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Perioperative medicine

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https://www.readbyqxmd.com/read/28796754/perioperative-patient-beliefs-regarding-potential-effectiveness-of-marijuana-cannabinoids-for-treatment-of-pain-a-prospective-population-survey
#1
Yury Khelemsky, Andrew T Goldberg, Yasmin L Hurd, Gary Winkel, Allen Ninh, Lucia Qian, Anna Oprescu, Jeffrey Ciccone, Daniel J Katz
BACKGROUND AND OBJECTIVES: Cannabinoids have an expanding presence in medicine. Perioperative patients' perceptions of the effectiveness of these compounds, and acceptance if prescribed for pain, have not been previously described. Our primary objective was to describe patients' beliefs regarding the potential effectiveness of cannabinoids for the treatment of acute and chronic pain, as well as gauge patient acceptance of these compounds if prescribed by a physician. In addition, demographic and pain history data were collected to elucidate the predictors of the aforementioned patient attitudes...
August 7, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28749248/update-in-perioperative-medicine-practice-changing-evidence-published-in-2016
#2
Dennis W Regan, Deanne Kashiwagi, Brian Dougan, Karna Sundsted, Karen Mauck
This summary reviews 18 key articles published in 2016 which have significant practice implications for the perioperative medical care of surgical patients. Due to the multi-disciplinary nature of the practice of perioperative medicine, important new evidence is published in journals representing a variety of medical and surgical specialties. Keeping current with the evidence that drives best practice in perioperative medicine is therefore challenging. We set out to identify, critically review, and summarize key evidence which has the most potential for practice change...
July 28, 2017: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/28744807/the-effectiveness-of-low-dose-and-high-dose-tranexamic-acid-in-posterior-lumbar-interbody-fusion-a-double-blinded-placebo-controlled-randomized-study
#3
Ki-Tack Kim, Cheung-Kue Kim, Yong-Chan Kim, Hyung-Suk Juh, Hyo-Jong Kim, Hyeon-Soo Kim, Se Jung Hong, Hwee Weng Dennis Hey
PURPOSE: Tranexamic acid is a proven drug used for reduction of intraoperative blood loss in spinal surgery. However, optimal dosing considering risk/benefits is not well established owing to the heterogeneity in patient selection and surgical procedures of previous studies. This study aimed to evaluate the effectiveness and safety of various tranexamic acid regimens in reducing perioperative blood loss in single-level posterior lumbar interbody fusion (PLIF). METHODS: Patients were randomly grouped into three different interventions: low-dose tranexamic acid (LD), high-dose tranexamic acid (HD), and placebo-controlled (PC) groups...
July 25, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28742770/role-of-the-perioperative-surgical-home-in-optimizing-the-perioperative-use-of-opioids
#4
Thomas R Vetter, Zeev N Kain
Several federal agencies have recently noted that the United States is in the midst of an unprecedented "opioid epidemic," with an increasing number of opioid-related overdoses and deaths. Providers currently face 3 population-level, public health challenges in providing optimal perioperative pain care: (1) the continued lack of overall improvement in the excessive incidence of inadequately treated postoperative pain, (2) minimizing or preventing postoperative opioid-related side effects, and (3) addressing current opioid prescribing patterns, and the accompanying problematic surge in prescription opioid diversion, misuse, abuse, addiction, and overdose...
July 24, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28733926/perioperative-management-of-endocrine-insufficiency-after-total-pancreatectomy-for-neoplasia
#5
REVIEW
Ajay V Maker, Raashid Sheikh, Vinita Bhagia
PURPOSE: Indications for total pancreatectomy (TP) have increased, including for diffuse main duct intrapapillary mucinous neoplasms of the pancreas and malignancy; therefore, the need persists for surgeons to develop appropriate endocrine post-operative management strategies. The brittle diabetes after TP differs from type 1/2 diabetes in that patients have absolute deficiency of insulin and functional glucagon. This makes glucose management challenging, complicates recovery, and predisposes to hospital readmissions...
July 21, 2017: Langenbeck's Archives of Surgery
https://www.readbyqxmd.com/read/28728322/perioperative-hypertension-management-during-facelift-under-local-anesthesia-with-intravenous-hypnotics
#6
Ki Ho Chung, Myeong Soo Cho, Hoon Jin
Perioperative hypertension is a phenomenon in which a surgical patient's blood pressure temporarily increases throughout the preoperative and postoperative periods and remains high until the patient's condition stabilizes. This phenomenon requires immediate treatment not only because it is observed in a majority of patients who are not diagnosed with high blood pressure, but also because occurs in patients with underlying essential hypertension who show a sharp increase in their blood pressure. The most common complication following facelift surgery is hematoma, and the most critical risk factor that causes hematoma is elevated systolic blood pressure...
