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https://www.readbyqxmd.com/read/28743150/-anesthesiology-and-outcome-impact-of-the-perioperative-process
#1
Jörg Zieger, Helene A Häberle
In recent years, the role of the anesthesiologist has turned tremendously from the "anaesthesia doctor" into a perioperative physician and risk specialist. Patients are older, multimorbid, and are called up for more and more extensive surgery and interventions. Socioeconomic aspects have grown in importance. The anesthesiologist, paving the way for a good outcome, is involved in nearly all perioperative processes: preoperative evaluation, definition and optimization of preoperative and intraoperative conditions, management of modern intraoperative anesthesia as well as postoperative medically indicated, effective and efficient treatment of partially highly complex patients...
July 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/28743148/-impact-of-cardiac-anaesthesia-on-patient-outcome
#2
Martina Nowak-Machen
The perioperative management of complex patients in a highly technical and subspecialized environment is the domain of the cardiac anesthesiologist. Evidence suggests that hemodynamic management using goal directed hemodynamic therapy (GDHT) improves patient outcome. Organ protection remains a main concern during cardiac surgery using extracorporeal circulation. Mortality can be decreased when remote ischemic preconditioning techniques (RIPC) are being used. Neurological outcomes can be improved with near-infrared-spectometry (NIRS), volatile anesthetics increase myocardial protection through preconditioning and perioperative echocardiography increases overall patient survival...
July 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/28742770/role-of-the-perioperative-surgical-home-in-optimizing-the-perioperative-use-of-opioids
#3
Thomas R Vetter, Zeev N Kain
Several federal agencies have recently noted that the United States is in the midst of an unprecedented "opioid epidemic," with an increasing number of opioid-related overdoses and deaths. Providers currently face 3 population-level, public health challenges in providing optimal perioperative pain care: (1) the continued lack of overall improvement in the excessive incidence of inadequately treated postoperative pain, (2) minimizing or preventing postoperative opioid-related side effects, and (3) addressing current opioid prescribing patterns, and the accompanying problematic surge in prescription opioid diversion, misuse, abuse, addiction, and overdose...
July 24, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28742014/results-and-limitations-of-outpatient-and-overnight-stay-laminectomies-for-lumbar-spinal-stenosis
#4
David Yen, Abdu Albargi
BACKGROUND: At our centre, laminectomies have been traditionally performed as inpatient surgery. A gradual change in practice occurred between 2010 and 2013 to try to do these procedures as outpatient or overnight stay surgery. METHODS: We conducted a retrospective cohort study of consecutive patients having laminectomies over 2 18-month periods: before the change in practice and after full implementation of the outpatient/overnight stay protocol. We collected information on patient characteristics (age, sex, American Society of Anesthesiologists [ASA] classification, home address, number of laminectomy levels, estimated blood loss) and patient outcome (complications, hospital length of stay, 30-day readmissions)...
August 1, 2017: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/28741365/in-response-to-the-letter-by-cabadas-r-and-%C3%A3-lvarez-escudero-j-about-the-editorial-will-societies-of-anesthesiologists-partake-in-the-take-off-of-non-anesthesiologist-administration-of-propofol
#5
Jean-Marc Dumonceau
I thank R. Cabadas and J. Álvarez-Escudero (1). 1. Apologies accepted. 2. The statistical significance of the difference in proportions seems doubtful. 3. Although these small studies do not allow us to confirm the safety of endoscopist-directed propofol sedation, they deserve a short comment as they represent the best available level of evidence (RCTs) and are also informative. 4. Hypoxemia, hypotension and bradycardia are frequent and have no clinical consequences in most cases. 5. The authors started this chapter by stating "scientific opinions must be carefully based" (3); 6...
