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Perioperative management

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https://www.readbyqxmd.com/read/28345572/late-dislocation-of-in-the-bag-intraocular-lenses-in-uveitic-eyes-an-analysis-of-management-and-complications
#1
Sudha K Ganesh, Parveen Sen, Hitesh R Sharma
AIM: An analysis of late in-the-bag dislocation of intraocular lenses (IOL), in uveitic eyes. SETTING: Referral uveitis clinic. DESIGN: Retrospective case series. MATERIALS AND METHODS: All case records of eyes with chronic uveitis that had phacoemulsification with IOL implantation, at a referral uveitis clinic between February 1997 and January 2015 were retrieved and analyzed. Only those eyes with no documented intraoperative complication and no predisposing risks to IOL dislocation, such as pseudoexfoliation, high myopia, trauma, and prior VR surgery were included in this study...
February 2017: Indian Journal of Ophthalmology
https://www.readbyqxmd.com/read/28343821/use-of-chronic-methadone-before-total-knee-arthroplasty
#2
Ferdinand J Chan, Andrew M Schwartz, Jason Wong, Cynthia Chen, Bharat Tiwari, Sun Jin Kim
BACKGROUND: A subset of patients who undergo total knee arthroplasty (TKA) are on methadone maintenance. They require more and often unpredictable quantities of opioids to function as effective painkillers. This study aims to compare the opioid requirements and the immediate postoperative course for patients on methadone maintenance with those who are not, after a TKA. METHODS: A retrospective, case-control study was performed. From 2005 to 2010, 36 patients, who underwent a unilateral TKA, on chronic methadone maintenance were identified...
February 28, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28343663/development-of-a-novel-technique-for-bilateral-rectus-sheath-nerve-blocks-under-laparoscopic-guidance
#3
Alessandra Landmann, Mihaela Visoiu, Marcus M Malek
BACKGROUND: Bilateral rectus sheath blocks have proven to be superior to local anesthetic infiltration for umbilical incisions and have been gaining popularity for the treatment of perioperative pain in children. We aim to develop a technique of surgeon performed rectus sheath blocks under laparoscopic-guidance alone. METHODS: In phase I, we observed the laparoscopic appearance of a rectus sheath block. The pain management team performed an ultrasound-guided rectus sheath nerve block as we visualized the posterior rectus sheath with the laparoscope...
March 16, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28342650/subtotal-cholecystectomy-for-the-hostile-gallbladder-failure-to-control-the-cystic-duct-results-in-significant-morbidity
#4
Michael E Lidsky, Paul J Speicher, Brian Ezekian, Edwin W Holt, Daniel P Nussbaum, Anthony W Castleberry, Alexander Perez, Theodore N Pappas
BACKGROUND: Outcomes following the inability to control the cystic duct due to a hostile triangle of Calot during cholecystectomy remain unknown. The purpose of this study was to analyze the safety and efficacy of subtotal cholecystectomy, with attention to the necessity for secondary interventions. METHODS: Sixteen thousand five hundred ninety six cholecystectomies from January 2002 to August 2014 were reviewed, identifying patients managed with subtotal cholecystectomy, defined as the inability to isolate/transect the cystic duct...
March 22, 2017: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
https://www.readbyqxmd.com/read/28341949/complications-and-outcomes-after-gynecomastia-surgery-analysis-of-204-pediatric-and-1583-adult-cases-from-a-national-multi-center-database
#5
Dmitry Zavlin, Kevin T Jubbal, Jeffrey D Friedman, Anthony Echo
BACKGROUND: Gynecomastia is a common disease that is prevalent across all age groups of boys and men. Although benign in nature, it can lead to psychological and social distress, prompting affected patients to seek medical attention. Management strategies include observation and drug therapy, yet surgical procedures remain the hallmark of treatment. The goal of this study was to analyze patient demographics, outcomes, and complication rates of gynecomastia surgery in a large multi-institutional cohort...
