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Perioperative managment

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https://www.readbyqxmd.com/read/29677302/effect-of-uterosacral-ligament-suspension-vs-sacrospinous-ligament-fixation-with-or-without-perioperative-behavioral-therapy-for-pelvic-organ-vaginal-prolapse-on-surgical-outcomes-and-prolapse-symptoms-at-5-years-in-the-optimal-randomized-clinical-trial
#1
J Eric Jelovsek, Matthew D Barber, Linda Brubaker, Peggy Norton, Marie Gantz, Holly E Richter, Alison Weidner, Shawn Menefee, Joseph Schaffer, Norma Pugh, Susan Meikle
Importance: Uterosacral ligament suspension (ULS) and sacrospinous ligament fixation (SSLF) are commonly performed pelvic organ prolapse procedures despite a lack of long-term efficacy data. Objective: To compare outcomes in women randomized to (1) ULS or SSLF and (2) usual care or perioperative behavioral therapy and pelvic floor muscle training (BPMT) for vaginal apical prolapse. Design, Setting, and Participants: This 2 × 2 factorial randomized clinical trial was conducted at 9 US medical centers...
April 17, 2018: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29677033/characterization-of-the-glucocorticoid-receptor-in-children-undergoing-cardiac-surgery
#2
Saul Flores, David S Cooper, Amy M Opoka, Ilias Iliopoulos, Sarah Pluckebaum, Matthew N Alder, Kelli A Krallman, Rashmi D Sahay, Lin Fei, Hector R Wong
OBJECTIVES: Postoperative administration of corticosteroids is common practice for managing catecholamine refractory low cardiac output syndrome. Since corticosteroid activity is dependent on the glucocorticoid receptor, we sought to characterize glucocorticoid receptor levels in children undergoing cardiac surgery and examined the association between glucocorticoid receptor levels and cardiovascular dysfunction. DESIGN: Prospective observational cohort study. SETTING: Large, tertiary pediatric cardiac center...
April 19, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29677001/impact-of-intravenous-acetaminophen-on-perioperative-opioid-utilization-and-outcomes-in-open-colectomies-a-claims-database-analysis
#3
Isaac Wasserman, Jashvant Poeran, Nicole Zubizarreta, Jason Babby, Stelian Serban, Andrew T Goldberg, Alexander J Greenstein, Stavros G Memtsoudis, Madhu Mazumdar, Andrew B Leibowitz
BACKGROUND: The value of intravenous acetaminophen in postoperative pain management remains debated. The authors tested the hypothesis that intravenous acetaminophen use, in isolation and in comparison to oral, would be associated with decreased opioid utilization (clinically significant reduction defined as 25%) and opioid-related adverse effects in open colectomy patients. METHODS: Using national claims data from open colectomy patients (Premier Healthcare Database, Premier Healthcare Solutions, Inc...
April 20, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29676943/impact-of-preoperative-thrombocytopenia-on-the-outcome-after-coronary-artery-bypass-grafting
#4
Wail Nammas, Magnus Dalén, Stefano Rosato, Riccardo Gherli, Daniel Reichart, Giuseppe Gatti, Francesco Onorati, Giuseppe Faggian, Marisa De Feo, Ciro Bancone, Sidney Chocron, Sorosh Khodabandeh, Giuseppe Santarpino, Antonino S Rubino, Daniele Maselli, Saverio Nardella, Antonio Salsano, Tiziano Gherli, Francesco Nicolini, Marco Zanobini, Matteo Saccocci, Karl Bounader, Paola D'Errigo, Tuomas Kiviniemi, Eeva-Maija Kinnunen, Andrea Perrotti, Juhani Airaksinen, Giovanni Mariscalco, Vito G Ruggieri, Fausto Biancari
The impact of thrombocytopenia on postoperative bleeding and other major adverse events after cardiac surgery is unclear. This issue was investigated in a series of patients who underwent isolated coronary artery bypass grafting (CABG) from the prospective, multicenter E-CABG registry. Preoperative thrombocytopenia was defined as preoperative platelet count <150 × 109 /L and it was considered moderate-severe when preoperative platelet count was <100 × 109 /L. Multilevel mixed-effects regression analysis was performed to adjust the effect of thrombocytopenia on outcomes for baseline and operative covariates as well as for interinstitutional differences in patient-blood management...