July 25, 2017: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/28741196/how-safe-is-performing-cholecystectomy-in-the-oldest-old-a-15-year-retrospective-study-from-a-single-institution
#6
Matteo Novello, Davide Gori, Salomone Di Saverio, Matteo Bianchin, Lorenzo Maestri, Francesco Vito Mandarino, Giuseppe Cavallari, Bruno Nardo
BACKGROUND: Globally, the number of people aged 80 years or over, the "oldest old," is the fastest growing population group. Because of the strong association between age and gallstone disease, both prevalence and incidence of this disease are increasing. The feasibility of the cholecystectomy in octogenarians has been evaluated in several studies that confirmed the safety of the operation. However, the safety of this procedure in nonagenarians is still controversial. The aim of this study was to evaluate the safety of cholecystectomies in nonagenarians and identify related predictors for postoperative hospital length of stay (LOS) and in-hospital mortality up to 30 days postoperatively...
July 24, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28739067/the-unique-role-of-the-pediatric-clinical-research-nurse-in-anesthesia-an-interdisciplinary-collaboration
#7
Christine Dube, Vanessa Young, Michelle Anderson, Brenda Barton, Izabela Leahy
This article describes the distinctive function of the pediatric clinical research nurse (CRN) in the anesthesia setting. The pediatric CRN in anesthesia acts as a liaison between families and the research team and is the major nexus between the principal investigator or anesthesiologist on a study, and the collaborating surgeons from many different departments. This is unique because the CRNs collaborate with physicians in specialties that can include plastics, urology, neurosurgery, orthopaedics, otolaryngology, cardiology, critical care, and many other departments...
August 2017: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/28735639/free-flap-reconstruction-for-patients-aged-85-years-and-over-with-head-and-neck-cancer-clinical-considerations-for-comprehensive-care
#8
X F Chen, Y M Chen, S Gokavarapu, Q C Shen, T Ji
We aimed to identify and evaluate the clinical challenges involved in microvascular flap reconstructions of defects caused by resection of head and neck cancer among patients aged 85 and over. We designed a retrospective study of patients who were treated in the head and neck department of a tertiary referral centre from 2005 to 2015, and all patients aged 85 years and over who had reconstructions with microvascular flaps for head and neck cancer were entered into the study. A total of 24 patients fulfilled the criteria, of whom 15 were men and nine were women...
July 20, 2017: British Journal of Oral & Maxillofacial Surgery
https://www.readbyqxmd.com/read/28734531/event-based-control-of-depth-of-hypnosis-in-anesthesia
#9
Luca Merigo, Manuel Beschi, Fabrizio Padula, Nicola Latronico, Massimiliano Paltenghi, Antonio Visioli
BACKGROUND AND OBJECTIVE: In this paper, we propose the use of an event-based control strategy for the closed-loop control of the depth of hypnosis in anesthesia by using propofol administration and the bispectral index as a controlled variable. METHODS: A new event generator with high noise-filtering properties is employed in addition to a PIDPlus controller. The tuning of the parameters is performed off-line by using genetic algorithms by considering a given data set of patients...
August 2017: Computer Methods and Programs in Biomedicine
https://www.readbyqxmd.com/read/28733534/low-dose-of-dexmedetomidine-as-an-adjuvant-to-bupivacaine-in-cesarean-surgery-provides-better-intraoperative-somato-visceral-sensory-block-characteristcs-and-postoperative-analgesia
#10
Yong-Hong Bi, Xiao-Guang Cui, Rui-Qin Zhang, Chun-Yu Song, Yan-Zhuo Zhang
OBJECT: In this study, we aimed to investigate the beneficial effects of dexmedetomidine on somato-visceral sensory block characteristcs, postoperative analgesia and stress response of intrathecal bupivacaine administration in women undergoing cesarean section, and to find out which dose is better. METHODS: Sixty parturients with the American Society of Anesthesiologists (ASA) physical status I or II were anesthetized with intrathecal bupivacaine(10mg) alone or in combination with dexmedetomidine (3 μg and 5 μg) to undergo cesarean section...
