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Perioperative management

A Schernberg, E Rivin Del Campo, B Rousseau, O Matzinger, M Loi, P Maingon, F Huguet
An estimated 990,000 new cases of gastric cancer are diagnosed worldwide each year. Surgical excision, the only chance for prolonged survival, is feasible in about 20% of cases. Even after surgery, the median survival is limited to 12 to 20 months due to the frequency of locoregional and/or metastatic recurrences. This led to clinical trials associating surgery with neoadjuvant or adjuvant treatments to improve tumor control and patient survival. The most studied modalities are perioperative chemotherapy and adjuvant chemoradiotherapy...
March 2018: Clinical and Translational Radiation Oncology
Hai-Feng Huang, Jia-Liang Tian, Xian-Teng Yang, Li Sun, Ru-Yin Hu, Zhi-Hui Yan, Shan-Shan Li, Quan Xie, Xiao-Bin Tian
BACKGROUND: Venous thromboembolism (VTE) is considered a potentially serious complication of knee arthroscopy and leads to conditions such as deep venous thrombosis (DVT) and pulmonary embolism (PE). Low-molecular-weight heparin (LMWH) is widely employed in knee arthroscopy to reduce perioperative thromboembolic complications. However, the efficacy and safety of LMWH in knee arthroscopy remains unclear. METHODS: Seven randomized controlled clinical trials on LMWH in knee arthroscopy were identified and included in this meta-analysis...
2018: PloS One
Allan F Simpao, Annie A Ma, Jonathan M Tan, Jack O Wasey, Aaron J Masino, Jorge A Gálvez
We present the case of a laryngospasm event in a 21-month-old child in which the changes in pulse oximetry and end-tidal carbon dioxide were recorded by both our Anesthesia Information Management System and middleware medical device integration platform. When this case was analyzed retrospectively, we noted that the 2 systems recorded the event very differently with respect to pulse oximetry. This case report illustrates the impact of data sampling rates on post hoc analysis of perioperative events and highlights the importance of understanding data collection processes when using electronically recorded data...
June 18, 2018: A&A practice
Masahide Enomoto, Takeshi Kinoshita, Yasuo Kondo, Tomoaki Suzuki, Tohru Asai
We present the case of a 61-year-old patient with a history of essential thrombocythemia (ET) who was diagnosed as having aortic valve stenosis and dilatation of his ascending aorta. His aortic valve and ascending aorta were replaced under hypothermic circulatory arrest (HCA). No clear guideline exists for preoperative, perioperative, and postoperative management of cardiac surgery using HCA for ET patients. After performing risk assessment, we prescribed preoperative aspirin therapy and postoperative care was planned as usual for cardiovascular surgery in our establishment...
June 21, 2018: Annals of Thoracic and Cardiovascular Surgery
William C Buhrman, William B Lyman, Russell C Kirks, Michael Passeri, Dionisios Vrochides
For over two decades, enhanced recovery pathways have been implemented in many surgical disciplines, most notably in colorectal surgery. Since 2001, the Enhanced Recovery After Surgery (ERAS® ) Study Group has developed a main protocol comprising 24 evidence-based core items. While these core items unite similar preoperative, intraoperative, and postoperative principles across surgical subspecialties, variations and modifications exist to these core items based on unique considerations for each surgical subspecialty...
June 20, 2018: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Mohammed Alhaidar, Mohanad Algaeed, Richard Amdur, Rami Algahtani, Shahram Majidi, Dimitri Sigounas, Christopher R Leon Guerrero
Background: Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are both viable treatment options for carotid artery stenosis. We sought to compare perioperative outcomes after CEA and CAS for the management of carotid stenosis using a "real-world" sample. Methods: We conducted a retrospective observational study using the National Surgical Quality Improvement Program database to compare 30-day (periprocedural) outcomes in patients with carotid stenosis undergoing CEA versus CAS from 2005 to 2012...
June 2018: Journal of Vascular and Interventional Neurology
Brandon D D'Aloiso, Sarah S Rupchak, Kaitlin J Gettle, Claudio Lima, Robert D Rush
Waldenström's Macroglobulinemia (WM) is a rare lymphoma caused by the overproduction of immunoglobulin M (IgM). The elevated level of IgM causes serum hyperviscosity, cold agglutinins, and cryoglobulinemia. Anemia is also present because of impaired production of erythrocytes. For these reasons, placing a patient with WM on cardiopulmonary bypass (CPB) requires careful preparation. In this case, the patient was a 73-year-old male with known Waldenström's disease who required coronary artery bypass graft surgery...
