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perioperative fluid therapy

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https://www.readbyqxmd.com/read/29441350/perioperative-goal-directed-therapy-using-invasive-uncalibrated-pulse-contour-analysis
#1
Bernd Saugel, Daniel A Reuter
"Perioperative goal-directed therapy" (PGDT) aims at an optimization of basic and advanced global hemodynamic variables to maintain adequate oxygen delivery to the end-organs. PGDT protocols help to titrate fluids, vasopressors, or inotropes to hemodynamic target values. There is considerable evidence that PGDT can improve patient outcome in high-risk patients if both fluids and inotropes are administered to target hemodynamic variables reflecting blood flow. Despite this evidence, PGDT strategies aiming at an optimization of blood flow seem to be not well implemented in routine clinical care...
2018: Frontiers in Medicine
https://www.readbyqxmd.com/read/29438158/intensive-care-unit-enhanced-recovery-pathway-for-patients-undergoing-orthotopic-liver-transplants-recipients-a-prospective-observational-study
#2
Adam B King, Clark D Kensinger, Yaping Shi, Matthew S Shotwell, Seth J Karp, Pratik P Pandharipande, J Kelly Wright, Liza M Weavind
BACKGROUND: Liver transplant recipients continue to have high perioperative resource utilization and prolonged length of stay despite improvements in perioperative care. Enhanced recovery pathways have been shown in other surgical populations to produce reductions in hospital resource utilization. METHODS: A prospective, observational study was performed to examine the effect of an enhanced recovery pathway for postoperative care after liver transplantation. Outcomes from patients undergoing liver transplantation from November 1, 2013, to October 31, 2014, managed by the pathway were compared to transplant recipients from the year before pathway implementation...
February 9, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29416455/fluid-choice-during-perioperative-care-in-children-a-survey-of-present-day-proposing-practice-by-anesthesiologists-in-a-tertiary-care-hospital
#3
Muhammad Faisal Khan, Khalid Maudood Siddiqui, Muhammad Ali Asghar
Background: Perioperative fluid therapy in pediatrics has always been a challenging avenue for anesthesiologists. Inappropriate choice of fluid leads to multiple side effects, for instance iatrogenic hyponatremia. Our aim was to observe the current practice of perioperative fluid therapy in pediatric population undergoing surgery in a tertiary care hospital. Methods: After obtaining approval from the Departmental Research Review Committee, a survey form including questions was emailed to anesthesiologists from January 2015 to June 2015...
January 2018: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/29406186/current-concepts-of-fluid-management-in-enhanced-recovery-pathways
#4
REVIEW
R Makaryus, T E Miller, T J Gan
Perioperative fluid management impacts outcomes and plays a pivotal role in enhanced recovery pathways (ERPs). There have been major advances in understanding the effects of fluid therapy and administration during the perioperative period. Improving fluid management during this period leads to a decrease in complications, decrease in length of stay (LOS), and enhanced patient outcomes. It is important to consider preoperative and postoperative fluid management to be just as critical as intraoperative management given multiple associated benefits to the patients...
February 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29406176/normal-saline-versus-a-balanced-crystalloid-for-goal-directed-perioperative-fluid-therapy-in-major-abdominal-surgery-a-double-blind-randomised-controlled-study
#5
C A Pfortmueller, G-C Funk, C Reiterer, A Schrott, O Zotti, B Kabon, E Fleischmann, G Lindner
BACKGROUND: This double-blind randomised controlled trial investigated whether normal saline or a balanced crystalloid has distinct effects on vasopressor use in patients undergoing major abdominal surgery. METHODS: Patients received either normal saline 0.9% or an acetate-buffered crystalloid for intraoperative volume replacement in a goal-directed fashion. The primary outcome was need for vasopressors; the secondary outcomes were the total dose of catecholamines, total perioperative fluid, and unplanned intensive care admissions...
