As such, we undertook a historical cohort study evaluating intraoperative testing practices within our region where POCT is not used. METHODS: In 2012, we obtained a random sample of 1,000 adult patients undergoing noncardiac surgery in three of our health system hospitals...
February 27, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28239802/anesthetic-management-of-patients-with-dilated-cardiomyopathy-for-noncardiac-surgery
#5
C-Q Chen, X Wang, J Zhang, S-M Zhu
Anesthetic management of patients with dilated cardiomyopathy (DCM) is a challenge to the anesthesiologist, due to poor left systolic function, ventricular enlargement, risk of malignant arrhythmias and sudden cardiac death. Therefore, preoperative assessment and appropriate anesthetic management are important in patients with DCM. This review describes the preoperative evaluation and anesthesia considerations of patients with DCM undergoing non-cardiac surgery. Patient pathophysiology and clinical status, such as ventricular function, degree of myocardial fibrosis, resting heart rate and high-sensitivity C-reactive protein can affect survival rates...
February 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28211198/safety-of-antifibrinolytics-in-cranial-vault-reconstructive-surgery-a-report-from-the-pediatric-craniofacial-collaborative-group
#6
Susan M Goobie, Franklyn P Cladis, Chris D Glover, Henry Huang, Srijaya K Reddy, Allison M Fernandez, David Zurakowski, Paul A Stricker
BACKGROUND: Antifibrinolytic therapy significantly decreases blood loss and transfusion in pediatric cranial vault reconstructive surgery; however, concern regarding the side effects profile limits clinical use. AIMS: The aim was to utilize the Pediatric Craniofacial Surgery Perioperative Registry database to identify the safety profile of antifibrinolytic therapy for cranial vault reconstructive surgery by reporting the incidence of adverse events as they relate to exposure to tranexamic acid and aminocaproic acid compared to no exposure to antifibrinolytics...
March 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28197046/outcome-of-noncardiac-surgical-patients-admitted-to-a-multidisciplinary-intensive-care-unit
#7
Pradeep Kumar, M K Renuka, M S Kalaiselvan, A S Arunkumar
CONTEXT: Surgical procedures carry significant morbidity and mortality depending on the type of surgery and patients. There is a dearth of evidence from India on the outcome of surgical patients admitted to an Intensive Care Unit (ICU). AIMS: We aimed to describe the incidence and risk factors of postoperative complications and mortality in noncardiac surgical patients admitted to the ICU. SETTINGS AND DESIGN: This was a prospective observational study on all perioperative patients admitted to a multidisciplinary ICU for 18 months...
January 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28072601/risk-factors-and-clinical-outcomes-associated-with-perioperative-transfusion-associated-circulatory-overload
#8
Leanne Clifford, Qing Jia, Arun Subramanian, Hemang Yadav, Darrell R Schroeder, Daryl J Kor
BACKGROUND: Transfusion-associated circulatory overload remains underappreciated in the perioperative environment. The authors aimed to characterize risk factors for perioperative transfusion-associated circulatory overload and better understand its impact on patient-important outcomes. METHODS: In this case-control study, 163 adults undergoing noncardiac surgery who developed perioperative transfusion-associated circulatory overload were matched with 726 transfused controls who did not develop respiratory complications...
March 2017: Anesthesiology
https://www.readbyqxmd.com/read/28030663/perioperative-major-adverse-cardiovascular-and-cerebrovascular-events-associated-with-noncardiac-surgery
#9
Nathaniel R Smilowitz, Navdeep Gupta, Harish Ramakrishna, Yu Guo, Jeffrey S Berger, Sripal Bangalore
Importance: Major adverse cardiovascular and cerebrovascular events (MACCE) are a significant source of perioperative morbidity and mortality following noncardiac surgery. Objective: To evaluate national trends in perioperative cardiovascular outcomes and mortality after major noncardiac surgery and to identify surgical subtypes associated with cardiovascular events using a large administrative database of United States hospital admissions. Design, Setting, Participants: Patients who underwent major noncardiac surgery from January 2004 to December 2013 were identified using the National Inpatient Sample...
February 1, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/27992624/association-of-perioperative-statin-use-with-mortality-and-morbidity-after-major-noncardiac-surgery
#10
Martin J London, Gregory G Schwartz, Kwan Hur, William G Henderson
Importance: The efficacy of statins in reducing perioperative cardiovascular and other organ system complications in patients undergoing noncardiac surgery remains controversial. Owing to a paucity of randomized clinical trials, analyses of large databases may facilitate informed hypothesis generation and more efficient trial design. Objective: To evaluate associations of early perioperative statin use with outcomes in a national cohort of veterans undergoing noncardiac surgery...
February 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/27906721/preoperative-evaluation-and-preparation-of-the-morbidly-obese-patient
#11
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...
February 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27906717/spectrum-of-postoperative-complications-in-pulmonary-hypertension-and-obesity-hypoventilation-syndrome
#12
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...
