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https://www.readbyqxmd.com/read/29787410/the-effect-of-dexmedetomidine-on-propofol-requirements-during-anesthesia-administered-by-bispectral-index-guided-closed-loop-anesthesia-delivery-system-a-randomized-controlled-study
#1
Amitabh Dutta, Nitin Sethi, Jayashree Sood, Bhuwan C Panday, Manish Gupta, Prabhat Choudhary, Goverdhan D Puri
BACKGROUND: Dexmedetomidine, a selective α2-adrenergic agonist currently approved for continuous intensive care unit sedation, is being widely evaluated for its role as a potential anesthetic. The closed-loop anesthesia delivery system (CLADS) is a method to automatically administer propofol total intravenous anesthesia using bi-spectral index (BIS) feedback and attain general anesthesia (GA) steady state with greater consistency. This study assessed whether dexmedetomidine is effective in further lowering the propofol requirements for total intravenous anesthesia facilitated by CLADS...
May 21, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29783184/postoperative-outcomes-in-patients-with-a-do-not-resuscitate-dnr-order-undergoing-elective-procedures
#2
Ethan Y Brovman, Elisa C Walsh, Brittany N Burton, Christine E Kuo, Charlotta Lindvall, Rodney A Gabriel, Richard D Urman
STUDY OBJECTIVE: Do-not-resuscitate (DNR) status has been shown to be an independent risk factor for mortality in the post-operative period. Patients with DNR orders often undergo elective surgeries to alleviate symptoms and improve quality of life, but there are limited data on outcomes for informed decision making. DESIGN: Retrospective cohort study. SETTING: A multi-institutional setting including operating room, postoperative recovery area, inpatient wards, and the intensive care unit...
May 18, 2018: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/29774388/withholding-or-withdrawing-of-life-sustaining-therapy-in-older-adults-%C3%A2-80-years-admitted-to-the-intensive-care-unit
#3
Bertrand Guidet, Hans Flaatten, Ariane Boumendil, Alessandro Morandi, Finn H Andersen, Antonio Artigas, Guido Bertolini, Maurizio Cecconi, Steffen Christensen, Loredana Faraldi, Jesper Fjølner, Christian Jung, Brian Marsh, Rui Moreno, Sandra Oeyen, Christina Agwald Öhman, Bernardo Bollen Pinto, Ivo W Soliman, Wojciech Szczeklik, Andreas Valentin, Ximena Watson, Tilemachos Zafeiridis, Dylan W De Lange
PURPOSE: To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU. METHODS: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. RESULTS: LST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision)...
May 17, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29771797/measuring-in-hospital-recovery-after-colorectal-surgery-within-a-well-established-enhanced-recovery-pathway-a-comparison-between-hospital-length-of-stay-and-time-to-readiness-for-discharge
#4
Saba Balvardi, Nicolò Pecorelli, Tanya Castelino, Petru Niculiseanu, A Sender Liberman, Patrick Charlebois, Barry Stein, Franco Carli, Nancy E Mayo, Liane S Feldman, Julio F Fiore
BACKGROUND: Hospital length of stay is often used as a measure of in-hospital recovery but may be confounded by organizational factors. Time to readiness for discharge may provide a superior index of recovery. OBJECTIVE: The purpose of this study was to contribute evidence for the construct validity of time to readiness for discharge and length of stay as measures of in-hospital recovery after colorectal surgery in the context of a well-established enhanced recovery pathway...
May 15, 2018: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/29756676/impact-of-serious-mental-illness-on-surgical-patient-outcomes
#5
Kate E McBride, Michael J Solomon, Jane M Young, Daniel Steffens, Tim J Lambert, Nick Glozier, Paul G Bannon
BACKGROUND: People with comorbid mental illness have poorer health status and disparate access to healthcare. Several studies internationally have reported mixed findings regarding the association between mental illness and surgical patient outcomes. This study examines the surgical outcomes in people with decompensated serious mental illness (SMI) within the setting of the Australian universal healthcare system. METHODS: Retrospective cohort study involving elective overnight surgical patients aged 18 years and above who attended a large public tertiary referral hospital in Sydney, Australia, between 2010 and 2014...