February 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29390270/anesthetic-management-of-off-pump-simultaneous-coronary-artery-bypass-grafting-and-lobectomy-case-report-and-literature-review
#6
Xian Zhao, Yuhong Li, Hai-Ying Kong, Lin Zhang, Xiao-Hong Wen
RATIONALE: Survey data show approximately 10% patients with lung cancer may present concomitant coronary heart disease. Simultaneous surgery is a challenge for anesthetist. We review our experience in the anesthesia with 5 patients who required simultaneous off-pump coronary artery bypass grafting (OPCABG) and pulmonary resection for lung cancer. PATIENT CONCERNS: Between 2014 and 2016, 5 patients with ASA (American Society of Anesthesiologists) grade II or III, underwent combined OPCABG and lung resection in the first Affiliated Hospital, Zhejiang University School of Medicine...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29368625/perioperative-fluid-management-in-kidney-transplantation-a-black-box
#7
REVIEW
Maria Helena Calixto Fernandes, Thomas Schricker, Sheldon Magder, Roupen Hatzakorzian
The incidence of delayed graft function in patients undergoing kidney transplantation remains significant. Optimal fluid therapy has been shown to decrease delayed graft function after renal transplantation. Traditionally, the perioperative volume infusion regimen in this patient population has been guided by central venous pressure as an estimation of the patient's volume status and mean arterial pressure, but this is based on sparse evidence from mostly retrospective observational studies. Excessive volume infusion to the point of no further fluid responsiveness can damage the endothelial glycocalyx and is no longer considered to be the best approach...
January 25, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29324500/hydroxyethyl-starch-130-0-4-and-its-impact-on-perioperative-outcome-a-propensity-score-matched-controlled-observation-study
#8
Judith-Irina Pagel, Markus Rehm, Tobias Kammerer, Nikolai Hulde, Eike Speck, Josef Briegel, Falk Reinholz, Alexander Crispin, Klaus F Hofmann-Kiefer
BACKGROUND: Adverse effects of hydroxyethyl starches (HESs) have been verified in patients suffering from sepsis or kidney disease, but not in surgical patients at large. The investigation aimed to determine whether the use of HES 130/0.4 was associated with the incidence of acute postinterventional adverse events compared to Ringer's acetate alone in a perioperative setting. METHODS: This propensity score matched, controlled observational study was performed in a single-centre university hospital...
January 9, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29282510/changes-in-clinical-practice-reduce-the-rate-of-anastomotic-leakage-after-colorectal-resections
#9
Henrik Iversen, Madelene Ahlberg, Marja Lindqvist, Christian Buchli
BACKGROUND: Anastomotic leakage is a serious clinical problem after colorectal resections and is associated with a significantly increased length of stay, morbidity and mortality. The aim of the present study was to evaluate the effect of changes in clinical practice on anastomotic leakage rate after colorectal resections. METHODS: Retrospective cohort study based on prospectively collected data. All 894 patients with primary anastomosis after colorectal resection at a tertiary referral center between 2006 and 2013 were analyzed...
December 28, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/29260698/-abdominal-cocoon-syndrome-in-an-eigth-year-old-girl-caused-acute-bowel-obstruction
#10
Johan Tolstrup, Morten Laksáfoss Lauritsen
This case report describes an eight-year-old girl who was admitted under the suspicion of gastroenteritis. The physical examination revealed symptoms of acute bowel obstruction, which was confirmed by abdominal CT scan. Explorative laparotomy showed a fibrotic membrane encapsulating the small intestine causing obstruction and ischaemia, and the perioperative diagnosis was abdominal cocoon syndrome. Two metres of the small intestine, excessive peritoneal membrane and the appendix was resected and an ileostomy was performed...
December 11, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/29234998/reduction-of-cardiopulmonary-renal-complications-with-serum-bnp-guided-volume-status-management-in-posthepatectomy-patients
#11
Sameer H Patel, Bradford J Kim, Ching-Wei D Tzeng, Yun Shin Chun, Claudius Conrad, Jean-Nicolas Vauthey, Thomas A Aloia
BACKGROUND: After hepatectomy, over- and under-resuscitations induce cardiopulmonary complications and acute kidney injury, respectively, leading to significant perioperative morbidity and mortality. Unlike serum chemistries or urine output, serum brain natriuretic peptide (BNP) levels have been shown to accurately reflect current intravascular fluid balance without influence from alterations of hormonal axes. Based on these data, this study was designed to measure the impact of a serum BNP-guided hepatobiliary fluid protocol on the incidence of posthepatectomy cardiopulmonary/renal complications...