March 24, 2017: Aesthetic Plastic Surgery
https://www.readbyqxmd.com/read/28341492/understanding-antibiotic-decision-making-in-surgery-a-qualitative-analysis
#6
E Charani, C Tarrant, K Moorthy, N Sevdalis, L Brennan, A H Holmes
OBJECTIVE: To investigate the characteristics and culture of antibiotic decision making in the surgical specialty. METHODS: A qualitative study including ethnographic observation and face to face interviews with participants from six surgical teams at a teaching hospital in London was conducted. Over a three month period: 1) thirty ward rounds (WRs) (100 hours) were observed, 2) face-to-face follow up interviews took place with thirteen key informants, 3) multidisciplinary meetings on the management of surgical patients and daily practice on wards were observed...
March 21, 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/28341442/risk-factors-for-postoperative-delirium-after-colorectal-operation
#7
Frederik J van der Sluis, Pieter L Buisman, Mark Meerdink, Wouter B Aan de Stegge, Boudewijn van Etten, Geertruida H de Bock, Barbara L van Leeuwen, Robert A Pol
BACKGROUND: A clear understanding of risk factors for postoperative delirium helps in the selection of individuals who might benefit from targeted perioperative intervention. The aim of this study was to identify risk factors for postoperative delirium after colorectal operation for malignancy. METHODS: All consecutive patients who underwent elective or emergency operation because of malignancy of the colon, sigmoid, or rectum between 2009 and 2012 were included in this study...
March 2017: Surgery
https://www.readbyqxmd.com/read/28339431/perioperative-ketamine-administration-for-thoracotomy-pain
#8
Daniel W Moyse, Alan D Kaye, James H Diaz, Muhammad Y Qadri, David Lindsay, Srinivas Pyati
BACKGROUND: Of all the postsurgical pain conditions, thoracotomy pain poses a particular therapeutic challenge in terms of its prevalence, severity, and ensuing postoperative morbidity. Multiple pain generators contribute to the severity of post-thoracotomy pain, and therefore a multimodal analgesic therapy is considered to be a necessary strategy. Along with opioids, thoracic epidural analgesia, and paravertebral blocks, N-Methyl-D-Aspartate (NMDA) receptor antagonists such as ketamine have been used as adjuvants to improve analgesia...
March 2017: Pain Physician
https://www.readbyqxmd.com/read/28338589/managing-hip-fracture-and-lower-limb-surgery-in-the-emergency-setting-potential-role-of-non-vitamin-k-antagonist-oral-anticoagulants
#9
William Fisher
Trauma, immobilization, and subsequent surgery of the hip and lower limb are associated with a high risk of developing venous thromboembolism (VTE). Individuals undergoing hip fracture surgery (HFS) have the highest rates of VTE among orthopedic surgery and trauma patients. The risk of VTE depends on the type and location of the lower limb injury. Current international guidelines recommend routine pharmacological thromboprophylaxis based on treatment with heparins, fondaparinux, dose-adjusted vitamin K antagonists and acetylsalicylic acid for patients undergoing emergency HFS; however, not all guidelines recommend pharmacological prophylaxis for patients with lower limb injuries...
March 23, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28338491/perioperative-management-of-blood-loss-in-spine-surgery
#10
Rabia Qureshi, Varun Puvanesarajah, Amit Jain, Hamid Hassanzadeh
Spine procedures are associated with high rates of blood loss which can result in a greater need for transfusions. Repeated exposure to blood products is associated with risks and adverse reactions such as transfusion-related acute lung injury, fluid shifting, and infections. With the higher number of spine procedures and the increasing open surgery times associated with difficult procedures, excessive blood loss has become more prevalent. Perioperative methods have been established to combat the excessive blood loss and decrease the need for blood products...