May 14, 2018: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/29742703/nebulized-heparin-and-n-acetylcysteine-for-smoke-inhalational-injury-a-case-report
#6
Umair Ashraf, Bharat Bajantri, Gabriella Roa-Gomez, Sindhaghatta Venkatram, Amanda Cantin, Gilda Diaz-Fuentes
RATIONALE: Every year, ∼40,000 people suffer burn-related injuries in the United States. Despite recent advances, the odds of dying from exposure to fire, flames, or smoke are one in ∼1500. Smoke inhalation causes injury to the airways via a complex physiological process, and the treatment is mainly supportive. Many recent interventions aim to decrease the formation of fibrin casts, the main cause of airway damage in these patients. Among these, treatment with a combination of nebulized heparin and N-acetylcysteine (NAC) has shown benefit...
May 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29739621/the-incidence-and-outcome-of-hyperlactatemia-in-patients-admitted-to-the-intensive-care-unit-after-elective-surgery
#7
Tatsuhiko Abe, Shigehiko Uchino, Yusuke Sasabuchi, Masanori Takinami
BACKGROUND: Although hyperlactatemia is often developed in critically ill patients, it is unclear whether hyperlactatemia is associated with poor prognosis for surgical ICU (SICU) patients. METHODS: We performed a retrospective analysis in an academic hospital in Tokyo. The maximum lactate was defined as the highest value within the SICU stay. The primary outcome was the composite outcome of in-hospital mortality, re-admission to the SICU or admission to the general ICU and emergency reoperation...
April 23, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/29721734/short-term-outcomes-and-benefits-of-eras-program-in-elderly-patients-undergoing-colorectal-surgery-a-case-matched-study-compared-to-conventional-care
#8
Patricia Tejedor, Carlos Pastor, Santiago Gonzalez-Ayora, Mario Ortega-Lopez, Hector Guadalajara, Damian Garcia-Olmo
PURPOSE: The aim of the study was to evaluate the benefits of implementing Enhanced Recovery After Surgery (ERAS) protocols in elderly patients undergoing elective colorectal surgery. METHODS: A retrospective non-randomized cohort study was conducted from September 2012 to December 2016. We included patients ≥ 70 years undergoing elective colorectal surgery. Outcome measures, compliance with interventions, and postoperative complications of patients treated under ERAS were case-matched (based on gender, age, type of surgery, and the presence/absence of a temporal stoma) to a retrospective group of patients ≥ 70 years treated under conventional care...
May 3, 2018: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/29720858/preoperative-elective-transjugular-intrahepatic-portosystemic-shunt-for-cirrhotic-patients-undergoing-abdominal-surgery
#9
REVIEW
Deepanshu Jain, Ejaz Mahmood, Maria V-Bandres, Eyob Feyssa
Despite improvements in the surgical techniques, anesthesia and intensive care, abdominal surgery in patients with cirrhosis remains a challenge. Transjugular intrahepatic portosystemic shunt (TIPS) has been used to manage complications of portal hypertension. Preoperative TIPS (prophylactic) can theoretically improve outcomes in this population. Seven original studies were identified with 24 patients who underwent prophylactic TIPS before abdominal surgery. No perioperative mortality or major abdominal bleeding attributable to portal hypertension was reported for this cohort...
May 2018: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
https://www.readbyqxmd.com/read/29710352/laboratory-tests-and-x-ray-imaging-in-a-surgical-intensive-care-unit-checking-the-checklist
#10
Brian K Yorkgitis, Jesse W Loughlin, Zachary Gandee, Halla H Bates, Gerald Weinhouse
Context: Patients in the surgical intensive care unit (ICU) frequently undergo laboratory and imaging testing. These tests can lead to iatrogenic anemia and radiation exposure. Many of these tests may be unnecessary for the management of a patient's illness in the surgical ICU, and their ordering may be a reflex rather than in response to a clinical question. Checklists have been used in critical care to identify and address patient care strategies. Objective: To examine whether adding a "diagnostic testing" section to a daily checklist used for patient rounds in a surgical ICU would decrease the amount of laboratory tests and chest x-ray imaging ordered...