June 29, 2017: Oncotarget
https://www.readbyqxmd.com/read/28732458/use-of-a-complete-autologous-blood-recovery-system-the-sorin-xtra%C3%A2-autotransfusion-system-during-mechanical-thrombectomy-of-extensive-cerebral-venous-sinus-thrombosis
#11
C Castaño, C Cubells, S Remollo, M R García-Sort, M Terceño
Background The endovascular therapy for cerebral venous sinus thrombosis (CVST) is currently accepted as a second-line treatment for patients who have failed or those in whom systemic anticoagulation is contraindicated or in a subgroup of patients presenting with rapid neurologic deterioration. A number of different mechanical and pharmacologic endovascular strategies have been reported, either as separate or combined approaches. These new catheters and aspiration systems have a high power and vacuum capacity, which carries a risk of anemization of the patient and hypovolemic shock, being necessitating the transfusion of the patient...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28731975/the-consensus-bundle-on-hypertension-in-pregnancy-and-the-anesthesiologist-doing-all-the-right-things-for-all-the-patients-all-of-the-time
#12
Mihaela Podovei, Brian T Bateman
No abstract text is available yet for this article.
August 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28728322/perioperative-hypertension-management-during-facelift-under-local-anesthesia-with-intravenous-hypnotics
#13
Ki Ho Chung, Myeong Soo Cho, Hoon Jin
Perioperative hypertension is a phenomenon in which a surgical patient's blood pressure temporarily increases throughout the preoperative and postoperative periods and remains high until the patient's condition stabilizes. This phenomenon requires immediate treatment not only because it is observed in a majority of patients who are not diagnosed with high blood pressure, but also because occurs in patients with underlying essential hypertension who show a sharp increase in their blood pressure. The most common complication following facelift surgery is hematoma, and the most critical risk factor that causes hematoma is elevated systolic blood pressure...
July 2017: Archives of Plastic Surgery
https://www.readbyqxmd.com/read/28726137/long-and-short-term-outcomes-of-laparoscopic-gastrectomy-versus-open-gastrectomy-in-patients-with-clinically-and-pathological-locally-advanced-gastric-cancer-a-propensity-score-matching-analysis
#14
Mikito Inokuchi, Masatoshi Nakagawa, Toshiro Tanioka, Keisuke Okuno, Kentaro Gokita, Kazuyuki Kojima
BACKGROUND: Laparoscopic (laparoscopy-assisted) gastrectomy (LG) has several short-term benefits as compared with open distal gastrectomy (OG) in patients with advanced gastric cancer (AGC). Survival rates did not differ significantly between LG and OG in retrospective studies of AGC, although some studies included unmatched groups of patients or patients with AGC who had a preoperative diagnosis of early gastric cancer. The aim of present study was to compare the short- and long-term outcomes of patients with AGC who underwent LG with those of patients with AGC who underwent OG using a propensity-score matching analysis...
July 19, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28725247/novel-anesthetic-technique-for-combined-intracavitary-and-interstitial-brachytherapy-for-cervix-cancer-in-an-outpatient-setting
#15
Yiat Horng Leong, Kenneth Hock Soon Tan, Bok Ai Choo, Vicky Yaling Koh, Johann I-Hsiung Tang
PURPOSE: To determine the feasibility and safety of outpatient combined intracavitary and interstitial brachytherapy for cervix cancer with sedation and local anesthesia. MATERIAL AND METHODS: We included patients diagnosed with non-metastatic cervix cancer and have completed brachytherapy between December 2015 and December 2016. Moderate to deep sedation was achieved using intravenous midazolam, propofol, fentanyl, and oxycodone. Local anesthesia was achieved with 2% lignocaine gel and a paracervical block containing a mixture of 1% ropivacaine, 2% lignocaine, and 1 : 1,000 adrenaline...
