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https://www.readbyqxmd.com/read/29792232/effect-of-postoperative-goal-directed-therapy-in-cancer-patients-undergoing-high-risk-surgery-a-randomized-clinical-trial-and-meta-analysis
#1
Aline Rejane Muller Gerent, Juliano Pinheiro Almeida, Evgeny Fominskiy, Giovanni Landoni, Gisele Queiroz de Oliveira, Stephanie Itala Rizk, Julia Tizue Fukushima, Claudia Marques Simoes, Ulysses Ribeiro, Clarice Lee Park, Rosana Ely Nakamura, Rafael Alves Franco, Patricia Inês Cândido, Cintia Rosa Tavares, Ligia Camara, Graziela Dos Santos Rocha Ferreira, Elisangela Pinto Marinho de Almeida, Roberto Kalil Filho, Filomena Regina Barbosa Gomes Galas, Ludhmila Abrahão Hajjar
BACKGROUND: Perioperative goal-directed hemodynamic therapy (GDHT) has been advocated in high-risk patients undergoing noncardiac surgery to reduce postoperative morbidity and mortality. We hypothesized that using cardiac index (CI)-guided GDHT in the postoperative period for patients undergoing high-risk surgery for cancer treatment would reduce 30-day mortality and postoperative complications. METHODS: A randomized, parallel-group, superiority trial was performed in a tertiary oncology hospital...
May 23, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29743884/exploring-postoperative-cognitive-dysfunction-and-delirium-in-noncardiac-surgery-using-mri-a-systematic-review
#2
REVIEW
Chenxi Huang, Johan Mårtensson, Ismail Gögenur, Mohammad Sohail Asghar
Surgical patients are at high risk of developing postoperative cognitive dysfunction (POCD) and postoperative delirium (POD). POCD and POD are associated with increased morbidity and mortality and worsening functional outcomes leading to severe socioeconomic consequences for the patient and the society in general. Magnetic resonance imaging (MRI) offers a unique opportunity to study the anatomy and function of the brain. MRI thus plays an important role in elucidating the neuronal component of POCD and POD...
2018: Neural Plasticity
https://www.readbyqxmd.com/read/29742684/myocardial-injury-after-noncardiac-surgery-incidence-and-predictors-from-a-prospective-observational-cohort-study-at-an-indian-tertiary-care-centre
#3
Rubin George, Vidya P Menon, Fabia Edathadathil, Sabarish Balachandran, Merlin Moni, Dipu Sathyapalan, Preetha Prasanna, Gokuldas S, Jerry Paul, Chandrababu K K, Lakshmi Kumar, Ashok Pillai
Asymptomatic myocardial injury following noncardiac surgery (MINS) is an independent predictor of 30-day mortality and may go unrecognized based on standard diagnostic definition for myocardial infarction (MI). Given lack of published research on MINS in India, our study aims to determine incidence of MINS in patients undergoing noncardiac surgery at our tertiary care hospital, and evaluate the clinical characteristics including 30-day outcome.The prospective observational study included patients >65 years or >45 years with either hypertension (HTN), diabetes mellitus (DM), coronary artery disease (CAD), cerebrovascular accident (CVA), or peripheral arterial disease undergoing noncardiac surgery...
May 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29741972/effects-of-perioperative-statins-on-patient-outcomes-after-noncardiac-surgery-a-meta-analysis
#4
Baoxin Ma, Jingwu Sun, Shuling Diao, Bo Zheng, Hua Li
BACKGROUND: Cardiovascular complications are strongly correlated with a higher risk of mortality during follow-up after noncardiac surgery. However, controversy remains regarding whether perioperative administration of hydroxymethylglutaryl-CoA reductase inhibitors (statins) has a beneficial effect on patient outcomes. OBJECTIVE: We performed a meta-analysis to validate the hypothesis that perioperative statins improve patient outcomes after noncardiac surgery. METHODS: Electronic databases (PubMed, Web of Science, EMBASE, and the Cochrane Library) were searched for randomized controlled trials (RCTs) published up to 10 November 2017...
May 9, 2018: Annals of Medicine
https://www.readbyqxmd.com/read/29734243/incidence-and-risk-factors-for-perioperative-cardiovascular-and-respiratory-adverse-events-in-pediatric-patients-with-congenital-heart-disease-undergoing-noncardiac-procedures
#5
Sandra Lee, Elise Reddington, Sophia Koutsogiannaki, Michael R Hernandez, Kirsten C Odegard, James A DiNardo, Koichi Yuki
BACKGROUND: While mortality and adverse perioperative events after noncardiac surgery in children with a broad range of congenital cardiac lesions have been investigated using large multiinstitutional databases, to date single-center studies addressing adverse outcomes in children with congenital heart disease (CHD) undergoing noncardiac surgery have only included small numbers of patients with significant heart disease. The primary objective of this study was to determine the incidences of perioperative cardiovascular and respiratory events in a large cohort of patients from a single institution with a broad range of congenital cardiac lesions undergoing noncardiac procedures and to determine risk factors for these events...