May 1, 2018: Journal of the American Osteopathic Association
https://www.readbyqxmd.com/read/29709436/extracorporeal-membrane-oxygenation-beyond-cardiac-surgery-and-intensive-care-unit-unconventional-uses-and-future-perspectives
#11
REVIEW
Fabrizio Monaco, Alessandro Belletti, Tiziana Bove, Giovanni Landoni, Alberto Zangrillo
Extracorporeal membrane oxygenation (ECMO) is used with increasing frequency to treat severe cardiac or respiratory failure as it can provide respiratory only or combined circulatory and respiratory support. Despite efforts aimed at increasing its diffusion however, ECMO is currently reserved, usually as last resort, in very severe cases, which are managed almost exclusively in the intensive care unit (ICU). Recent improvements in both technology and patients' management is leading to constant improvement in patients' outcome, especially in centers with a high caseload volume and after ensuring careful patients' selection...
March 20, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29708031/the-use-of-remowell-oxygenator-integrated-device-in-the-prevention-of-the-complications-related-to-aortic-valve-surgery-in-the-elderly-patient-preliminary-results
#12
Alberto Molardi, Maria V Di Chicco, Davide Carino, Matteo Goldoni, Matteo Ricci, Bruno Borrello, Florida Gripshi, Tiziano Gherli, Francesco Nicolini
Background The effects of fat microembolization due to cardiopulmonary bypass are well known in cardiac surgery. Our aim is to evaluate the use of the RemoweLL device (Eurosets, Medolla, Italy) during elective aortic valve replacement in elderly patients (>70 years old) to rate its biochemical and clinical effects. The RemoweLL device is an oxygenator-integrated reservoir which combines two strategies for fat emboli and leucocytes removal: filtration and supernatant elimination. Methods Forty-four elderly patients were enrolled and assigned randomly to a Group A (standard device) and a Group B (RemoweLL)...
June 2018: European Journal of Preventive Cardiology
https://www.readbyqxmd.com/read/29701496/evaluation-of-hospital-length-of-stay-and-revenues-as-a-function-of-admission-mode-clinical-pathways-including-observation-unit-stay-and-hospitalization-characteristics
#13
Enrique Casalino, Anne Perozziello, Christophe Choquet, Sonia Curac, Christophe Leroy, Romain Hellmann
Objectives Hospital length of stay (days) and revenues per day (euros) could be different depending on admission mode. To determine the impact of admission mode as a function of clinical pathway, we conducted the present study. DATA SOURCES: We included 159,206 admissions to three academic hospitals during a four-year period. Data were obtained from the electronic system of the hospital trust. Study design A case (through-emergency department)-control (elective (EA)) study was conducted (77,052), matched by age, stay severity and type, disease-related group, and discharge mode...
January 1, 2018: Health Services Management Research
https://www.readbyqxmd.com/read/29701425/analgesia-management-for-mitral-valve-repair-via-minithoracotomy-a-case-report
#14
Andreia Fernandes, Clara Gaio Lima, Nelson Paulo, Catarina Celestino, Ana Fonte Boa, Fátima Lima, Manuela Vieira
INTRODUCTION: Minimally invasive cardiac surgery (MICS), via minithoracotomy, is thought to be a fast track to extubation and recovery after surgery. Chronic pain, due to intercostal nerve injury, develops in up to 50% of postthoracotomy patients.A number of regional anaesthesia and analgesia techniques may be employed, and the anaesthesiologists play a key role in facilitating optimal outcomes after surgery. METHODS: We report a case of postoperative pain management with a local anesthetic infiltration for MICS...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29699805/minimally-invasive-versus-full-sternotomy-aortic-valve-replacement-in-low-risk-patients-which-will-stand-against-transcatheter-aortic-valve-replacement
#15
Sameer A Hirji, Masaki Funamoto, Jiyae Lee, Fernando Ramirez Del Val, Ahmed A Kolkailah, Siobhan McGurk, Marc P Pelletier, Sary Aranki, Prem S Shekar, Tsuyoshi Kaneko
BACKGROUND: Minimally invasive aortic valve replacement using upper-hemisternotomy has been associated with improved results compared to full sternotomy aortic valve replacement. Given the likely expansion of transcatheter aortic valve replacement to low-risk patients, we examine contemporary outcomes after full sternotomy and minimally invasive aortic valve replacement in low-risk patients using our 15-year experience. METHODS: Two thousand ninety-five low-risk patients (Society of Thoracic Surgeons Predicted Risk of Mortality score <4) underwent elective isolated aortic valve replacement, including 1,029 (49%) minimally invasive and 1,066 (51%) full sternotomy, from 2002 to 2015...