June 2017: Journal of Contemporary Brachytherapy
https://www.readbyqxmd.com/read/28723752/full-covered-self-expandable-metal-stents-for-the-treatment-of-anastomotic-leak-using-a-silk-thread
#16
Cheol Woong Choi, Dae Hwan Kang, Hyung Wook Kim, Su Bum Park, Su Jin Kim, Sun Hwi Hwang, Si Hak Lee
To evaluate the safety and effectiveness of fixation of the fully covered self-expandable metal stent (SEMS) placement using a silk thread for complete closure of an anastomotic leak. An anastomotic leak is a life-threatening complication after gastrectomy. Although the traditional treatment of choice was surgical re-intervention, an endoscopic SEMS can be used alternatively.During the study period, we retrospectively reviewed consecutive patients who received a modified covered SEMS capable of being fixed using a silk thread (Shim technique) due to an anastomotic leak after gastrectomy to prevent stent migration...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28721120/effective-learning-environments-the-process-of-creating-and-maintaining-an-online-continuing-education-tool
#17
Sharon Davies, Gianni Roberto Lorello, Kristi Downey, Zeev Friedman
Continuing medical education (CME) is an indispensable part of maintaining physicians' competency. Since attending conferences requires clinical absenteeism and is not universally available, online learning has become popular. The purpose of this study is to conduct a retrospective analysis examining the creation process of an anesthesia website for adherence to the published guidelines and, in turn, provide an illustration of developing accredited online CME. Using Kern's guide to curriculum development, our website analysis confirmed each of the six steps was met...
2017: Advances in Medical Education and Practice
https://www.readbyqxmd.com/read/28719887/anesthetic-management-of-cytoreductive-surgery-and-hyperthermic-intraperitoneal-chemotherapy-crs-hipec-the-importance-of-hydro-electrolytic-and-acid-basic-control
#18
Fabrício Tavares Mendonça, Marília Moreira Guimarães, Sérgio Honorato de Matos, Rúbia Garcia Dusi
JUSTIFICATION AND OBJECTIVES: Patients affected by gynecological or gastrointestinal tract neoplasms that evolve to peritoneal carcinomatosis experience a significant drop in their quality of life, high morbidity and short survival times with currently available chemotherapeutic schemes. The surgical treatment based on cytoreduction and the employment of hyperthermic intraperitoneal chemotherapy in the intra-operative period is a true challenge to anesthesiologist. CASE REPORT: A 67 years old patient diagnosed with mucinous adenocarcinoma of the Appendix associated with mucinous carcinomatosis, was submitted to cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), under general anesthesia and epidural block...
July 10, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28719527/pupillometry-guided-intraoperative-remifentanil-administration-versus-standard-practice-influences-opioid-use-a-randomized-study
#19
Nada Sabourdin, Jérôme Barrois, Nicolas Louvet, Agnès Rigouzzo, Marie-Laurence Guye, Christophe Dadure, Isabelle Constant
BACKGROUND: Pupillometry has shown promising results for assessing nociception in anesthetized patients. However, its benefits in clinical practice are not demonstrated. The aim of this prospective randomized study was to evaluate the impact of intraoperative pupillometry monitoring on perioperative opioid consumption in major gynecologic surgery. METHODS: After receiving ethics committee approval and written consent of patients, American Society of Anesthesiologists status I to II women undergoing gynecologic surgery were included in this single-blinded, prospective, parallel-arm randomized study...
August 2017: Anesthesiology
https://www.readbyqxmd.com/read/28719524/establishing-obstetric-anesthesiology-practice-guidelines-in-the-republic-of-armenia-a-global-health-collaboration
#20
Gordon Yuill, Ashot Amroyan, Simon Millar, Emil Vardapetyan, Ashraf S Habib, Medge D Owen
BACKGROUND: Disparity exists in anesthesia practices between high- and low-to-middle income countries, and awareness has been raised within the global health community to improve the standards of anesthesia care and patient safety. The establishment of international collaborations and appropriate practice guidelines may help address clinical care deficiencies. This report's aim was to assess the impact of a multiyear collaboration on obstetric anesthesia practices in the Republic of Armenia...
August 2017: Anesthesiology
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