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https://www.readbyqxmd.com/read/28436074/an-evaluation-of-the-mixed-pediatric-unit-for-blood-loss-replacement-in-pediatric-craniofacial-surgery
#1
Stefan Mogensen, Norbert Lubenow, Pelle Nilsson, Henrik Engquist, Folke Knutsson, Per Enblad, Daniel Nowinski, Peter Frykholm
BACKGROUND: Surgical correction for craniosynostosis is often associated with significant perioperative hemorrhage. We implemented a transfusion strategy with a strict protocol including transfusion triggers, frequent assessment of coagulation tests, and the use of a novel transfusion unit, the mixed pediatric unit. AIM: The aim of the study was to evaluate if the applied transfusion strategy could reduce total blood loss and number of blood donors. METHODS: Children <1 year old admitted for craniosynostosis surgery were included for the study...
April 23, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28434547/stress-dose-corticosteroid-versus-placebo-in-neonatal-cardiac-operations-a-randomized-controlled-trial
#2
Pertti K Suominen, Juho Keski-Nisula, Tiina Ojala, Paula Rautiainen, Timo Jahnukainen, Johanna Hästbacka, Pertti J Neuvonen, Olli Pitkänen, Jussi Niemelä, Anu Kaskinen, Jukka Salminen, Risto Lapatto
BACKGROUND: Corticosteroids can improve the hemodynamic status of neonates with postoperative low cardiac output syndrome after cardiac operations. This study compared a prophylactically administered stress-dose corticosteroid (SDC) regimen against placebo on inflammation, adrenocortical function, and hemodynamic outcome. METHODS: Forty neonates undergoing elective open heart operations were randomized into two groups. The SDC group received perioperatively 2 mg/kg methylprednisolone, and 6 hours after the operation, a hydrocortisone infusion (0...
April 20, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28433337/increased-resource-utilization-and-overall-morbidity-are-associated-with-general-versus-regional-anesthesia-for-carotid-endarterectomy-in-data-collected-by-the-michigan-surgical-quality-collaborative
#3
Ahmad S Hussain, Andrew Mullard, William F Oppat, Kevin D Nolan
OBJECTIVE: Advocates for performing carotid endarterectomy (CEA) under regional anesthesia (RA) cite reduction in hemodynamic instability and the ability for neurologic monitoring, but many still prefer general anesthesia (GA) as benefits of RA have not been clearly demonstrated, reliable RA may not be available in all centers, and a certain amount of movement by the patient during the procedure may not be uniformly tolerated. We evaluated the association of anesthesia type and perioperative morbidity and mortality as well as resource utilization in patients undergoing CEA using the Michigan Surgical Quality Collaborative (MSQC) database...
April 19, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28431883/primary-repair-of-traumatic-distal-biceps-ruptures-in-a-military-population-clinical-outcomes-of-single-versus-2-incision-technique
#4
Brian R Waterman, Lorenzo Navarro-Figueroa, Brett D Owens
PURPOSE: To determine the success of distal biceps repair in a high-demand military population and to comparatively evaluate the perioperative risk profile, functional results, and adverse patient outcomes of a single- versus 2-incision technique within this high-risk group. METHODS: Between 2007-2013, all military service members undergoing primary surgical repair for distal biceps rupture through the Military Health System were isolated. Patients with allograft tendon reconstruction, revision procedures, nonmilitary status, and/or follow-up of less than 24 month were excluded...