April 27, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29712717/long-term-mortality-after-acute-kidney-injury-in-the-pediatric-icu
#6
Erin Hessey, Geneviève Morissette, Jacques Lacroix, Sylvie Perreault, Susan Samuel, Marc Dorais, Philippe Jouvet, Jean-Philippe Lafrance, Jacques LeLorier, Véronique Phan, Ana Palijan, Michael Pizzi, Louise Roy, Michael Zappitelli
OBJECTIVES: (1) To evaluate the association between acute kidney injury (AKI) in the PICU and long-term mortality and (2) to determine the extent to which adding the urine output (UO)-defined AKI alters the association. METHODS: A 2-center retrospective cohort study of children (≤18 years old) admitted to the PICU between 2003 and 2005 for noncardiac surgery, with follow-up until 2010. Patients with end stage renal disease, no provincial health insurance number, who died during hospitalization, or could not be linked to administrative data were excluded...
May 2018: Hospital Pediatrics
https://www.readbyqxmd.com/read/29697506/association-of-neuraxial-anesthesia-with-postoperative-venous-thromboembolism-after-noncardiac-surgery-a-propensity-matched-analysis-of-acs-nsqip-database
#7
Alparslan Turan, Gausan R Bajracharya, Steve Leung, Merve Yazici Kara, Guangmei Mao, Thomas Botsford, Kurt Ruetzler, Kamal Maheshwari, Wael Ali Sakr Esa, Hesham Elsharkawy, Daniel I Sessler
BACKGROUND: Neuraxial anesthesia improves components of the Virchow's triad (hypercoagulability, venous stasis, and endothelial injury) which are key pathogenic contributors to venous thrombosis in surgical patients. However, whether neuraxial anesthesia reduces the incidence of venous thromboembolism (VTE) remain unclear. We therefore tested the primary hypothesis that neuraxial anesthesia reduces the incidence of 30-day VTE in adults recovering from orthopedic surgery. Secondarily, we tested the hypotheses that neuraxial anesthesia reduces 30-day readmission, 30-day mortality, and the duration of postoperative hospitalization...
April 23, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29685515/cerebral-embolization-during-endovascular-infrarenal-juxtarenal-and-suprarenal-aortic-aneurysm-repair-high-risk-maneuvers-and-associated-neurologic-outcomes
#8
Ruth A Benson, David Matthews, Vanessa Loftus, Grainne Nicholson, David Tropman, Ian M Loftus
BACKGROUND: Risk factors for postoperative cognitive decline after noncardiac surgery are multifactorial and poorly understood. Evidence suggests that perioperative microembolic damage to the brain on movement of wires and catheters during endovascular aortic procedures may play an important role. Endovascular aortic aneurysm repair requires invasive manipulation of wires and cannulas within the aorta, but research into cerebral emboli during aortic aneurysm repair and cognitive or neurologic injury is scarce and limited to thoracic aneurysms...
April 20, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29672409/association-of-preoperative-anticholinergic-medication-exposure-with-postoperative-healthcare-resource-use-and-outcomes-a-population-based-cohort-study
#9
Daniel I McIsaac, Coralie A Wong, Deric Diep, Carl van Walraven
OBJECTIVE: The aim of this study was to measure the association of preoperative anticholinergic exposure with length of stay (LOS) and other outcomes in older people having elective noncardiac surgery. SUMMARY BACKGROUND DATA: Anticholinergic medications are associated with adverse events in nonsurgical populations; the association of anticholinergic medications with outcomes in elective surgery patients is poorly described. METHODS: We conducted a retrospective, population-based cohort study using linked administrative data in Ontario, Canada...
April 18, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29630129/a-meta-analysis-of-pharmacological-neuroprotection-in-noncardiac-surgery-focus-on-statins-lidocaine-ketamine-and-magnesium-sulfate
#10
Z-W Zeng, Y-N Zhang, W-X Lin, W-Q Zhang, R Luo
OBJECTIVE: Non-cardiac surgery is associated with perioperative cerebral complications (delirium, postoperative cognition dysfunction, stroke). While rare, these complications can lead to disabilities and deaths. Information is ambiguous as to whether pharmacological preoperative treatment exerts neuroprotection. We wished to systematically assess potential modulation by statins, lidocaine, ketamine or magnesium sulfate of the relative risk of cerebral complications in noncardiac surgery...