July 2017: Archives of Plastic Surgery
https://www.readbyqxmd.com/read/28727581/perioperative-gabapentin-does-not-reduce-postoperative-delirium-in-older-surgical-patients-a-randomized-clinical-trial
#7
Jacqueline M Leung, Laura P Sands, Ningning Chen, Christopher Ames, Sigurd Berven, Kevin Bozic, Shane Burch, Dean Chou, Kenneth Covinsky, Vedat Deviren, Sakura Kinjo, Joel H Kramer, Michael Ries, Bobby Tay, Thomas Vail, Philip Weinstein, Stacey Chang, Gabriela Meckler, Stacey Newman, Tiffany Tsai, Vanessa Voss, Emily Youngblom
BACKGROUND: Postoperative pain and opioid use are associated with postoperative delirium. We designed a single-center, randomized, placebo-controlled, parallel-arm, double-blinded trial to determine whether perioperative administration of gabapentin reduced postoperative delirium after noncardiac surgery. METHODS: Patients were randomly assigned to receive placebo (N = 347) or gabapentin 900 mg (N = 350) administered preoperatively and for the first 3 postoperative days...
July 20, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28719458/acupuncture-for-chronic-pain-an-update-and-critical-overview
#8
Changshik Yin, Thomas E Buchheit, Jongbae J Park
PURPOSE OF REVIEW: Acupuncture is now recommended for several chronic pain conditions. Despite supportive evidence of its effectiveness, this ancient approach is often misunderstood, and may still be underused in mainstream practice. A critical review on its effectiveness and practice integration, and mechanisms of action is essential to the medical community that is continuing to seek nonopioid therapies for chronic pain. RECENT FINDINGS: Mounting evidence supports the effectiveness of acupuncture to treat chronic low back, neck, shoulder, and knee pain, as well as headaches...
July 15, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28685255/-erratum-to-structured-patient-handovers-in-perioperative-medicine-rationale-and-implementation-in-clinical-practice
#9
M J Merkel, V von Dossow, B Zwißler
No abstract text is available yet for this article.
July 6, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28682957/the-new-world-health-organization-recommendations-on-perioperative-administration-of-oxygen-to-prevent-surgical-site-infections-a-dangerous-reductionist-approach
#10
Manuel Wenk, Hugo Van Aken, Alexander Zarbock
In October 2016, the World Health Organization (WHO) published recommendations for preventing surgical site infections (SSIs). Among those measures is a recommendation to administer oxygen at an inspired fraction of 80% intra- and postoperatively for up to 6 hours. SSIs have been identified as a global health problem, and the WHO should be commended for their efforts. However, this recommendation focuses only on the patient's "wound," ignores other organ systems potentially affected by hyperoxia, and may ultimately worsen patient outcomes...
August 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28682422/analysis-on-application-timing-of-iabp-in-emergency-pci-treatment-of-patients-with-combined-acute-myocardial-infarction-and-cardiac-shock
#11
M Zhou, K Yu, X-H Wang, C-S Yang, Y-P Lei, Y-G Wang, Y-Z Xue, H-C Yao, B Gao
OBJECTIVE: To study the application timing and effect of intra-aortic balloon pump (IABP) in the emergency PCI treatment of patients with combined acute myocardial infarction (AMI) and cardiogenic shock (CS). PATIENTS AND METHODS: 84 cases of patients with combined AMI and CS under PCI in emergency treatment were randomly divided into the control group (n=42) and observational group (n=42). The control group underwent IABP again, after the invalidation of internal medicine drug treatment, while the observational group underwent IABP before the operation...
June 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28676187/anesthetic-techniques-in-transcatheter-aortic-valve-replacement-and-the-evolving-role-of-the-anesthesiologist
#12
REVIEW
Peter J Neuburger, Prakash A Patel
The development of transcatheter aortic valve replacement (TAVR) has transformed the treatment of patients with aortic valve disease. This procedure now is used widely for patients at high and intermediate risk for surgical aortic valve replacement. The rapid acceptance and popularity of TAVR most clearly was enabled by advancements in device technology and procedural experience. Such a dramatic change to the standard medical practice is not without consequence to fields of medicine beyond cardiology and cardiac surgery...
March 27, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28667227/defining-clinically-important-perioperative-blood-loss-and-transfusion-for-the-standardised-endpoints-for-perioperative-medicine-step-collaborative-a-protocol-for-a-scoping-review
#13
Justyna Bartoszko, Leon Vorobeichik, Mohandas Jayarajah, Keyvan Karkouti, Andrew A Klein, Andre Lamy, C David Mazer, Mike Murphy, Toby Richards, Marina Englesakis, Paul S Myles, Duminda N Wijeysundera
INTRODUCTION: 'Standardised Endpoints for Perioperative Medicine' (StEP) is an international collaboration undertaking development of consensus-based consistent definitions for endpoints in perioperative clinical trials. Inconsistency in endpoint definitions can make interpretation of trial results more difficult, especially if conflicting evidence is present. Furthermore, this inconsistency impedes evidence synthesis and meta-analyses. The goals of StEP are to harmonise definitions for clinically meaningful endpoints and specify standards for endpoint reporting in clinical trials...