April 20, 2018: Platelets
https://www.readbyqxmd.com/read/29676223/opiate-free-tricuspid-valve-replacement-case-report
#5
Jeffrey P Cardinale, George Gilly
The utility of opioid pain medications for perioperative analgesia is well described. However, opioids have many dangerous side effects including respiratory depression, acute tolerance, hyperalgesia, and chronic opioid dependence. Multimodal approaches continue to be used in more invasive and complex surgical procedures for enhanced recovery and decreased postoperative complications from opioid administration. The current case report centers on a 30-year-old male recovering from opioid addiction presenting with severe tricuspid regurgitation scheduled to undergo a tricuspid valve replacement...
April 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29672400/enhanced-recovery-after-surgery-eras-pathway-in-esophagectomy-is-a-reasonable-prediction-of-hospital-stay-possible
#6
Paolo Parise, Carlo Ferrari, Andrea Cossu, Francesco Puccetti, Ugo Elmore, Stefano De Pascale, Leonardo Garutti, Uberto Romario Fumagalli, Mariaclelia Stefania Di Serio, Riccardo Rosati
OBJECTIVE: To assess whether perioperative variables or deviation from enhanced recovery after surgery (ERAS) items could be associated with delayed discharge after esophagectomy, and to convert them into a scoring system to predict it. SUMMARY BACKGROUND DATA: ERAS perioperative pathways have been recently applied to esophageal resections. However, low adherence to ERAS items and high rates of protocol deviations are often reported. METHODS: All patients who underwent esophagectomy between April 2012 and March 2017 were managed with a standardized perioperative pathway according to ERAS principles...
April 18, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29672387/perioperative-surgical-home-evaluation-of-a-new-protocol-focused-on-a-multidisciplinary-approach-to-manage-children-undergoing-posterior-spinal-fusion-operation-erratum
#7
(no author information available yet)
No abstract text is available yet for this article.
May 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29666933/-pain-relief-during-and-after-surgical-procedures-results-of-an-austria-wide-patient-survey-on-postoperative-pain-and-perioperative-pain-management
#8
W Jaksch, R Likar, U Frohner, F Herbst
BACKGROUND: Pain after surgery, especially on the first postoperative day, results in longer hospital stays, increased complication rates and may also cause a higher risk of pain chronification. However, the expected intensity of pain is often misjudged and therefore not adequately treated. METHODOLOGY: An Austria-wide patient survey on the pain situation on the first postoperative day and on the quality of perioperative pain management was carried out on a voluntary and anonymous basis...
April 17, 2018: Der Schmerz
https://www.readbyqxmd.com/read/29666709/anesthetic-considerations-for-an-adult-patient-with-freeman-sheldon-syndrome-undergoing-open-heart-surgery
#9
S Viehmeyer, P Gabriel, K Bauer, S Bauer, R Sodian, J N Hilberath
Freeman-Sheldon syndrome (FSS) or "whistling face" syndrome is a rare congenital disorder complicated by characteristic facial deformities and muscular contractures. We report on a 64-year-old male patient presenting for surgical replacement of his aortic valve and review the available literature on anesthetic considerations and perioperative management principles. FSS frequently poses a significant challenge to airway management and gaining vascular access. Moreover, these patients are reportedly at risk for developing malignant hyperthermia (MH) or neuroleptic malignant syndrome...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29664527/-perioperative-nutrition-in-eras-protocols
#10
Andrés Sánchez C, Karin Papapietro V
The trauma involved in any surgical procedure, even if elective, causes a metabolic stress response characterized by postoperative insulin resistance (PIR). PIR is considered a surgical stress marker and is associated with increased morbidity and postoperative length of stay. PIR worsens when the patient is operated in a state of prolonged preoperative fasting or when postoperative feeding is delayed. The ERAS Protocols (Enhanced Recovery After Surgery) includes anesthetic, surgical, kinesiology, nutritional and nursing interventions aimed to modulate PIR...