April 23, 2018: Surgery
https://www.readbyqxmd.com/read/29698662/liberal-use-of-delayed-sternal-closure-in-children-is-not-associated-with-increased-morbidity
#16
S Ram Kumar, Nigel Scott, Winfield J Wells, Vaughn A Starnes
BACKGROUND: Delayed sternal closure (DSC) is often employed to optimize hemodynamics following pediatric cardiac surgery. Prior reports have suggested that DSC may be associated with increased morbidity. We sought to analyze the impact of a liberal policy of DSC on surgical outcomes at our center. METHODS: We retrospectively evaluated the clinical course of 1,000 consecutive patients between July 2005 and June 2015 whose sternum was electively left open following pediatric cardiac surgery...
April 23, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29696108/comparing-the-effectiveness-of-patient-control-analgesia-pump-and-bolus-morphine-in-controlling-pain-after-cardiopulmonary-bypass-graft-surgery
#17
Vali Imantalab, Ali Mirmansouri, Ali Mohammadzadeh Jouryabi, Bahram Naderi Nabi, Gholamreza Kanani, Nassir Nassiri Sheikhani, Zahra Atrkarroushan, Samaneh Ghazanfar Tehran, Nastaran Samadpour
Background: Postoperative pain is a complex process commonly caused by surgical trauma. It is one of the major concerns of patients undergoing heart surgery. Despite new techniques and modern analgesic treatments, postoperative pain is still one of the most important controversial issues. Methods: 68 patients scheduled for elective CABG with CPB were included in a prospective, double-blind clinical trial. They were randomly divided into two groups. One group received PCA pump including morphine (group P) with underlying infusion of 0...
October 2017: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/29691166/improved-perioperative-care-of-elective-joint-replacement-patients-the-impact-of-an-orthopedic-perioperative-hospitalist
#18
Steven J Fitzgerald, Terrence C Palmer, Matthew J Kraay
BACKGROUND: We developed an orthopedic hospitalist fellowship program for our total joint replacement program at a large urban academic medical center. The goal of the program was to improve patient outcomes, quality, and healthcare value through collaborative perioperative care and improved care coordination. This study evaluates the implementation and impact of our modified Hospitalist-Orthopaedic Team Co-management model on quality and performance metrics. METHODS: We reviewed our Quality Institute data using 3 databases for the 16 months before (PreOH) and 18 months after (PostOH) implementation...
March 21, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29679531/the-association-of-early-postoperative-lactate-levels-with-morbidity-after-elective-major-abdominal-surgery
#19
Jelena Veličković, Ivan Palibrk, Biljana Miličić, Dejan Veličković, Bojan Jovanović, Goran Rakić, Milorad Petrović, Vesna Bumbaširević
Lactate levels are widely used as an indicator of outcome in critically ill patients. We investigated the prognostic value of postoperative lactate levels for postoperative complications (POC), mortality and length of hospital stay after elective major abdominal surgery. A total of 195 patients were prospectively evaluated. Lactate levels were assessed on admission to the intensive care unit (ICU) [L0], 4 hours (L4), 12 hours (L12), and 24 hours (L24) after the operation. Demographic and perioperative clinical data were collected...
April 21, 2018: Bosnian Journal of Basic Medical Sciences
https://www.readbyqxmd.com/read/29678158/dexmedetomidine-infusion-as-an-analgesic-adjuvant-during-laparoscopic-%C3%B1-holecystectomy-a-randomized-controlled-study
#20
Kateryna Bielka, Iurii Kuchyn, Volodymyr Babych, Kseniia Martycshenko, Oleksii Inozemtsev
BACKGROUND: Dexmedetomidine (DEX) has sedative, sympatholytic and analgesic effects and might be beneficial if used as an adjuvant to: improve analgesia; modulate haemodynamic responses to intubation and pneumoperitoneum and; reduce the number of opioid-associated adverse events. The aim of this study was to evaluate the efficacy and safety of DEX infusion during elective laparoscopic cholecystectomy (LC). METHODS: A randomized, single-centre, parallel-group, placebo-controlled study was carried out between May 2016 and June 2017...
April 20, 2018: BMC Anesthesiology
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