June 2018: Journal of Extra-corporeal Technology
Jong Man Kim, Choon Hyuck David Kwon, Heejin Yoo, Kyeung-Sik Kim, Jisoo Lee, Kyunga Kim, Gyu-Seong Choi, Jae-Won Joh
BACKGROUND: Laparoscopic liver resection has been reported as a safe and effective approach for the management of hepatocellular carcinoma (HCC). However, its perioperative and oncological outcomes have not been evaluated in left hepatectomy patients. The aim of the present study is to compare the outcomes of left hepatectomy through laparoscopic and open approaches in left HCC. METHODS: From December 2012 to October 2016, laparoscopic left hepatectomy (LLH) was performed in 40 patients and open left hepatectomy (OLH) was performed in 80 patients...
June 19, 2018: BMC Cancer
Chris D Glover, Allison M Fernandez, Henry Huang, Christopher Derderian, Wendy Binstock, Russell Reid, Nicholas M Dalesio, John Zhong, Paul A Stricker
BACKGROUND/AIMS: The evolution of Le Fort III and Monobloc procedures with utilization of distraction devices has resulted in shortened surgical times, greater facial advancements, and decreased transfusion requirements. The aim of this observational study was to utilize data from the multicenter Pediatric Craniofacial Surgery Perioperative Registry to present and compare patient characteristics and outcomes in children undergoing midface advancement with distraction osteogenesis. METHODS: We queried the Pediatric Craniofacial Surgery Perioperative Registry for children undergoing midface advancement involving distractor application from June 2012 to September 2016...
June 19, 2018: Paediatric Anaesthesia
Robert C Rennert, Kristine Ravina, Ben A Strickland, Joshua Bakhsheshian, Joseph Carey, Jonathan J Russin
BACKGROUND: Surgical innovation is critical for the management of challenging cerebrovascular pathology. Flow-through free flaps are versatile composite grafts that combine viable tissue with a revascularization source. Neurosurgical experience with these flaps is limited. OBJECTIVE: To provide an in-depth technical description of the radial artery fascial (and fasciocutaneous) flow-through free flap (RAFF and RAFCF, respectively) for complex cerebral revascularizations...
June 16, 2018: Operative Neurosurgery (Hagerstown, Md.)
Héctor-Omar Malagón-Hidalgo, Roberto Vilchis-López, Diego-Raúl González-Chapa, Richael-Antonio Silva-Suárez, Eugenio García-Cano, José-Luis Lastiri-Barrios, Fernando González-Magaña
INTRODUCTION: The LeFort II osteotomy has a specific number of indications, thus this is true, there is less experience with the technique. The authors present a modification to the technique and extensive step-by-step procedure explanation in order to share their experience for making a safe surgery. MATERIAL AND METHODS: A clinical report is presented of a nonsyndromatic patient with nasomaxillary hypoplasia, in which the authors make an LeFort II osteotomy with circumvestibular, transcaruncular, and "W"-shaped approaches, with minimal scar showing, in order to offer better aesthetic outcomes as well as functional and skeletal...
June 18, 2018: Journal of Craniofacial Surgery
Kristin E Rojas, Donna-Marie Manasseh, Peter L Flom, Solomon Agbroko, Nicole Bilbro, Charusheela Andaz, Patrick I Borgen
BACKGROUND: The evolving conceptualization of the management of surgical pain was a major contributor to the supply of narcotics that led to the opioid crisis. We designed and implemented a breast surgery-specific Enhanced Recovery After Surgery (ERAS) protocol using opioid-sparing techniques to eliminate narcotic prescription at discharge without sacrificing perioperative pain control. METHODS: A pilot observational study included patients with and without cancer undergoing lumpectomy...
June 18, 2018: Breast Cancer Research and Treatment
C Griffiths, R S Howell, H Boinpally, E Jimenez, E Chalas, F Musa, S Gorenstein
Postoperative management of patients with vulvar cancer is associated with a high incidence of poor wound healing and radiation -induced late tissue necrosis. This case series demonstrates the impact on wound healing with the use of hyperbaric oxygen therapy and advanced wound care following radical vulvectomy and/or radiation therapy. A retrospective case series was performed of all patients from 2016 to 2017 with lower genital cancer who underwent radical surgery with or without chemoradiation treatment, experienced wound dehiscence or late tissue radionecrosis, and were treated with advanced wound care, including hyperbaric oxygen therapy (HBO)...