April 18, 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/28431425/the-association-of-frailty-with-outcomes-and-resource-use-after-emergency-general-surgery-a-population-based-cohort-study
#5
Daniel I McIsaac, Husein Moloo, Gregory L Bryson, Carl van Walraven
BACKGROUND: Older patients undergoing emergency general surgery (EGS) experience high rates of postoperative morbidity and mortality. Studies focused primarily on elective surgery indicate that frailty is an important predictor of adverse outcomes in older surgical patients. The population-level effect of frailty on EGS is poorly described. Therefore, our objective was to measure the association of preoperative frailty with outcomes in a population of older patients undergoing EGS. METHODS: We created a population-based cohort study using linked administrative data in Ontario, Canada, that included community-dwelling individuals aged >65 years having EGS...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28431420/generative-retrieval-improves-learning-and-retention-of-cardiac-anatomy-using-transesophageal-echocardiography
#6
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/28430694/iron-loading-exaggerates-the-inflammatory-response-to-the-toll-like-receptor-4-ligand-lipopolysaccharide-by-altering-mitochondrial-homeostasis
#7
Konrad Hoeft, Donald B Bloch, Jan A Graw, Rajeev Malhotra, Fumito Ichinose, Aranya Bagchi
BACKGROUND: Perioperative and critically ill patients are often exposed to iron (in the form of parenteral-iron administration or blood transfusion) and inflammatory stimuli, but the effects of iron loading on the inflammatory response are unclear. Recent data suggest that mitochondrial reactive oxygen species have an important role in the innate immune response and that increased mitochondrial reactive oxygen species production is a result of dysfunctional mitochondria. We tested the hypothesis that increased intracellular iron potentiates lipopolysaccharide-induced inflammation by increasing mitochondrial reactive oxygen species levels...
April 21, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28430689/perioperative-outcomes-of-robotic-assisted-hysterectomy-compared-with-open-hysterectomy
#8
Bhargavi Gali, Jamie N Bakkum-Gamez, David J Plevak, Darrell Schroeder, Timothy O Wilson, Christopher J Jankowski
BACKGROUND: Increasing numbers of robotic hysterectomies (RH) are being performed. To provide ventilation (with pneumoperitoneum and steep Trendelenburg position) for these procedures, utilization of lung protective strategies with limiting airway pressures and tidal volumes is difficult. Little is known about the effects of intraoperative mechanical ventilation and high peak airway pressures on perioperative complications. We performed a retrospective review to determine whether patients undergoing RH had increased pulmonary complications compared to total abdominal hysterectomy (TAH)...
April 19, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28430594/the-prognostic-significance-of-preoperative-left-ventricular-diastolic-dysfunction-and-left-atrial-enlargement-on-acute-coronary-syndrome-in-kidney-transplantation
#9
Jin Ho Hwang, Jun-Bean Park, Yong-Jin Kim, Jung Nam An, Jaeseok Yang, Curie Ahn, In Mok Jung, Chun Soo Lim, Yon Su Kim, Young Hoon Kim, Jung Pyo Lee
Echocardiography is commonly performed as a screening test to evaluate perioperative risks before kidney transplantation. However, only limited data are available on echocardiographic parameters of left ventricular diastolic dysfunction (LVDD) and left atrial enlargement (LAE) on acute coronary syndrome and mortality in kidney transplant recipients. We reviewed 2779 adult recipients who underwent pretransplant echocardiography from 1997 to 2012. We divided the patients into two and four groups by two categories: LVDD grades 0-1 vs...
April 5, 2017: Oncotarget
https://www.readbyqxmd.com/read/28429198/managing-the-perioperative-patient-on-direct-oral-anticoagulants
#10
Jordan Leitch, Janet van Vlymen
PURPOSE: Patients are increasingly treated with direct oral anticoagulants (DOACs) for the prevention of stroke due to non-valvular atrial fibrillation and for the treatment of venous thromboembolism. When these patients present for urgent or emergent surgical procedures, they present a challenge to the anesthesiologist who must manage perioperative risk due to anticoagulation. The purpose of this module is to review the literature surrounding the perioperative management of DOACs. Timing, laboratory monitoring, and availability of reversal agents are important considerations to optimize patients being treated with DOACs who require emergent surgery...