March 2018: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/29621027/cardiac-output-monitoring-how-to-choose-the-optimal-method-for-the-individual-patient
#11
Bernd Saugel, Jean-Louis Vincent
PURPOSE OF REVIEW: To review the different methods available for the assessment of cardiac output (CO) and describe their specific indications in intensive care and perioperative medicine. RECENT FINDINGS: In critically ill patients, persistent circulatory shock after initial resuscitation is an indication for the assessment of CO to monitor the response to fluids and vasoactive agents. In patients with circulatory shock associated with right ventricular dysfunction, pulmonary artery hypertension, or acute respiratory distress syndrome, invasive CO monitoring using indicator dilution methods is indicated...
June 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29618572/influence-of-diabetes-on-trends-in-perioperative-cardiovascular-events
#12
Jonathan D Newman, Tanya Wilcox, Nathaniel R Smilowitz, Jeffrey S Berger
OBJECTIVE: Patients undergoing noncardiac surgery frequently have diabetes mellitus (DM) and an elevated risk of cardiovascular disease. It is unknown whether temporal declines in the frequency of perioperative major adverse cardiovascular and cerebrovascular events (MACCEs) apply to patients with DM. RESEARCH DESIGN AND METHODS: Patients ≥45 years of age who underwent noncardiac surgery from January 2004 to December 2013 were identified using the U.S. National Inpatient Sample...
April 4, 2018: Diabetes Care
https://www.readbyqxmd.com/read/29578401/association-between-preoperative-renin-angiotensin-system-inhibitor-use-and-postoperative-acute-kidney-injury-risk-in-patients-with-hypertension
#13
Nana Xu, Qian Long, Ting He, Xing Liu, Haijiang Dai, Yao Lu, Jia Wen, Qiaoyu Wu, Hong Yuan
PURPOSE: To determine whether preoperative renin-angiotensin system (RAS) inhibitor use within 7 days of noncardiac surgery is associated with a lower incidence of postoperative acute kidney injury (AKI) in hypertensive patients. MATERIALS AND METHODS: We retrospectively analyzed 12,545 hypertensive patients undergoing noncardiac surgery at the Third Xiangya Hospital of Central South University from February 2007 to November 2015. According to the use of RAS inhibitors within 7 days of surgery, the patients were divided into a RASI group and a non-RASI group...
March 26, 2018: Clinical Nephrology
https://www.readbyqxmd.com/read/29571640/comparison-of-clinical-outcomes-between-general-anesthesiologists-and-cardiac-anesthesiologists-in-the-management-of-left-ventricular-assist-device-patients-in-noncardiac-surgeries-and-procedures
#14
Tod A Brown, Jocelyn Kerpelman, Bethany J Wolf, Julie R McSwain
OBJECTIVE: To describe the authors' experience and comparative results after introducing noncardiac fellowship-trained anesthesiologists to a service previously managed by fellowship-trained cardiac anesthesiologists caring for left ventricular assist device (LVAD) patients undergoing low-risk noncardiac procedures with anesthesia. DESIGN: A retrospective chart review. SETTING: Single-site academic medical center in the United States. INTERVENTIONS: Anesthesia and intraoperative therapy...
February 12, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29533264/implication-of-major-adverse-postoperative-events-and-myocardial-injury-on-disability-and-survival-a-planned-subanalysis-of-the-enigma-ii-trial
#15
W Scott Beattie, Duminda N Wijeysundera, Matthew T V Chan, Philip J Peyton, Kate Leslie, Michael J Paech, Daniel I Sessler, Sophie Wallace, Paul S Myles, W Galagher, C Farrington, A Ditoro, S Baulch, S Sidiropoulos, R Bulach, D Bryant, E O'Loughlin, V Mitteregger, S Bolsin, C Osborne, R McRae, M Backstrom, R Cotter, S March, B Silbert, S Said, R Halliwell, J Cope, D Fahlbusch, D Crump, G Thompson, A Jefferies, M Reeves, N Buckley, T Tidy, T Schricker, R Lattermann, D Iannuzzi, J Carroll, M Jacka, C Bryden, N Badner, M W Y Tsang, B C P Cheng, A C M Fong, L C Y Chu, E G Y Koo, N Mohd, L E Ming, D Campbell, D McAllister, S Walker, S Olliff, R Kennedy, A Eldawlatly, T Alzahrani, N Chua, R Sneyd, H McMillan, I Parkinson, A Brennan, P Balaji, J Nightingale, G Kunst, M Dickinson, B Subramaniam, V Banner-Godspeed, J Liu, A Kurz, B Hesler, A Y Fu, C Egan, A N Fiffick, M T Hutcherson, A Turan, A Naylor, D Obal, E Cooke
BACKGROUND: Globally, >300 million patients have surgery annually, and ≤20% experience adverse postoperative events. We studied the impact of both cardiac and noncardiac adverse events on 1-year disability-free survival after noncardiac surgery. METHODS: We used the study cohort from the Evaluation of Nitrous oxide in Gas Mixture of Anesthesia (ENIGMA-II) trial, an international randomized trial of 6992 noncardiac surgical patients. All were ≥45 years of age and had moderate to high cardiac risk...
