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Perioperative Anesthesia

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https://www.readbyqxmd.com/read/29691180/multimodal-clinical-pathway-with-adductor-canal-block-decreases-hospital-length-of-stay-improves-pain-control-and-reduces-opioid-consumption-in-total-knee-arthroplasty-patients-a-retrospective-review
#1
Terry A Ellis, Hassan Hammoud, Philip Dela Merced, Nishankkumar P Nooli, Farhad Ghoddoussi, Joshua Kong, Sandeep H Krishnan
BACKGROUND: Total knee arthroplasty volume is increasing significantly in the United States. Reducing hospital length of stay may represent the best method for accommodating expanding volume and reducing costs. We hypothesized that tailoring a clinical pathway to facilitate early ambulation would decrease costs and resource utilization. METHODS: We conducted a sequential before-and-after study of total knee arthroplasty patients after a phased implementation of a clinical pathway that includes multimodal oral analgesic protocols, adductor canal nerve block, and standardized day of surgery ambulation protocols...
March 27, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29688925/interdisciplinary-dialogue-is-needed-when-defining-perioperative-recommendations-conflicting-guidelines-for-anesthetizing-patients-for-pilonidal-surgery
#2
Roland E Andersson, Dietrich Doll, Verena K Stauffer, Andreas P Vogt, Steven D Boggs, Markus M Luedi
National or international guidelines can help surgeons and anesthesiologists make treatment decisions, but the existence of conflicting recommendations can hinder treatment rather than helping. A case in point is the treatment of pilonidal sinus disease, a chronic subcutaneous infection located in the sacrococcygeal area. Its incidence is rising, reaching almost 100/100,000 inhabitants. Three surgical societies have proposed guidelines for treating the disease, but these guidelines vary greatly in their approach to anesthesia...
April 23, 2018: A&A practice
https://www.readbyqxmd.com/read/29686989/enhanced-recovery-after-surgery-protocols-in-major-urologic-surgery
#3
REVIEW
Natalija Vukovic, Ljubomir Dinic
The purpose of the review: The analysis of the components of enhanced recovery after surgery (ERAS) protocols in urologic surgery. Recent findings: ERAS protocols has been studied for over 20 years in different surgical procedures, mostly in colorectal surgery. The concept of improving patient care and reducing postoperative complications was also applied to major urologic surgery and especially procedure of radical cystectomy. This procedure is technically challenging, due to a major surgical resection and high postoperative complication rate that may reach 65%...
2018: Frontiers in Medicine
https://www.readbyqxmd.com/read/29685712/no-difference-in-major-complication-and-readmission-rates-following-simultaneous-bilateral-vs-unilateral-total-hip-arthroplasty
#4
Mina W Morcos, Adam Hart, John Antoniou, Olga L Huk, David J Zukor, Stephane G Bergeron
BACKGROUND: Simultaneous bilateral total hip arthroplasty (THA) is an attractive option for patients with osteoarthritis as it requires a single anesthetic and hospitalization. Nonetheless, serious concerns remain over the perioperative safety and rate of hospital readmission. The purpose of the present study was to compare the rate of 30-day major complications and hospital readmissions between patients undergoing simultaneous bilateral vs unilateral THA using the National Surgical Quality Improvement Program database...
March 27, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29685019/effect-of-branched-chain-amino-acids-on-perioperative-temperature-glucose-level-and-fat-metabolism-in-patients-with-gastrointestinal-tumors
#5
L Y Wen, Y S Zhang, X Zhou, G Li, C Y Hu, Y Li, L J Jin
This study aimed to investigate the effect of branched chain amino acids (BCCAs) on perioperative temperature, glucose and fat metabolism in patients with gastrointestinal tumors. Fifty-six patients undergoing gastrointestinal tumor surgery were included in the study and randomly divided into two groups of 28 patients each: an experimental and a control group. During surgery, the experimental group received 5.64mL·Kg-1·h-1(4KJ·Kg-1·h-1) of BCCAs intravenously, through an infusion pump, and the control group received an equal volume of NaCl 0...