April 20, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28427002/incidental-posterior-mediastinal-paraganglioma-the-safe-approach-to-management-case-report
#11
Juan A Muñoz-Largacha, Roan J Glocker, Jacob Moalem, Michael J Singh, Virginia R Litle
INTRODUCTION: Paragangliomas are neuroendocrine tumors arising from chromaffin cells located in sympathetic paraganglia. Mediastinal paragangliomas are extremely rare and can be classified as functional or non-functional according to their ability for secreting catecholamines. Patients can be asymptomatic and the diagnosis is usually incidental. Complete surgical resection remains the standard of care for paragangliomas. PRESENTATION OF CASE: We present a 44-year-old woman with a functional mediastinal paraganglioma incidentally found during the perioperative imaging workup for a diagnosed breast carcinoma...
March 31, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28426465/neoadjuvant-treatment-a-novel-standard
#12
Sandro Pasquali, Elena Palassini, Silvia Stacchiotti, Paolo G Casali, Alessandro Gronchi
PURPOSE OF REVIEW: The aim of this study was to summarize developments in the adjuvant/neoadjuvant chemotherapy of high-risk adult-type soft tissue sarcomas (STS). RECENT FINDINGS: The role of adjuvant/neaodjuvant chemotherapy in these patients is controversial, with a meta-analysis suggesting a 10% survival benefit. Recently, a randomized controlled trial in high-risk STS of extremities and trunk wall showed a 20% improvement in progression-free and overall survival after three preoperative cycles of epirubicin along with ifosfamide compared with a histology-tailored chemotherapy...
April 19, 2017: Current Opinion in Oncology
https://www.readbyqxmd.com/read/28423997/do-lipid-microemboli-induce-acute-kidney-injury-during-cardiopulmonary-bypass
#13
Richard Issitt, Tim James, Bronagh Walsh, David Voegeli
BACKGROUND: Acute kidney injury (AKI) following cardiopulmonary bypass affects 5% of patients, representing significant postoperative morbidity and mortality. Animal models have shown an increased uptake of lipid microemboli (LME) into the renal vasculature, potentially indicating ischaemic causation. This study tested a new lipid filtration system (RemoweLL) against a conventional system with no lipid-depleting capacity to determine the efficacy of the filtration system and its effects on renal function...
April 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28420221/a-narrative-review-actigraphy-as-an-objective-assessment-of-perioperative-sleep-and-activity-in-pediatric-patients
#14
REVIEW
Nicole Conrad, Joelle Karlik, Amy Lewandowski Holley, Anna C Wilson, Jeffrey Koh
Sleep is an important component of pediatric health and is crucial for cognitive development. Actigraphy is a validated, objective tool to capture sleep and movement data that is increasingly being used in the perioperative context. The aim of this review is to present recent pediatric studies that utilized actigraphy in the perioperative period, highlight gaps in the literature, and provide recommendations for future research. A literature search was completed using OVID and PubMed databases and articles were selected for inclusion based on relevance to the topic...
April 18, 2017: Children
https://www.readbyqxmd.com/read/28419229/non-invasive-assessment-of-cerebral-oxygen-metabolism-following-surgery-of-congenital-heart-disease
#15
Felix Neunhoeffer, Katharina Sandner, Milena Wiest, Christoph Haller, Hanna Renk, Matthias Kumpf, Christian Schlensak, Michael Hofbeck
OBJECTIVES: Cerebral protection is a major issue in the treatment of infants with complex congenital heart disease. We tested a new device combining tissue spectrometry and laser Doppler flowmetry for non-invasive determination of cerebral oxygen metabolism following cardiac surgery in infants. METHODS: We prospectively measured regional cerebral oxygen saturation cSO 2 and microperfusion (rcFlow) in 43 infants 12-24 h following corrective ( n  = 30) or palliative surgery ( n  = 13) of congenital heart defects...