October 11, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/29234943/enhanced-recovery-care-versus-traditional-care-after-laparoscopic-liver-resections-a-randomized-controlled-trial
#12
Xiao Liang, Hanning Ying, Hongwei Wang, Hongxia Xu, Minjun Liu, Haiyan Zhou, Huiqing Ge, Wenbin Jiang, Lijun Feng, Hui Liu, Yingchun Zhang, Zhiying Mao, Jianhua Li, Bo Shen, Yuelong Liang, Xiujun Cai
BACKGROUND: Enhanced recovery after surgery (ERAS), with several evidence-based elements, has been shown to shorten length of hospital stay and reduce perioperative hospital costs in many operations. This randomized clinical trial was performed to compare complications and hospital stay of laparoscopic liver resection between ERAS and traditional care. METHODS: A randomized controlled trial was performed for laparoscopic liver resection from August 2015 to August 2016...
December 12, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/29225814/perioperative-plasma-lyte-use-reduces-the-incidence-of-renal-replacement-therapy-and-hyperkalaemia-following-renal-transplantation-when-compared-with-0-9-saline-a-retrospective-cohort-study
#13
Anamika Adwaney, David W Randall, Mark J Blunden, John R Prowle, Christopher J Kirwan
Background: Kidney transplant recipients often receive large volumes of intravenous fluid replacement in the peri-operative period. Administration of 0.9% saline has previously been associated with acidosis, hyperkalaemia and acute kidney injury. The perioperative use of physiologically balanced replacement fluids may reduce the incidence of post-operative renal replacement therapy and hyperkalaemia. Methods: A retrospective review of consecutive renal transplants before and after a change in perioperative fluid prescription from 0...
December 2017: Clinical Kidney Journal
https://www.readbyqxmd.com/read/29189271/low-versus-high-chloride-content-intravenous-solutions-for-critically-ill-and-perioperative-adult-patients-a-systematic-review-and-meta-analysis
#14
Leticia Kawano-Dourado, Fernando G Zampieri, Luciano C P Azevedo, Thiago D Corrêa, Mabel Figueiró, Matthew W Semler, John A Kellum, Alexandre B Cavalcanti
BACKGROUND: To assess whether use of low-chloride solutions in unselected critically ill or perioperative adult patients for maintenance or resuscitation reduces mortality and renal replacement therapy (RRT) use when compared to high-chloride fluids. METHODS: Systematic review and meta-analysis with random-effects inverse variance model. PubMed, Cochrane library, EMBASE, LILACS, and Web of Science were searched from inception to October 2016. Published and unpublished randomized controlled trials in any language that enrolled critically ill and/or perioperative adult patients and compared a low- to a highchloride solution for volume maintenance or resuscitation...
November 14, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29174123/intraoperative-anesthetic-management-of-lung-transplantation-center-specific-practices-and-geographic-and-centers-size-differences
#15
Roland Tomasi, David Betz, Sophie Schlager, Tobias Kammerer, Dominik J Hoechter, Thomas Weig, Peter Slinger, Laura V Klotz, Bernhard Zwißler, Nandor Marczin, Vera von Dossow
OBJECTIVE: Although increasing evidence in lung transplantation (LTx) suggests that intraoperative management could influence outcomes, there are no guidelines available regarding intraoperative management of LTx. The overall goal of the study was to assess geographic and center volume-specific clinical practices in perioperative management. DESIGN: Prospective data analysis. SETTING: Online survey from a single-center university hospital...