November 2017: Revista Médica de Chile
https://www.readbyqxmd.com/read/29664526/-perioperative-care-of-older-patients-with-hip-fractures
#11
Francisco Bengoa, Marcela Carrasco, Pedro Pablo Amenábar, Daniel Schweitzer, Eduardo Botello, Ianiv Klaber
The number of osteoporotic fractures is increasing along with population aging. Most patients with these type of fractures are older than 65 years, with multiple chronic conditions and different degrees of disability. Hip fracture is the most relevant osteoporotic fracture due to its frequency, costs, severity and complications. Multidisciplinary management is of the utmost importance to obtain good therapeutic results. We herein review the management of this fracture. Orthogeriatric joint management should be incorporated in fragility fracture treatment...
November 2017: Revista Médica de Chile
https://www.readbyqxmd.com/read/29664113/peripartum-management-of-hla-alloimmune-platelet-refractoriness
#12
Jeremy Ryan Peña, Leanna Sudhof, Barbara O'Brien
BACKGROUND: Platelet (PLT) refractoriness presents a challenging problem for transfusion support, especially in the perioperative setting, where there is urgency for human leukocyte antigen (HLA)-compatible units, yet identification and provision of compatible PLT concentrates requires time. CASE REPORT: A 22-year-old G3P1 woman with thrombocytopenia due to aplastic anemia, likely autoimmune, presented in her third trimester for peripartum care and newly diagnosed HLA alloimmune PLT refractoriness...
April 17, 2018: Transfusion
https://www.readbyqxmd.com/read/29661575/outcomes-of-laparoscopic-resection-of-meckel-s-diverticulum-are-equivalent-to-open-laparotomy
#13
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/29661410/use-of-prothrombin-complex-concentrate-for-management-of-coagulopathy-after-cardiac-surgery-a-propensity-score-matched-comparison-to-plasma
#14
J Fitzgerald, M Lenihan, J Callum, S A McCluskey, C Srinivas, A van Rensburg, K Karkouti
BACKGROUND: An important cause of coagulopathy in cardiac surgery is impaired thrombin generation. While plasma is often used to correct this element of the coagulopathy, studies in vitro suggest that prothrombin complex concentrates (PCCs) might be more effective. Comparative data, however, are scant. METHODS: We compared the outcomes of those who received only plasma with those who received PCCs (with or without plasma) for management of coagulopathy in patients who underwent cardiac surgery with cardiopulmonary bypass at a single institution from 2012 to 2016...
May 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29661205/comparison-between-minimally-invasive-spine-stabilization-with-and-without-posterior-decompression-for-the-management-of-spinal-metastases-a-retrospective-cohort-study
#15
Hiroshi Uei, Yasuaki Tokuhashi, Masafumi Maseda, Masahiro Nakahashi, Hirokatsu Sawada, Enshi Nakayama, Hirotoki Soma
BACKGROUND: Posterior decompression and stabilization plays significant roles in palliative surgery for metastatic spinal tumor. However, the indication for addition of posterior decompression have not been examined. The purpose of this study was to investigate a retrospective cohort of outcomes of metastatic spinal tumor treated with minimally invasive spine stabilization (MISt) with or without posterior decompression. METHODS: The subjects were 40 patients who underwent MISt using percutaneous pedicle screws for metastatic spinal tumor, including 20 patients treated with stabilization alone (group A) and 20 patients with added posterior decompression (group B)...
April 16, 2018: Journal of Orthopaedic Surgery and Research
https://www.readbyqxmd.com/read/29660924/vasopressor-support-vs-liberal-fluid-administration-in-deep-inferior-epigastric-perforator-diep-free-flap-breast-reconstruction-a-randomized-controlled-trial
#16
A M Anker, L Prantl, C Strauss, V Brébant, N Heine, P Lamby, S Geis, F Schenkhoff, M Pawlik, S M Klein
BACKGROUND: Perioperatively, patients' hemodynamics are modulated predominantly by intravenous fluid administration and vasoactive pharmacological support. Vasopressor agents are suspected to be detrimental on free flap survival by the cause of vasoconstriction of the pedicle with consecutive reduced overall flap perfusion and by aggravation of flap dissection. OBJECTIVE: A novel, standardized fluid restrictive perioperative hemodynamic management was assessed for its feasibility in clinical practice in free flap patients undergoing breast reconstruction...