March 2018: Journal of Biological Regulators and Homeostatic Agents
https://www.readbyqxmd.com/read/29684989/intradermal-skin-tests-for-rocuronium-and-cisatracurium-in-patients-with-a-history-of-allergy-a-retrospective-study
#6
Yu Yil Kim, Ik Thae Kim, Sung In Shin, So Mang Yim
Background: Neuromuscular blocking agents (NMBAs) are a leading cause of perioperative anaphylaxis. However, the performance of systematic screening skin tests to detect reactions for NMBAs prior to general anesthesia is not recommended. We retrospectively examined intradermal tests (IDTs) for rocuronium and cisatracurium in patients with a history of allergy. Methods: We reviewed the records of patients who underwent IDTs for NMBAs between January 1 and December 31, 2016...
April 24, 2018: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/29684306/does-sphenopalatine-ganglion-block-improve-pain-control-and-intraoperative-hemodynamics-in-children-undergoing-palatoplasty-a-randomized-controlled-trial
#7
Anantanarayanan Parameswaran, Muruganand V Ganeshmurthy, Yashoda Ashok, Manikandhan Ramanathan, Anthony F Markus, Hermann F Sailer
PURPOSE: Children undergoing cleft palate repair have pain, dysphagia, and wound irritation in the immediate postoperative phase that may compromise surgical outcomes. This trial evaluates the efficacy of the sphenopalatine ganglion block (SPGB) in optimizing intraoperative hemodynamics and postoperative analgesia in children undergoing primary palatoplasty. MATERIALS AND METHODS: The study was designed as a prospective, double-blind, randomized controlled trial comparing the use of SPGB with general anesthesia (GA) (study group) versus the use of only GA (control group)...
March 30, 2018: Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/29683007/perioperative-noninvasive-cardiac-output-monitoring-in-parturients-undergoing-cesarean-delivery-with-spinal-anesthesia-and-prophylactic-phenylephrine-drip-a-prospective-observational-cohort-study
#8
Sharon Orbach-Zinger, Ilya Bizman, Shlomo Firman, Shaul Lev, Roi Gat, Eran Ashwal, Mordehay Vaturi, Eitan Razinski, Atara Davis, Anat Shmueli, Leonid A Eidelman
INTRODUCTION: Spinal anesthesia for cesarean delivery is associated with high incidence of hypotension and is most often prevented by a prophylactic phenylephrine infusion (PPI). In this study, we aimed to identify maternal hemodynamic changes both intraoperatively and postoperatively with the use of the NICaS noninvasive cardiac output monitor in healthy singleton parturients undergoing cesarean delivery (CD) with spinal anesthesia and PPI. METHODS: Healthy term women undergoing spinal anesthesia for singleton CD were enrolled...
April 22, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29681567/recovery-of-endothelial-function-after-minor-to-moderate-surgery-is-impaired-by-diabetes-mellitus-obesity-hyperuricemia-and-sevoflurane-based-anesthesia
#9
Sachi Ohno, Atsushi Kohjitani, Masaaki Miyata, Akina Tohya, Kaoru Yamashita, Teruto Hashiguchi, Mitsuru Ohishi, Mitsutaka Sugimura
Endothelial dysfunction is observed in several cardiovascular diseases, where endothelium-dependent vasodilation is impaired by oxidative stress. However, the time course of endothelial function during the perioperative period of a minor-to-moderate surgery, and the effects of atherosclerotic risk factors and employed general anesthetics on recovery of endothelial function, are unknown. Endothelial function of 30 patients was evaluated as the reactive hyperemia index (RHI) of reactive hyperemia peripheral arterial tonometry...
April 20, 2018: International Heart Journal
https://www.readbyqxmd.com/read/29680811/does-the-age-of-acute-care-physicians-impact-their-1-crisis-management-performance-and-2-learning-after-simulation-based-education-a-protocol-for-a-multicentre-prospective-cohort-study-in-toronto-and-ottawa-canada
#10
Fahad Alam, Vicki R LeBlanc, Alan Baxter, Jordan Tarshis, Dominique Piquette, Yuqi Gu, Caroline Filipkowska, Ashley Krywenky, Nicole Kester-Greene, Pierre Cardinal, Shelly Au, Sandy Lam, Sylvain Boet, Perioperative Anesthesia Clinical Trials Group
INTRODUCTION: The proportion of older acute care physicians (ACPs) has been steadily increasing. Ageing is associated with physiological changes and prospective research investigating how such age-related physiological changes affect clinical performance, including crisis resource management (CRM) skills, is lacking. There is a gap in the literature on whether physician's age influences baseline CRM performance and also learning from simulation. We aim to investigate whether ageing is associated with baseline CRM skills of ACPs (emergency, critical care and anaesthesia) using simulated crisis scenarios and to assess whether ageing influences learning from simulation-based education...
