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preoperative evaluation noncardiac surgery

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https://www.readbyqxmd.com/read/28395291/undiagnosed-obstructive-sleep-apnea-and-postoperative-outcomes-a-prospective-observational-study
#1
Uma Devaraj, Srinivas Rajagopala, Ajay Kumar, Priya Ramachandran, Philip J Devereaux, George A D'Souza
BACKGROUND: The prevalence of undiagnosed obstructive sleep apnea (OSA) during preoperative evaluation and the best method to screen OSA and its association with postoperative complications remain unclear. OBJECTIVES: To determine the prevalence of undiagnosed OSA in preoperative Indian patients undergoing noncardiac surgery, to compare the diagnostic accuracy of the STOP-BANG questionnaire to a preoperative level III sleep study, and to assess the association of OSA with postoperative complications...
April 11, 2017: Respiration; International Review of Thoracic Diseases
https://www.readbyqxmd.com/read/28239802/anesthetic-management-of-patients-with-dilated-cardiomyopathy-for-noncardiac-surgery
#2
C-Q Chen, X Wang, J Zhang, S-M Zhu
Anesthetic management of patients with dilated cardiomyopathy (DCM) is a challenge to the anesthesiologist, due to poor left systolic function, ventricular enlargement, risk of malignant arrhythmias and sudden cardiac death. Therefore, preoperative assessment and appropriate anesthetic management are important in patients with DCM. This review describes the preoperative evaluation and anesthesia considerations of patients with DCM undergoing non-cardiac surgery. Patient pathophysiology and clinical status, such as ventricular function, degree of myocardial fibrosis, resting heart rate and high-sensitivity C-reactive protein can affect survival rates...
February 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28184265/effects-of-preanesthetic-dexmedetomidine-on-hemodynamic-responses-to-endotracheal-intubation-in-elderly-patients-undergoing-treatment-for-hypertension-a-randomized-double-blinded-trial
#3
Chan Woo Lee, Miwoon Kim
BACKGROUND: Dexmedetomidine is an alpha-2 adrenergic agonist with sedative, anxiolytic, and analgesic properties. This study was designed to evaluate the inhibitory effects of preoperative administration of 0.5 µg/kg dexmedetomidine on hemodynamic responses caused by endotracheal intubation in elderly patients undergoing treatment for hypertension. METHODS: Forty elderly (≥ 65 years old) patients who had been receiving hypertension treatment, had American Society of Anesthesiologists physical status II, and were scheduled to undergo elective noncardiac surgery were randomly selected and assigned to 2 groups...
February 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/27982268/utility-of-ultraportable-echocardiography-in-the-preoperative-evaluation-of-noncardiac-surgery
#4
Jean Allan Costa, Maria Lucia Pereira Almeida, Tereza Cristina Duque Estrada, Guilherme Lobosco Werneck, Alexandre Marins Rocha, Maria Luiza Garcia Rosa, Mario Luiz Ribeiro, Claudio Tinoco Mesquita
Background: The ultraportable echocardiogram machine, with relevant portability and easiness in performing diagnoses, when in experienced hands, may contribute to the reliability of preoperative evaluation in noncardiac surgeries. Objectives: To assess cardiac function parameters in patients aged older than 60 years, candidates of elective noncardiac surgeries, classified as ASA1 or ASA 2 according to surgical risk. Methods: A total of 211 patients referred for elective surgeries, without suspicion of previous heart diseases, were included in the study...
November 2016: Arquivos Brasileiros de Cardiologia
https://www.readbyqxmd.com/read/27919097/preoperative-evaluation-for-noncardiac-surgery
#5
Steven L Cohn
This issue provides a clinical overview of preoperative evaluation for noncardiac surgery, focusing on risk factors, elements of evaluation, medication management, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers...
December 6, 2016: Annals of Internal Medicine
https://www.readbyqxmd.com/read/27918330/preoperative-echocardiographic-indices-of-diastolic-dysfunction-and-brain-natriuretic-peptide-in-predicting-postoperative-atrial-fibrillation-after-noncardiac-surgery
#6
Oren Brecher, Harleena Gulati, Nancy Roistacher, Hao Zhang, Weiji Shi, Howard T Thaler, David Amar
BACKGROUND: We have shown previously that either echocardiographic indices of diastolic dysfunction or increased preoperative brain natriuretic peptide (BNP) predict postoperative atrial fibrillation (POAF). Because these 2 predictors of POAF have not been evaluated together, our goal was to further elucidate their concurrent role in patients undergoing noncardiac thoracic surgery. METHODS: We retrospectively identified 191 patients who had a preoperative transthoracic echocardiogram and serum BNP level collected as part of routine care before major lung or esophageal resection...