March 23, 2017: Clinical Spine Surgery
https://www.readbyqxmd.com/read/28338449/development-of-a-preoperative-predictive-model-for-major-complications-following-adult-spinal-deformity-surgery
#11
Justin K Scheer, Justin S Smith, Frank Schwab, Virginie Lafage, Christopher I Shaffrey, Shay Bess, Alan H Daniels, Robert A Hart, Themistocles S Protopsaltis, Gregory M Mundis, Daniel M Sciubba, Tamir Ailon, Douglas C Burton, Eric Klineberg, Christopher P Ames
OBJECTIVE The operative management of patients with adult spinal deformity (ASD) has a high complication rate and it remains unknown whether baseline patient characteristics and surgical variables can predict early complications (intraoperative and perioperative [within 6 weeks]). The development of an accurate preoperative predictive model can aid in patient counseling, shared decision making, and improved surgical planning. The purpose of this study was to develop a model based on baseline demographic, radiographic, and surgical factors that can predict if patients will sustain an intraoperative or perioperative major complication...
March 24, 2017: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/28338025/preventing-perioperative-bleeding-in-patients-with-inherited-bleeding-disorders
#12
Colin Watterson, Nicholas Beacher
Data sourcesCochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register, a regularly updated database informed by trials identified within electronic databases including MEDLINE. Further defined searches were undertaken in PubMed, Embase, The Cochrane Library, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform. Additional hand searching of relevant journals and books of conference proceedings was undertaken.Study selectionRandomised and quasi-randomised controlled trials in people of all ages with haemophilia or VWD undergoing oral or dental procedures using antifibrinolytic agents (tranexamic acid (TXA) or epsilon aminocaproic acid (EACA)) to prevent perioperative bleeding compared to no intervention with or without placebo...
March 2017: Evidence-based Dentistry
https://www.readbyqxmd.com/read/28336037/deep-vein-thrombosis-and-pulmonary-embolism-considerations-in-orthopedic-surgery
#13
REVIEW
Jasmine Saleh, Mouhanad M El-Othmani, Khaled J Saleh
Patients undergoing orthopedic surgery have an increased risk for deep venous thrombosis (DVT) and pulmonary embolism (PE). These complications are considered detrimental, as they cause major postoperative morbidity and mortality and lead to a substantial health care burden. Because of the high incidence and serious nature of these complications, it is essential for orthopedic surgeons to have a comprehensive knowledge of the risk factors, diagnosis, and treatment of acute DVT and PE. Perioperative management of orthopedic patients to prevent postoperative DVT and PE and optimize postoperative outcomes is also discussed in this review...
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336026/viscoelastic-studies-effective-tools-for-trauma-and-surgical-resuscitation-efforts
#14
Dagoberto Salinas
Trauma-induced coagulopathy (TIC) is an abrupt disruption of all hemostatic components of coagulation resulting from severe tissue injury and hypoperfusion. The effective management of TIC has remained elusive to clinicians using traditional laboratory methods, challenging efforts to improve outcomes related to uncontrolled bleeding. Recent initiatives have aimed to reduce TIC-associated morbidity and mortality, further invoking trauma experts to explore innovative modalities in the field of viscoelastic studies, such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM)...
April 2017: AORN Journal
https://www.readbyqxmd.com/read/28335987/community-health-indicators-associated-with-outcomes-of-pancreatectomy
#15
Lauren Slakey Pointer, Zaid Al-Qurayshi, David Taylor Pointer, Emad Kandil, Douglas Philip Slakey
PURPOSE: This study evaluates the association of environmental, social and health risk factors in relation to outcomes of pancreatic surgery. METHODS: Patients who underwent pancreatectomy with a 30 day postoperative follow up in Florida, New York and Washington states were identified using the State Inpatient Databases (SID) from 2010 to 2011. This data was merged with community health indicators complied from the County Health Ranking database. Fourteen community health indicators were used to determine higher risk communities...