April 21, 2018: BMJ Open
https://www.readbyqxmd.com/read/29680394/the-clinical-effects-of-a-low-dose-dexmedetomidine-constant-rate-infusion-in-isoflurane-anesthetized-cats
#11
B T Simon, E M Scallan, C D Coursey, W M Kiehl, E J Moore
The aim of this study was to evaluate the effects of a low dose dexmedetomidine constant rate infusion (CRI) on cardiopulmonary function, inhalant anesthetic concentration and recovery in isoflurane anesthetized cats. In a prospective, randomized, blinded, controlled design, 12 cats undergoing anesthesia for ovariohysterectomy were administered hydromorphone (0.1mg/kg) intramuscularly, propofol (4.3-7.8mg/kg) intravenously and maintained with isoflurane. During isoflurane anesthesia, the cats were administered either a dexmedetomidine loading dose (0...
April 2018: Veterinary Journal
https://www.readbyqxmd.com/read/29680176/perianesthesia-nurses-survey-of-their-knowledge-and-practice-with-obstructive-sleep-apnea
#12
Andrea M Erwin, Kim A Noble, June Marshall, Susan Cooper
PURPOSE: Anesthesia, sedation, and analgesia can negatively impact adult patients with obstructive sleep apnea (OSA). Despite known risks, current evidence, and practice guidelines, insufficient evidence exists that standardization and clinical application of OSA screening tools, problem identification, and perioperative nursing intervention and management strategies are consistently implemented for OSA patients across perianesthesia settings. The purpose of this study was to conduct a knowledge and practice assessment of perianesthesia nurses who care for adult patients with diagnosed or undiagnosed OSA...
April 18, 2018: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/29678142/abnormally-low-bispectral-index-and-severe-hypoglycemia-during-maintenance-of-and-recovery-from-general-anesthesia-in-diabetic-retinopathy-surgery-two-case-reports
#13
Chunhua Xi, Chuxiong Pan, Tianzuo Li
BACKGROUND: Hypoglycemia is one of the most fatal complications during the perioperative period. General anesthesia or sedation can mask a hypoglycemia-altered mental status. Acute hypoglycemia might result in permanent brain injury. There is no way to detect hypoglycemia during general anesthesia, except for intermittent blood glucose monitoring. CASE PRESENTATION: Hypoglycemia is associated with changes in electroencephalogram readings. Here, we report two cases of patients with an abnormally low Bispectral Index (BIS) associated with diabetic retinopathy surgery, one in the recovery stage of general anesthesia and the other in the maintenance of general anesthesia...
April 20, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29677106/effect-of-propofol-continuous-rate-infusion-on-intravenous-glucose-tolerance-test-in-dogs
#14
Kenichi Maeda, Munehiro Iwasaki, Yuki Itou, Satomi Iwai, Shozo Okano
Hyperglycemia causes perioperative complications and many anesthetics impair glucose metabolism and cause hyperglycemia. We evaluated the effects of propofol on blood glucose metabolism and insulin secretion during an intravenous glucose tolerance test (IVGTT) in dogs. Blood glucose, insulin, triglyceride, cholesterol, and free fatty acid (FFA) levels were measured in dogs during IVGTT in a conscious state and under the effect of 2.0% isoflurane, low-concentration propofol (0.2 mg/kg/min), and high-concentration propofol (0...
April 20, 2018: Veterinary Sciences
https://www.readbyqxmd.com/read/29677063/the-anesthesia-perioperative-call-for-help-experience-at-a-quaternary-pediatric-medical-center-analysis-of-67-564-anesthesia-encounters
#15
Bistra G Vlassakova, Sean M Sinnott, Nissa Askins, Matthew X Callahan, Izabela C Leahy, David Zurakowski, Paul R Hickey, Joseph P Cravero
BACKGROUND: During the past several decades, anesthesia has become increasingly safe. Truly major adverse events are rare, and anesthesia quality researchers have instituted programs to evaluate "near miss" or less critical adverse events to evaluate the safety of anesthesia delivery. In this study, we aimed to evaluate calls for emergency help in our institution as a surrogate for pending critical events. We hypothesized that calls would be more common in patients with high American Society of Anesthesiologists (ASA) physical status, history of prematurity, and children with recent respiratory illness compared to those without these characteristics...