April 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27906721/preoperative-evaluation-and-preparation-of-the-morbidly-obese-patient
#7
Andreas B Böhmer, Frank Wappler
PURPOSE OF REVIEW: This review aims to familiarize with the most current findings regarding preoperative evaluation and preparation of morbidly obese patients prior to elective, noncardiac surgery. In the light of the increasing number of surgical patients being morbidly obese, the knowledge of evidence-based preoperative evaluation strategies is profound for a rational approach. RECENT FINDINGS: Preoperative evaluation should be carried out with sufficient time before the day of surgery to allow modification of the perioperative management...
February 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27906717/spectrum-of-postoperative-complications-in-pulmonary-hypertension-and-obesity-hypoventilation-syndrome
#8
Roop K Kaw
PURPOSE OF REVIEW: The purpose of this review is to identify chronic pulmonary conditions which may often not be recognized preoperatively especially before elective noncardiac surgery and which carry the highest risk of perioperative morbidity and mortality. RECENT FINDINGS: This review discusses some of the most recent studies that highlight the perioperative complications, and their prevention and management strategies. SUMMARY: Pulmonary hypertension is a well recognized risk factor for postoperative complications after cardiac surgery but the literature surrounding noncardiac surgery is sparse...
February 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27906705/arterial-pressure-variation-in-elective-noncardiac-surgery-identifying-reference-distributions-and-modifying-factors
#9
Michael R Mathis, Samuel A Schechtman, Milo C Engoren, Amy M Shanks, Aleda Thompson, Sachin Kheterpal, Kevin K Tremper
BACKGROUND: Assessment of need for intravascular volume resuscitation remains challenging for anesthesiologists. Dynamic waveform indices, including systolic and pulse pressure variation, are demonstrated as reliable measures of fluid responsiveness for mechanically ventilated patients. Despite widespread use, real-world reference distributions for systolic and pulse pressure variation values have not been established for euvolemic intraoperative patients. The authors sought to establish systolic and pulse pressure variation reference distributions and assess the impact of modifying factors...
February 2017: Anesthesiology
https://www.readbyqxmd.com/read/27865641/canadian-cardiovascular-society-guidelines-on-perioperative-cardiac-risk-assessment-and-management-for-patients-who-undergo-noncardiac-surgery
#10
Emmanuelle Duceppe, Joel Parlow, Paul MacDonald, Kristin Lyons, Michael McMullen, Sadeesh Srinathan, Michelle Graham, Vikas Tandon, Kim Styles, Amal Bessissow, Daniel I Sessler, Gregory Bryson, P J Devereaux
The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of evidence assessment for patients who undergo noncardiac surgery. Strong recommendations included: 1) measuring brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery to enhance perioperative cardiac risk estimation in patients who are 65 years of age or older, are 45-64 years of age with significant cardiovascular disease, or have a Revised Cardiac Risk Index score ≥ 1; 2) against performing preoperative resting echocardiography, coronary computed tomography angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging to enhance perioperative cardiac risk estimation; 3) against the initiation or continuation of acetylsalicylic acid for the prevention of perioperative cardiac events, except in patients with a recent coronary artery stent or who will undergo carotid endarterectomy; 4) against α2 agonist or β-blocker initiation within 24 hours before surgery; 5) withholding angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker starting 24 hours before surgery; 6) facilitating smoking cessation before surgery; 7) measuring daily troponin for 48 to 72 hours after surgery in patients with an elevated NT-proBNP/BNP measurement before surgery or if there is no NT-proBNP/BNP measurement before surgery, in those who have a Revised Cardiac Risk Index score ≥1, age 45-64 years with significant cardiovascular disease, or age 65 years or older; and 8) initiating of long-term acetylsalicylic acid and statin therapy in patients who suffer myocardial injury/infarction after surgery...