February 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27865641/canadian-cardiovascular-society-guidelines-on-perioperative-cardiac-risk-assessment-and-management-for-patients-who-undergo-noncardiac-surgery
#13
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...
January 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/27755054/relationship-between-preoperative-evaluation-blood-pressure-and-preinduction-blood-pressure-a-cohort-study-in-patients-undergoing-general-anesthesia
#14
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...
February 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27737442/association-of-clinical-risk-factors-and-postoperative-complications-with-unplanned-hospital-readmission-after-head-and-neck-cancer-surgery
#15
Andrés M Bur, Jason A Brant, Carolyn L Mulvey, Elizabeth A Nicolli, Robert M Brody, John P Fischer, Steven B Cannady, Jason G Newman
Importance: Unplanned hospital readmission is costly and in recent years has become a focus of health care legislation intended to reduce health care expenditures. Greater understanding of which perioperative complications are associated with hospital readmission after surgery for head and neck cancer is needed to reduce unplanned readmissions. Objective: To determine which clinical risk factors and complications are associated with 30-day unplanned readmission after surgery for malignant neoplasms of the head and neck...
December 1, 2016: JAMA Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/27627817/perioperative-aspirin-for-prevention-of-venous-thromboembolism-the-perioperative-ischemia-evaluation-2-trial-and-a-pooled-analysis-of-the-randomized-trials
#16
John W Eikelboom, Clive Kearon, Gordon Guyatt, Daniel I Sessler, Salim Yusuf, Deborah Cook, James Douketis, Ameen Patel, Andrea Kurz, Rene Allard, Philip M Jones, Rodolfo J Dennis, Thomas W Painter, Sergio D Bergese, Kate Leslie, Duminda N Wijeysundera, Kumar Balasubramanian, Emmanuelle Duceppe, Scott Miller, Johan Diedericks, P J Devereaux
BACKGROUND: The PeriOperative ISchemia Evaluation-2 (POISE-2) trial compared aspirin with placebo after noncardiac surgery. METHODS: The authors randomly assigned 10,010 patients undergoing noncardiac surgery to receive 200 mg aspirin or placebo 2 to 4 h before surgery and then 100 mg aspirin daily or placebo daily for up to 30 days after surgery. Herein, the authors report the effect of aspirin on venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, as well as an updated pooled analysis of randomized trials of antiplatelet therapy for VTE prevention in noncardiac surgery patients...
December 2016: Anesthesiology
https://www.readbyqxmd.com/read/27607474/baseline-pulse-pressure-acute-kidney-injury-and-mortality-after-noncardiac-surgery
#17
Adriana D Oprea, Frederick W Lombard, Wen-Wei Liu, William D White, Jörn A Karhausen, Yi-Ju Li, Timothy E Miller, Solomon Aronson, Tong J Gan, Manuel L Fontes, Miklos D Kertai
BACKGROUND: Increased pulse pressure (PP) is an important independent predictor of cardiovascular outcome and acute kidney injury (AKI) after cardiac surgery. The objective of this study was to determine whether elevated baseline PP is associated with postoperative AKI and 30-day mortality after noncardiac surgery. METHODS: We evaluated 9125 adult patients who underwent noncardiac surgery at Duke University Medical Center between January 2006 and December 2009. Baseline arterial blood pressure was defined as the mean of the first 5 measurements recorded by the automated record keeping system before inducing anesthesia...
December 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27549425/guidelines-in-review-comparison-of-the-2014-acc-aha-guidelines-on-perioperative-cardiovascular-evaluation-and-management-of-patients-undergoing-noncardiac-surgery-and-the-2014-esc-esa-guidelines-on-noncardiac-surgery-%C3%A2-cardiovascular%C3%A2-assessment-and-management
#19
EDITORIAL
Alejandro Velasco, Eliana Reyes, Fadi G Hage
No abstract text is available yet for this article.
February 2017: Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology
https://www.readbyqxmd.com/read/27537762/clonidine-does-not-reduce-pain-or-opioid-consumption-after-noncardiac-surgery
#20
Alparslan Turan, Rovnat Babazade, Andrea Kurz, Phillip J Devereaux, Nicole M Zimmerman, Matthew T Hutcherson, Amanda J Naylor, Wael Ali Sakr Esa, Joel Parlow, Ian Gilron, Hooman Honar, Vafi Salmasi, Daniel I Sessler
BACKGROUND: Clonidine is an α2-adrenoceptor agonist, which has analgesic properties. However, the analgesic efficacy of perioperative clonidine remains unclear. We, therefore, tested the hypothesis that clonidine reduces both pain scores and cumulative opioid consumption during the initial 72 hours after noncardiac surgery. METHODS: Six hundred twenty-four patients undergoing elective noncardiac surgery under general and spinal anesthesia were included in this substudy of the PeriOperative ISchemia Evaluation-2 trial...
September 2016: Anesthesia and Analgesia
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