April 17, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29677059/pediatric-perioperative-cardiac-arrest-death-in-the-off-hours-a-report-from-wake-up-safe-the-pediatric-quality-improvement-initiative
#16
Robert E Christensen, Angela C Lee, Marie S Gowen, Mallikarjuna R Rettiganti, Jayant K Deshpande, Jeffrey P Morray
BACKGROUND: Pediatric perioperative cardiac arrest (CA) is a rare but catastrophic event. This case-control study aims to analyze the causes, incidence, and outcomes of all pediatric CA reported to Wake Up Safe. Factors associated with CA and mortality after arrest are examined and possible strategies for improving outcomes are considered. METHODS: CA in children was identified from the Wake Up Safe Pediatric Anesthesia Quality Improvement Initiative, a multicenter registry of adverse events in pediatric anesthesia...
April 17, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29663179/the-impact-of-obesity-on-pulmonary-deterioration-in-patients-undergoing-robotic-assisted-laparoscopic-prostatectomy
#17
Sebastian Blecha, Marion Harth, Florian Zeman, Timo Seyfried, Matthias Lubnow, Maximilian Burger, Stefan Denzinger, Michael T Pawlik
Obesity affects respiratory and hemodynamic function in anesthetized patients. The aim of this study was to evaluate the influence of the body mass index (BMI) on pulmonary changes in a permanent 45° steep Trendelenburg position (STP) during robotic-assisted laparoscopic prostatectomy (RALP). 51 patients undergoing RALP under standardized anesthesia were included. Perioperative pulmonary function and oxygenation were measured in awake patients (T0 ), 20 min after the induction of anesthesia (T1 ), after insufflation of the abdomen in supine position (T2 ), after 30 min in STP (T3 ), when controlling Santorini's plexus in STP (T4 ), before awakening while supine (T5 ), and after 45 min in the recovery room (T6 )...
April 16, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29661575/outcomes-of-laparoscopic-resection-of-meckel-s-diverticulum-are-equivalent-to-open-laparotomy
#18
Brian Ezekian, Harold J Leraas, Brian R Englum, Brian F Gilmore, Christopher Reed, Tamara N Fitzgerald, Henry E Rice, Elisabeth T Tracy
PURPOSE: Meckel's diverticulum (MD) is a common congenital anomaly caused by failure of involution of the omphalomesenteric duct. Enthusiasm for minimally invasive surgery (MIS) in children has burgeoned as technologies have advanced, but the outcomes of laparoscopic resection in comparison to open laparotomy for MD remain poorly defined. We queried a large national database to compare current practice patterns and clinical outcomes between surgical approaches for MD in the pediatric population...
March 15, 2018: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29661573/outcomes-following-laparoscopic-versus-open-surgery-for-pediatric-inguinal-hernia-repair-analysis-using-a-national-inpatient-database-in-japan
#19
Michimasa Fujiogi, Nobuaki Michihata, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga, Jun Fujishiro
BACKGROUND: This study compared perioperative outcomes between laparoscopic surgery (LS) and open surgery (OS) for pediatric inguinal hernia repair, using a national inpatient database. METHODS: Using the Diagnosis Procedure Combination database in Japan, we compared duration of anesthesia, postoperative complications, recurrence, and metachronous hernia (MH) between LS and OS for children undergoing inguinal hernia repair from July 2010 to March 2016. We used multivariable logistic regression analysis for postoperative complications and Cox regression analysis for recurrence...
March 17, 2018: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29661338/anesthesia-in-the-elderly-patient-undergoing-otolaryngology-head-and-neck-surgery
#20
REVIEW
Takumi Codère-Maruyama, Albert Moore
Geriatric patients undergoing surgery have a whole set of specific physiologic changes, perioperative needs, and postoperative complications. This review presents an overview of the basic concepts and the evolving challenges pertaining to the care of geriatric patients undergoing otolaryngologic procedures from the perspective of the anesthesiologist.
May 2018: Clinics in Geriatric Medicine
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