April 16, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28416334/a-systematic-approach-to-improve-the-outcomes-of-type-a-aortic-dissection
#16
Hidefumi Nishida, Minoru Tabata, Toshihiro Fukui, Yasunori Sato, Hajime Kin, Shuichiro Takanashi
OBJECTIVES: The aims of this study are to evaluate the outcomes and trends of contemporary emergency surgery for acute type A aortic dissection on the basis of a systematic approach and to assess the impact of temporary aortic crossclamping during systemic cooling on early and late outcomes. METHODS: We retrospectively reviewed 702 consecutive patients who underwent emergency surgery for acute type A aortic dissection between March 2004 and May 2015. Our clinical protocol includes rapid transfer to the operating room, quick establishment of cardiopulmonary bypass, temporary aortic crossclamping during cooling, primary entry resection, and open distal anastomosis...
March 23, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28410756/perioperative-sexual-interest-in-women-with-suspected-gynecologic-malignancies
#17
C Emi Bretschneider, Jeannette T Bensen, Elizabeth J Geller, Paola A Gehrig, Jennifer M Wu, Kemi M Doll
OBJECTIVES: For women with gynecologic cancer, the impact of surgery on sexual interest and desire in the immediate and later postoperative period is not well characterized. The objective of this study was to report the perioperative trends of changing sexual interest and desire in a cohort of women undergoing surgery for suspected gynecologic malignancies. METHODS: This is an ancillary analysis of a cohort study analyzing health-related outcomes in women who underwent primary surgical management of a suspected gynecologic malignancy between 10/2013 and 10/2014...
April 12, 2017: Gynecologic Oncology
https://www.readbyqxmd.com/read/28408176/using-the-nsqip-pancreatic-demonstration-project-to%C3%A2-derive-a-modified-fistula-risk-score-for-preoperative-risk-stratification-in-patients-undergoing-pancreaticoduodenectomy
#18
Olga Kantor, Mark S Talamonti, Henry A Pitt, Charles M Vollmer, Taylor S Riall, Bruce L Hall, Chi-Hsiung Wang, Marshall S Baker
BACKGROUND: The Fistula Risk Score (FRS) is a clinical tool developed from single-institutional data using primarily intraoperative factors to characterize the risk of clinically relevant pancreatic fistula (CR-POPF) after pancreaticoduodenectomy. We developed a modified FRS based on objective, nationally accrued data that is more readily determined before resection. STUDY DESIGN: The 2012 NSQIP Pancreatic Demonstration Project (PDP) was used to identify 1,731 pancreaticoduodenectomy resections over 14 months (2011 to 2012)...
March 9, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28405540/markedly-improved-success-rate-of-endoscopically-assisted-third-ventriculostomy-is-achieved-by-routine-placement-of-external-lumbar-drain
#19
Justen Watkins, Marc Cabanne, Dan Miulli
Hydrocephalus is a major cause of patient decreased quality of life and high health care financial burden in the United States and throughout the world. The placement of ventricular shunts (ventriculoperitoneal shunt) has proven to be a safe treatment for hydrocephalus, but it is associated with a high complication rate leading to a lower quality of life and continued financial burden for patients, their families, and society as a whole. The endoscopically assisted third ventriculostomy (ETV) has been practiced as an alternative to ventricular shunting since the 1990s...
April 2017: Journal of Neurological Surgery Reports
https://www.readbyqxmd.com/read/28405037/the-effect-of-different-dose-regimens-of-tranexamic-acid-in-reducing-blood-loss-during-hip-surgery
#20
Anil Kumar Thipparampall, Indira Gurajala, R Gopinath
BACKGROUND AND AIMS: Antifibrinolytics may help bleeding in orthopaedic surgeries. The present study was undertaken to compare two dose regimens of tranexamic acid (TA) on perioperative blood loss in patients undergoing hip surgeries. METHODS: In a prospective, randomised, controlled study, 59 patients scheduled for hip surgery were divided into Group C: receiving normal saline (n - 20), Group B: receiving single dose of TA (10 mg/kg) (n - 21), and Group I: receiving a bolus (10 mg/kg) plus infusion (1 mg/kg/h) of TA up to 4 h postoperatively (n - 18)...
March 2017: Indian Journal of Anaesthesia
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