January 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/27792044/relationship-between-intraoperative-hypotension-defined-by-either-reduction-from-baseline-or-absolute-thresholds-and-acute-kidney-and-myocardial-injury-after-noncardiac-surgery-a-retrospective-cohort-analysis
#11
Vafi Salmasi, Kamal Maheshwari, Dongsheng Yang, Edward J Mascha, Asha Singh, Daniel I Sessler, Andrea Kurz
BACKGROUND: How best to characterize intraoperative hypotension remains unclear. Thus, the authors assessed the relationship between myocardial and kidney injury and intraoperative absolute (mean arterial pressure [MAP]) and relative (reduction from preoperative pressure) MAP thresholds. METHODS: The authors characterized hypotension by the lowest MAP below various absolute and relative thresholds for cumulative 1, 3, 5, or 10 min and also time-weighted average below various absolute or relative MAP thresholds...
January 2017: Anesthesiology
https://www.readbyqxmd.com/read/27775997/withholding-versus-continuing-angiotensin-converting-enzyme-inhibitors-or-angiotensin-ii-receptor-blockers-before-noncardiac-surgery-an-analysis-of-the-vascular-events-in-noncardiac-surgery-patients-cohort-evaluation-prospective-cohort
#12
Pavel S Roshanov, Bram Rochwerg, Ameen Patel, Omid Salehian, Emmanuelle Duceppe, Emilie P Belley-Côté, Gordon H Guyatt, Daniel I Sessler, Yannick Le Manach, Flavia K Borges, Vikas Tandon, Andrew Worster, Alexandra Thompson, Mithin Koshy, Breagh Devereaux, Frederick A Spencer, Robert D Sanders, Erin N Sloan, Erin E Morley, James Paul, Karen E Raymer, Zubin Punthakee, P J Devereaux
BACKGROUND: The effect on cardiovascular outcomes of withholding angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in chronic users before noncardiac surgery is unknown. METHODS: In this international prospective cohort study, the authors analyzed data from 14,687 patients (including 4,802 angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker users) at least 45 yr old who had in-patient noncardiac surgery from 2007 to 2011...
January 2017: Anesthesiology
https://www.readbyqxmd.com/read/27755054/relationship-between-preoperative-evaluation-blood-pressure-and-preinduction-blood-pressure-a-cohort-study-in-patients-undergoing-general-anesthesia
#13
Wilton A van Klei, Judith A R van Waes, Wietze Pasma, Teus H Kappen, Leo van Wolfswinkel, Linda M Peelen, Cor J Kalkman
BACKGROUND: For outcomes research where changes in intraoperative blood pressure are a possible causative factor, it is important to determine an appropriate source for a reference value. We studied to what extent preinduction blood pressure values in the operating room differ from those obtained during preoperative evaluation outside the operating room. METHODS: Cohort study including 4408 patients aged 60 years or older undergoing noncardiac surgery. The outcome was the difference between the preinduction mean blood pressure (MBP) and the MBP obtained during preoperative evaluation...
February 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27737442/association-of-clinical-risk-factors-and-postoperative-complications-with-unplanned-hospital-readmission-after-head-and-neck-cancer-surgery
#14
Andrés M Bur, Jason A Brant, Carolyn L Mulvey, Elizabeth A Nicolli, Robert M Brody, John P Fischer, Steven B Cannady, Jason G Newman
Importance: Unplanned hospital readmission is costly and in recent years has become a focus of health care legislation intended to reduce health care expenditures. Greater understanding of which perioperative complications are associated with hospital readmission after surgery for head and neck cancer is needed to reduce unplanned readmissions. Objective: To determine which clinical risk factors and complications are associated with 30-day unplanned readmission after surgery for malignant neoplasms of the head and neck...
December 1, 2016: JAMA Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/27607474/baseline-pulse-pressure-acute-kidney-injury-and-mortality-after-noncardiac-surgery
#15
Adriana D Oprea, Frederick W Lombard, Wen-Wei Liu, William D White, Jörn A Karhausen, Yi-Ju Li, Timothy E Miller, Solomon Aronson, Tong J Gan, Manuel L Fontes, Miklos D Kertai
BACKGROUND: Increased pulse pressure (PP) is an important independent predictor of cardiovascular outcome and acute kidney injury (AKI) after cardiac surgery. The objective of this study was to determine whether elevated baseline PP is associated with postoperative AKI and 30-day mortality after noncardiac surgery. METHODS: We evaluated 9125 adult patients who underwent noncardiac surgery at Duke University Medical Center between January 2006 and December 2009. Baseline arterial blood pressure was defined as the mean of the first 5 measurements recorded by the automated record keeping system before inducing anesthesia...