May 17, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29170998/introducing-topmast-the-first-double-blind-randomized-clinical-trial-specifically-dedicated-to-perioperative-maintenance-fluid-therapy-in-adults
#16
Steven Hendrickx, Karen Van Vlimmeren, Ingrid Baar, Walter Verbrugghe, Karolien Dams, Sophie Van Cromphaut, Ella Roelant, Bart Embrecht, Anouk Wittock, Pieter Mertens, Jeroen M Hendriks, Patrick Lauwers, Paul E Van Schil, Amaryllis H Van Craenenbroeck, Tim Van den Wyngaert, Philippe Jorens, Niels Van Regenmortel
BACKGROUND: Although prescribed to every patient undergoing surgery, maintenance fluid therapy is a poorly researched part of perioperative fluid therapy. The tonicity of the chosen solutions, on the other hand, could be an important cause of morbidity, with hyponatremia being a potential side effect of hypotonic solutions, where isotonic solution could lead to fluid overload. METHODS: The TOPMAST-trial is an ongoing prospective single-center double-blind randomized trial comparing an isotonic and a hypotonic maintenance fluid strategy during and after surgery in patients undergoing different types of major thoracic surgery...
November 24, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29156484/-perioperative-intravenous-fluid-therapy-in-children
#17
Robert Sümpelmann
The objective of this consensus-based S1 Guideline for perioperative fluid therapy in children is to maintain or re-establish the child's homeostasis. Therefore, the perioperative fasting times should be as short as possible to prevent patient discomfort, dehydration, and ketoacidosis. For the intraoperative background infusion a physiologically composed balanced isotonic electrolyte solution (BS) with 1 - 2.5% glucose is recommended to maintain normal glucose concentrations and to avoid hyponatremia, hyperchloremia, and lipolysis...
November 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29149189/perioperative-body-weight-change-is-associated-with-in-hospital-mortality-in-cardiac-surgical-patients-with-postoperative-acute-kidney-injury
#18
Chih-Chung Shiao, Ya-Ting Huang, Tai-Shuan Lai, Tao-Min Huang, Jian-Jhong Wang, Chun-Te Huang, Pei-Chen Wu, Che-Hsiung Wu, I-Jung Tsai, Li-Jung Tseng, Chih-Hsien Wang, Tzong-Shinn Chu, Kwan-Dun Wu, Vin-Cent Wu
BACKGROUND: Postoperative acute kidney injury (AKI) is common following cardiac surgery (CS). Body weight (BW) may be an amenable variable by representing the summation of the nutritional and the fluid status. However, the predictive role of perioperative BW changes in CS patients with severe postoperative AKI is never explored. This study aimed to evaluate this association. METHODS: This study was conducted using a prospectively collected multicenter cohort, NSARF (National Taiwan University Hospital Study Group on Acute Renal Failure) database...
2017: PloS One
https://www.readbyqxmd.com/read/29073613/impact-of-the-flotrac-vigileotm-monitoring-on-intraoperative-fluid-management-and-outcome-after-liver-resection
#19
Enrico Giustiniano, Fabio Procopio, Nadia Ruggieri, Stefania Grimaldi, Guido Torzilli, Ferdinando Raimondi
BACKGROUNDS: Perioperative fluid-therapy is a still a debated issue. In hepatic surgery, volume load must be strictly monitored to assure both a safe hemodynamics and low central venous pressure (CVP) to limit the backflow bleeding. Retrospectively, we compared intraoperative fluid management before and after the adoption of a semi-invasive hemodynamic monitoring. METHODS: We compared patients submitted to liver resection monitored by FloTrac/VigileoTM (group A) vs...
October 26, 2017: Digestive Surgery
https://www.readbyqxmd.com/read/29067620/what-is-enhanced-recovery-and-how-can-i-do-it
#20
Bradford J Kim, Thomas A Aloia
BACKGROUND: Enhanced recovery (ER) and fast-track protocols were initially implemented in the perioperative management of the surgical patient over 20 years ago. These standardized protocols are now broadly implemented across most surgical specialties for its many benefits. ER is well known for its positive effects on decreasing length of stay and complications. However, patient-centric outcomes for adequate pain control, functional recovery, costs, and overall patient experience are less considered...
January 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
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