June 30, 2017: BMJ Open
https://www.readbyqxmd.com/read/28661955/tablet-based-intervention-for-reducing-children-s-preoperative-anxiety-a-pilot-study
#14
Cheryl H T Chow, Ryan J Van Lieshout, Louis A Schmidt, Norman Buckley
OBJECTIVES: To examine the feasibility, acceptability, and effects of a novel tablet-based application, Story-Telling Medicine (STM), in reducing children's preoperative anxiety. METHODS: Children (N = 100) aged 7 to 13 years who were undergoing outpatient surgery were recruited from a local children's hospital. This study comprised 3 waves: Waves 1 (n = 30) and 2 (n = 30) examined feasibility, and Wave 3 (n = 40) examined the acceptability of STM and compared its effect on preoperative anxiety to Usual Care (UC)...
July 2017: Journal of Developmental and Behavioral Pediatrics: JDBP
https://www.readbyqxmd.com/read/28654619/evidence-based-medicine-mandible-fractures
#15
Brent B Pickrell, Larry H Hollier
LEARNING OBJECTIVES: After reading this article, the participant should be able to: 1. Explain the epidemiology of mandible fractures. 2. Discuss preoperative evaluation of the patient with a mandible fracture. 3. Compare the various modalities of fracture fixation. 4. Identify common complications after fracture repair. SUMMARY: In this Maintenance of Certification/Continuing Medical Education article, the reader is provided with a review of the epidemiology, preoperative evaluation, perioperative management, and surgical outcomes of mandible fractures...
July 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28649376/re-designing-the-pathway-to-surgery-better-care-and-added-value
#16
Michael P W Grocott, James O M Plumb, Mark Edwards, Imogen Fecher-Jones, Denny Z H Levett
The case for radical pathway re-design before surgery is in part driven by healthcare system pressures which are in turn the result of continuously rising demand in the face of tightly constrained resources. Such circumstances tend to drive revolutionary, rather than incremental, change. The current approach to preoperative assessment, that typically occurs in the weeks leading up to surgery, but is all too often only a few days before surgery, results in a lost opportunity for perioperative physicians to improve patient care...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/28641357/-the-german-thorax-registry-implementation-of-an-established-tool-of-perioperative-health-care-research
#17
Jérôme Defosse, Mark Schieren, Torsten Loop, Cerstin Arndt, Rainer Röhrig, Erich Stoelben, Corinna Ludwig, Alexander Schleppers, Frank Wappler, Mark Gerbershagen, Alberto Lopez-Pastorini
The collection of clinical treatment data in registry databases is an important aspect of health services research. It allows for a critical evaluation of the safety, efficacy and cost-effectiveness of clinical treatment concepts in large patient populations. The findings of registry research represent real-world patients and treatment structures as they are not limited by strict inclusion criteria or unrealistic conditions as applied in prospective clinical trials. The implementation of the German Thorax Registry has enabled the collection and analysis of data on the interdisciplinary care (thoracic surgery, anaesthesiology, intensive care, pain management) of patients undergoing thoracic surgery...
June 2017: Zentralblatt Für Chirurgie
https://www.readbyqxmd.com/read/28633144/standardized-renal-endpoints-for-perioperative-clinical-trials-the-standardized-endpoints-in-perioperative-medicine-initiative
#18
David R McIlroy, Andrew D Shaw, Paul S Myles
Perioperative acute kidney injury is a common problem. While clinical trials seek to evaluate the impact of interventions on a variety of primary and secondary endpoints with the aim of implementing this knowledge to improve perioperative outcomes, the use of valid and relevant endpoints within clinical trials is of critical importance to achieving this goal. Suitable endpoints must be validated for the study population and in light of the clinical context under investigation while also considering regulatory requirements that govern the licensing of new therapeutic agents as well as the values of patients whose outcomes we seek to improve...
June 21, 2017: Nephron
https://www.readbyqxmd.com/read/28625450/vasoplegic-syndrome-an-update-on-perioperative-considerations
#19
REVIEW
Henry Liu, Ling Yu, Longqiu Yang, Michael S Green
Vasoplegic syndrome (VS) is increasingly recognized as an important clinical entity in perioperative medicine. VS is characterized by significant arterial hypotension, normal or high cardiac output, low systemic vascular resistance, and increased requirements for intravenous volume and vasopressors. Tremendous variations exist regarding incidence reported in the literature and management at different institutions; and the incidence of VS is likely significantly higher than many anesthesiologists believe. Thus the aims of this article are to review the pertinent aspects related to VS and alert clinical anesthesiologists to this under-recognized yet very challenging clinical condition...
August 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28625300/preeclampsia-in-2017-obstetric-and-anaesthesia-management
#20
REVIEW
Ross Hofmeyr, Mushi Matjila, Robert Dyer
In many centres, anaesthesia now incorporates perioperative medicine. Preeclampsia is a perioperative medical challenge requiring a multi-disciplinary team. New definitions stress the rapid progression of the disease and highlight the importance of early detection. Anaesthesiologists should understand the pathophysiology of the disease and develop the ultrasound skills required to assist in the assessment of disease severity. This facilitates the choice of anaesthesia method and perioperative management in complicated cases...
March 2017: Best Practice & Research. Clinical Anaesthesiology
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