December 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27461370/chronic-postsurgical-pain-in-patients-5-years-after-cardiac-surgery-a-prospective-cohort-study
#16
K H Gjeilo, R Stenseth, A Wahba, S Lydersen, P Klepstad
BACKGROUND: Chronic postsurgical pain (CPSP) is a common complication after many surgical procedures, including cardiac surgery. The prevalence of CPSP after cardiac surgery ranges from 9.5% to 56%. Most studies on CPSP after cardiac surgery are retrospective and long-term prospective studies are scarce. The aim of this study was to follow CPSP and health-related quality of life (HRQOL) prospectively in a cohort of patients, emphasizing the prevalence from 12 months to 5 years. METHODS: A total of 534 patients (23% ≥75 years, 67% men) were consecutively included before surgery...
March 2017: European Journal of Pain: EJP
https://www.readbyqxmd.com/read/27152422/effects-of-single-low-dose-of-dexamethasone-before-noncardiac-and-nonneurologic-surgery-and-general-anesthesia-on-postoperative-cognitive-dysfunction-a-phase-iii-double-blind-randomized-clinical-trial
#17
RANDOMIZED CONTROLLED TRIAL
Livia Stocco Sanches Valentin, Valeria Fontenelle Angelim Pereira, Ricardo S Pietrobon, Andre P Schmidt, Jean P Oses, Luis V Portela, Diogo O Souza, João Ricardo Nickenig Vissoci, Vinicius Fernando da Luz, Leticia Maria de Araujo de Souza Trintoni, Karen C Nielsen, Maria José Carvalho Carmona
UNLABELLED: Postoperative cognitive dysfunction (POCD) is a multifactorial adverse event most frequently in elderly patients. This study evaluated the effect of dexamethasone on POCD incidence after noncardiac and nonneurologic surgery. METHODS: One hundred and forty patients (ASA I-II; age 60-87 years) took part in a prospective phase III, double blind, randomized study involving the administration or not of 8 mg of IV dexamethasone before general anesthesia under bispectral index (BIS) between 35-45 or 46-55...
2016: PloS One
https://www.readbyqxmd.com/read/27113151/approach-to-evaluating-the-multimorbid-patient-with-cardiovascular-disease-undergoing-noncardiac-surgery
#18
REVIEW
William L Lyons
Older patients undergo more inpatient and outpatient procedures than do younger individuals, and their risk of suffering undesired outcomes is greater. The performance of a productive preoperative assessment entails more than the application of the sundry clinical practice guidelines relating to a patient's various medical diagnoses. A better approach involves adoption of a physiologically integrated, whole-person assessment that takes into account the patient's cognitive function, mood, physical function and mobility (including the possibility of frailty), social support, nutritional status, and medication use...
May 2016: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/27106641/congestive-heart-failure-and-noncardiac-operations-risk-of-serious-morbidity-readmission-reoperation-and-mortality
#19
Florence E Turrentine, Min-Woong Sohn, Rayford Scott Jones
BACKGROUND: Congestive heart failure (CHF) predicts surgical morbidity and mortality. However, few studies evaluate CHF's impact on noncardiac operations. Because of CHFs serious threat to health and survival, surgeons must understand risks CHF poses to patients undergoing a diverse array of operations. STUDY DESIGN: We used 2009 to 2013 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use Files to estimate the risk of serious morbidity, reoperation, readmission, mortality, and other postoperative complications associated with preoperative diagnosis of CHF...
June 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/26978592/the-patient-with-chronic-heart-failure-undergoing-surgery
#20
Valérie Smit-Fun, Wolfgang F Buhre
PURPOSE OF REVIEW: Congestive heart failure (CHF) is one of the most common diseases of the elderly patient. The underlying pathophysiology varies considerably and approximately 50% of the patients suffer from CHF with reduced left ventricular ejection fraction. Mortality in the perioperative period is increased in patients with CHF and this holds true for both minor and major surgeries. This review will summarize recent literature in the field of CHF and perioperative outcome in patients undergoing surgery with a special emphasis on actual guidelines, preoperative assessment and appropriate perioperative therapy...
June 2016: Current Opinion in Anaesthesiology
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