May 2018: Gynecologic Oncology Reports
Alain Borgeat, Christian Ofner, Andrea Saporito, Mazda Farshad, José Aguirre
STUDY OBJECTIVE: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in postoperative pain management. While an increasing number of in vitro and animal studies point toward an inhibitory effect of NSAIDs on bone healing process, the few existing retro- and prospective clinical studies present conflicting data. DESIGN: The aim of this qualitative, systematic review was to investigate the impact of perioperative use of NSAIDs in humans on postoperative fracture/spinal fusion healing compared to other used analgesics measured as fracture nonunion with radiological control...
June 15, 2018: Journal of Clinical Anesthesia
Bobby Yanagawa, Amine Mazine, Derrick Y Tam, Peter Jüni, Deepak L Bhatt, Stephen Spindel, John D Puskas, Subodh Verma, Jan O Friedrich
OBJECTIVE: Surgical management of aortic valve infective endocarditis (IE) with cryopreserved homograft has been associated with lower risk of recurrent IE, but there is equipoise with regard to the optimal prosthesis. This systematic review and meta-analysis were performed to compare outcomes between homograft and conventional prosthesis for aortic valve IE. METHODS: We searched MEDLINE database to September 2017 for studies comparing homograft versus conventional prosthesis...
June 15, 2018: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Xinchun Liu
Full endoscopy spine surgery is one of the minimally invasive procedures for lumbar spine disease and is especially popular in East Asia. As for the interlaminar approach, lumbar recess stenosis can be manipulated through a uniportal bigger diameter working channel spinal endoscope or a smaller one, or a biportal arthroscope. Each kind of procedure has its advantages and shortcomings. Here, a novel experience in biportal interlaminar approach for lumbar recess stenosis is presented. A smaller uniportal spinal endoscope is adopted for biportal procedures rather than the arthroscope...
June 15, 2018: Clinical Spine Surgery
Elina Tiippana, Kaisa Nelskylä, Eija Nilsson, Eero Sihvo, Matti Kataja, Eija Kalso
Background and aims Thoracotomies can cause severe pain, which persists in 21-67% of patients. We investigated whether NSAID + intravenous patient-controlled analgesia (IV-PCA) with morphine is an efficacious alternative to thoracic epidural analgesia (TEA). We also wanted to find out whether an extended controlled pain management protocol within a clinical study can decrease the incidence of persistent post-thoracotomy pain. Methods Thirty thoracotomy patients were randomized into 3 intervention groups with 10 patients in each...
December 29, 2017: Scandinavian Journal of Pain
Madhuri S Kurdi, Ashwini H Ramaswamy
The menstrual cycle is a physiological phenomenon that is accompanied by several hormonal fluctuations involving oestrogen and progesterone. Oestrogen and progesterone exert several physiological effects. There are many questions pertaining to the influence of the physiology of menstruation on anaesthesia. We attempted to find out whether the phase of the menstrual cycle can alter the physiological functions during anaesthesia, the perioperative management and outcomes. We performed a literature search in Google Scholar, PubMed and Cochrane databases for original and reviewed articles on the phases of the menstrual cycle and their relation to anaesthesia-related physiological parameters to find an answer to these questions...
May 2018: Indian Journal of Anaesthesia
Hongzhang Guo, Changde Wang, Yufang He
BACKGROUND: The objective of this study was to assess whether intravenous acetaminophen for patients undergoing knee or hip arthroplasty could reduce the opioid consumption and improve pain management. METHOD: Eligible studies were searched from electronic databases including PubMed, Web of Science, Embase (Ovid interface) and Cochrane Library (Ovid interface). The quality assessments were performed according to the Cochrane systematic review method. The assessed outcomes were including opioid consumption, pain scores, length of hospital stays and total occurrence of adverse events...
June 14, 2018: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Estelle Everett, Nestoras Mathioudakis
PURPOSE OF REVIEW: Hyperglycemia occurs frequently in hospitalized patients with stroke and peripheral vascular disease (PVD). Guidelines for inpatient glycemic management are not well established for this patient population. We will review the clinical impact of hyperglycemia in this acute setting and review the evidence for glycemic control. RECENT FINDINGS: Hyperglycemia in acute stroke is associated with poor short and long-term outcomes, and perioperative hyperglycemia in those undergoing revascularization for PVD is linked to increased post-surgical complications...
June 16, 2018: Current Diabetes Reports
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