April 7, 2018: Clinical Hemorheology and Microcirculation
https://www.readbyqxmd.com/read/29660502/the-place-of-fibrinogen-concentrates-in-the-management-of-perioperative-bleeding-a-position-paper-from-the-francophone-working-group-on-perioperative-hemostasis-gihp
#17
REVIEW
Charles Marc Samama, Brigitte Ickx, Yves Ozier, Annick Steib, Sophie Susen, Anne Godier
The consumption of fibrinogen concentrates has been increasing steadily for several years in surgery, trauma and obstetrics. However, data from the literature are conflicting. The French Working Group on Perioperative Haemostasis (GIHP) proposes a position paper based on a narrative review of the literature, and addresses the following questions: - What is the exact role of fibrinogen in haemostasis? - Which rational support for the use of perioperative fibrinogen? - Which thrombotic risk? - What are the most recent professional recommendations on the use of fibrinogen concentrates? Then, evidence-based recommendations are proposed: 1 - It is suggested not to administer prophylactic FC to prevent haemorrhage...
April 13, 2018: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29660396/analysis-of-clinical-management-of-infected-breast-implants-and-of-factors-associated-to-successful-breast-pocket-salvage-in-infections-occurring-after-breast-reconstruction
#18
Simonetta Franchelli, Marianna Pesce, Ilaria Baldelli, Anna Marchese, Pierluigi Santi, Andrea De Maria
OBJECTIVES: Considerable efforts have been devoted so far to improve salvage procedures of infected breast implants in absence of defined guidelines or validated clinical protocols. Within a cohort of prospectively recruited patients who underwent breast reconstruction, we performed a retrospective review of proven implant infections in order to describe factors contributing to management success. METHODS: We collected data in 1293 consecutive patients who underwent two stage (expander+ prosthesis) breast reconstruction with at least 12 months of follow-up...
April 13, 2018: International Journal of Infectious Diseases: IJID
https://www.readbyqxmd.com/read/29658975/thumb-basal-joint-arthroplasty-prospective-comparison-of-perioperative-analgesia-and-opioid-consumption
#19
Andrew J Miller, Michael Livesey, Dennis P Martin, Jack Abboudi, William H Kirkpatrick, Frederic E Liss, Christopher M Jones, Mark L Wang, Jonas L Matzon, Asif M Ilyas
Trapeziectomy alone or in combination with a suspensionplasty technique is a common surgical treatment for symptomatic thumb basal joint arthritis. The authors undertook a prospective comparative study to test the hypothesis that peripheral nerve blocks would provide better pain control than local anesthesia with bupivacaine or liposomal bupivacaine regarding pain scores and opioid pill consumption. Patients who elected to undergo basal joint arthroplasty were allocated to 1 of 3 postoperative pain management groups: (1) peripheral nerve block, (2) local anesthesia with bupivacaine, or (3) local anesthesia with liposomal bupivacaine...
April 16, 2018: Orthopedics
https://www.readbyqxmd.com/read/29658673/-application-of-rehabilitation-medicine-in-enhanced-recovery-after-surgery
#20
Haijun Li, Zuobing Chen
Enhanced recovery after surgery (ERAS) has been widely used in perioperative optimization. As an important component of ERAS, rehabilitation medicine mainly focuses on perioperative physical fitness management, respiratory training, exercise training to reduce the incidence of postoperative pulmonary infection, improve gastrointestinal and cardiopulmonary function. This paper explains rehabilitation medicine for respiratory, musculoskeletal, cardiovascular and digestive systems during the perioperative period...
May 25, 2017: Zhejiang da Xue Xue Bao. Yi Xue Ban, Journal of Zhejiang University. Medical Sciences
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