March 12, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29525764/hospital-readmission-after-perioperative-acute-myocardial-infarction-associated-with-noncardiac-surgery
#16
Nathaniel R Smilowitz, Joshua A Beckman, Scott E Sherman, Jeffrey S Berger
BACKGROUND : Acute myocardial infarction (AMI) is a major cardiovascular complication of noncardiac surgery. We aimed to evaluate the frequency, causes, and outcomes of 30-day hospital readmission after perioperative AMI. METHODS : Patients who were diagnosed with AMI during hospitalization for major noncardiac surgery were identified using the 2014 US Nationwide Readmission Database. Rates, causes, and costs of 30-day readmissions after noncardiac surgery with and without perioperative AMI were identified...
March 10, 2018: Circulation
https://www.readbyqxmd.com/read/29517567/utilizing-patient-e-learning-in-an-intervention-study-on-preoperative-smoking-cessation
#17
Jean Wong, Raviraj Raveendran, Junior Chuang, Zeev Friedman, Mandeep Singh, Jayadeep Patras, David T Wong, Frances Chung
BACKGROUND: Patients who smoke put themselves at increased risk for serious surgical complications, yet it is not currently routine practice to educate patients about the risk of complications due to smoking. Computer-based smoking cessation programs are increasingly being utilized in the general population and may overcome some of the barriers such as lack of time, knowledge, and training to provide interventions. Our objective was to develop and implement a patient e-learning program designed for surgical patients as part of a multifaceted program aimed at assisting them to quit smoking and to determine the factors cross-sectionally and longitudinally associated with abstinence...
May 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29499923/prognostic-significance-and-clinical-utility-of-intraventricular-conduction-delays-on-the-preoperative-electrocardiogram
#18
Karl M Richardson, Sharon T Shen, Deepak K Gupta, Quinn S Wells, Jesse M Ehrenfeld, Jonathan P Wanderer
The prognostic significance of the preoperative electrocardiogram (ECG), particularly intraventricular conduction delays (IVCDs), on postoperative outcomes among patients undergoing noncardiac surgery is uncertain. In a retrospective cohort, we evaluated the risk associated with preoperative IVCDs on in-hospital death and postoperative myocardial infarction (POMI). The 152,479 patients who underwent noncardiac surgery were categorized by preoperative electrocardiographic findings: normal (36.1%), left bundle branch block (LBBB, 1...
April 15, 2018: American Journal of Cardiology
https://www.readbyqxmd.com/read/29499005/inactivity-and-its-associated-factors-in-adults-scheduled-for-noncardiac-surgery-the-pamp-phase-i-study
#19
Olga L Cortés, Karen Moreno, Paula Alvarado, Camilo Povea, Monique Lloyd, Rodolfo Dennis
PURPOSE: The aim of this study was to determine the prevalence of physical inactivity and its associated factors in adult patients admitted to hospital for noncardiac surgery. DESIGN: Cross-sectional study. METHODS: Five hundred able-bodied patients (age ≥45 years) admitted to hospital, also participants in the VISION study, were recruited before noncardiac surgery. The physical activity level (PAL) was assessed with the International Physical of Activity Questionnaire...
March 2018: Rehabilitation Nursing: the Official Journal of the Association of Rehabilitation Nurses
https://www.readbyqxmd.com/read/29479953/hiv-infection-and-poor-renal-outcomes-following-noncardiac-surgery
#20
Yoshan Moodley
Background/aim: The relevance of HIV infection in perioperative renal risk stratification remains unclear. This research sought to investigate the impact of HIV infection, as well as other established preoperative risk factors for poor perioperative renal outcome (PPRO), in a population of 565,225 adult noncardiac surgery patients whose data were obtained from the 2009-2011 California State Inpatient Database. Materials and methods: HIV status, established preoperative risk factors, and the study outcome (PPRO) were determined with the Clinical Classification Software codes recorded for each patient...
February 23, 2018: Turkish Journal of Medical Sciences
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