March 10, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28334545/-conservative-treatment-of-late-aortic-graft-infection
#16
Peter Baľa, Kamil Zeman, Renata Kološová, Ivo Pavlas, Dušan Kučera
Aortic graft infection is one of the most serious complications of aortovascular surgery. Diagnosis is based on clini-cal and radiologic findings. The emphasis is put on early diagnosis and its impact on prognosis of patients. The management should be individualized. The gold standard is surgical treatment with complete excision of the infected foreign material with debridement of the surrounding tissue and repair of vascular continuity by extra-anatomic bypass or in situ bypass with autologous femoral vein or cryopreserved arterial allografts...
2017: Vnitr̆ní Lékar̆ství
https://www.readbyqxmd.com/read/28333038/detecting-colorectal-cancer-using-electrical-impedance-spectroscopy-an-ex-vivo-feasibility-study
#17
Angela Pathiraja, Paul Ziprin, Arsam Shiraz, Reza Mirnezami, Andrew Tizzard, Brian Brown, Andreas Demosthenous, Richard H Bayford
OBJECTIVE: Colorectal cancer is the fourth most common cancer worldwide, with a lifetime risk of around 20%. Current solutions do not allow clinicians to objectively assess tissue abnormality during endoscopy and perioperatively. A solution capable of objectively assessing samples in real time could greatly improve the treatment process. A solution that can be integrated in minimally invasive diagnostics and management strategies to provide real-time point-of-care information would be greatly transformative...
March 23, 2017: Physiological Measurement
https://www.readbyqxmd.com/read/28332129/development-of-an-enhanced-recovery-after-surgery-eras-protocol-in-laparoscopic-colorectal-surgery-results-of-the-first-120-consecutive-cases-from-a-university-hospital
#18
Antonio Brescia, Federico Tomassini, Giammauro Berardi, Carola Sebastiani, Massimo Pezzatini, Anna Dall'Oglio, Giovanni Guglielmo Laracca, Fabrizio Apponi, Marcello Gasparrini
The ERAS(®) represents a dynamic culmination of upon perioperative care elements, successfully applied to different surgical specialties with shorter hospital stay and lower morbidity rates. The aim of this study is to describe the introduction of the ERAS protocol in colorectal surgery in our hospital analysing our first series. Between September 2014 and June 2016, 120 patients suffering from colorectal diseases were included in the study. Laparoscopic approach was used in all patients if not contraindicated...
March 22, 2017: Updates in Surgery
https://www.readbyqxmd.com/read/28331362/anesthesia-for-the-patient-undergoing-total-knee-replacement-current-status-and-future-prospects
#19
REVIEW
Zachary A Turnbull, Dahniel Sastow, Gregory P Giambrone, Tiffany Tedore
Total knee arthroplasty (TKA) has become one of the most common orthopedic surgical procedures performed nationally. As the population and surgical techniques for TKAs have evolved over time, so have the anesthesia and analgesia used for these procedures. General anesthesia has been the dominant form of anesthesia utilized for TKA in the past, but regional anesthetic techniques are on the rise. Multiple studies have shown the potential for regional anesthesia to improve patient outcomes, such as a decrease in intraoperative blood loss, length of stay, and patient mortality...
2017: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/28329461/cardiac-function-after-tetralogy-of-fallot-complete-atrioventricular-canal-repair
#20
Elizabeth H Stephens, Jennifer Tingo, Marc Najjar, Betul Yilmaz, Stéphanie Levasseur, Jeffrey D Dayton, Ralph S Mosca, Paul Chai, Jan M Quaegebeur, Emile A Bacha
BACKGROUND: Repair of complete atrioventricular canal (CAVC) with tetralogy of Fallot (TOF) is a challenging operation increasingly being performed as a complete, primary repair in infancy. Previous studies have focused on perioperative outcomes; however, midterm valve function, ventricular function, and residual obstruction have received little attention. METHODS: We retrospectively reviewed 20 patients who underwent CAVC/TOF repair (January 2005 to December 2014)...
March 2017: World Journal for Pediatric & Congenital Heart Surgery
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