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Post operative fluid maintenance

Egidio Del Fabbro
102 Background: Intrathecal pumps (ITP) are used to manage severe malignancy related pain by delivering analgesics directly into the cerebrospinal fluid, in theory allowing for a reduced opioid dose and fewer complications. Although there is literature to support efficacy in patients with cancer, including improved survival, this mode of drug delivery also carries a risk of serious complications. Reports of complications in non-malignant pain suggest the risks and mortality related to ITP may be under-appreciated and that injury and liability occur with both ITP placement and ITP maintenance...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
M Horn, N Patel, D M MacLellan, N Millard
INTRODUCTION: Exposure to blood and body fluids is a major concern to health care professionals working in operating rooms (ORs). Thus, it is essential that hospitals use fluid waste management systems that minimise risk to staff, while maximising efficiency. METHOD: The current study compared the utility of a 'closed' system with a traditional canister-based 'open' system in the OR in a private hospital setting. RESULTS: A total of 30 arthroscopy, urology, and orthopaedic cases were observed...
June 2016: ORNAC Journal
Lorenzo Ball, Maddalena Dameri, Paolo Pelosi
Most patients undergoing surgical procedures need to be mechanically ventilated, because of the impact of several drugs administered at induction and during maintenance of general anaesthesia on respiratory function. Optimization of intraoperative mechanical ventilation can reduce the incidence of post-operative pulmonary complications and improve the patient's outcome. Preoxygenation at induction of general anaesthesia prolongs the time window for safe intubation, reducing the risk of hypoxia and overweighs the potential risk of reabsorption atelectasis...
September 2015: Best Practice & Research. Clinical Anaesthesiology
Helena Isabel Almeida, Maria Inês Mascarenhas, Helena Cristina Loureiro, Clara S Abadesso, Pedro S Nunes, Marta S Moniz, Maria Céu Machado
OBJECTIVES: To study the effect of two intravenous maintenance fluids on plasma sodium (Na), and acid-base balance in pediatric intensive care patients during the first 24h of hospitalization. METHODS: A prospective randomized controlled study was performed, which allocated 233 patients to groups: (A) NaCl 0.9% or (B) NaCl 0.45%. Patients were aged 1 day to 18 years, had normal electrolyte concentrations, and suffered an acute insult (medical/surgical). MAIN OUTCOME MEASURED: change in plasma sodium...
September 2015: Jornal de Pediatria
L-P Han, H-M Zhang, H-D Abha, T Liu, X-P Zhang
OBJECTIVE: To investigate the development and management of chylous leakage after laparoscopic retroperitoneal lymphadenectomy. PATIENTS AND METHODS: From July 2006 to September 2013, 13 cases of chylous leakage after the laparoscopic lymphadenectomy (6 cases of renal cell carcinoma, 4 cases of gastric cancer, 2 cases of ovarian cancer, 1 case of endometrial cancer) were studied to analyze the occurrence, development and management of chylous leakage. RESULTS: In 3 cases (2 cases of renal cell carcinoma, 1 case of gastric cancer) massive amount of milky fluid drainage was be seen after the first two days post operation...
2014: European Review for Medical and Pharmacological Sciences
Shilong Wang, Chaoliang Tang, Quan Zhang, Wenjun Chen
Tibial plateau fractures are often the result of blunt trauma and are associated with severe soft-tissue injury. Operative management of high-energy fractures remains difficult and challenging because the injuries often associated with serious complications. MicroRNAs (miRNAs) are the class of short noncoding single-stranded RNA molecules that negatively regulate gene expression. miRNAs contribute to every step of osteogenesis from embryonic bone development to maintenance of adult bone tissue, and disturbed miRNAs expression are identified related to osteoporosis, osteosarcoma, post-traumatic arthritis and bone remodeling...
2014: International Journal of Clinical and Experimental Pathology
O Sneh-Arbib, A Shiferstein, N Dagan, S Fein, L Telem, E Muchtar, N Eliakim-Raz, B Rubinovitch, G Rubin, Z H Rappaport, M Paul
Neurosurgery is characterized by a prolonged risk period for surgical site infection (SSI), mainly related to the presence of cerebrospinal fluid (CSF) drains. We aimed to examine factors associated with post-neurosurgical SSIs, focusing on post-operative factors. A prospective cohort study was conducted in a single center over a period of 18 months in Israel. Included were adult patients undergoing clean or clean-contaminated craniotomy, including craniotomies with external CSF drainage or shunts. SSIs were defined by the Centers for Disease Control and Prevention (CDC) criteria for healthcare-associated infections...
December 2013: European Journal of Clinical Microbiology & Infectious Diseases
Jussi M Leppilahti, Mikko A Kallio, Taina Tervahartiala, Timo Sorsa, Päivi Mäntylä
BACKGROUND: Molecular biomarkers are needed for diagnostic use in periodontal diseases. The aim of this study is to explore different gingival crevicular fluid (GCF) matrix metalloproteinase-8 (MMP-8) patterns in smokers and non-smokers with chronic periodontitis (CP) and test the utility of baseline GCF MMP-8 levels in predicting categorically assessed treatment outcomes. METHODS: The study population comprised 15 patients with CP (five non-smokers and 10 smokers)...
February 2014: Journal of Periodontology
Ryash Vather, Ian Bissett
BACKGROUND: Prolonged post-operative ileus (PPOI) occurs in up to 25% of patients following major elective abdominal surgery. It is associated with a higher risk of developing post-operative complications, prolongs hospital stay and confers a significant financial load on health-care institutions. Literature outlining best-practice management strategies for PPOI is nebulous. The aim of this text was to review the literature and provide concise evidence-based recommendations for its management...
May 2013: ANZ Journal of Surgery
David B Sachar
When a patient is hospitalized with acute, severe ulcerative colitis, the primary decision is whether or not to proceed directly to surgery. Absolute indications for an immediate colectomy include exsanguinating hemorrhage, perforation and cancer. If medical therapy is undertaken, however, the decision for urgent surgery or non-operative salvage therapy will still be required in 15-50% of the patients in which there is a failure to respond within 3-5 days to a standard regimen of i.v. steroids, antibiotics, decompressive maneuvers, fluid and electrolyte replacement and other supportive measures...
February 2012: Journal of Digestive Diseases
Matthew D Wiles, William J D Whiteley, Chris G Moran, Iain K Moppett
BACKGROUND: Approximately 70,000 patients/year undergo surgery for repair of a fractured hip in the United Kingdom. This is associated with 30-day mortality of 9% and survivors have a considerable length of acute hospital stay postoperatively (median 26 days). Use of oesophageal Doppler monitoring to guide intra-operative fluid administration in hip fracture repair has previously been associated with a reduction in hospital stay of 4-5 days. Most hip fracture surgery is now performed under spinal anaesthesia...
September 28, 2011: Trials
Thomas G Saba, James Fairbairn, Fiona Houghton, Diane Laforte, Bethany J Foster
BACKGROUND: Isotonic saline has been proposed as a safer alternative to traditional hypotonic solutions for intravenous (IV) maintenance fluids to prevent hyponatremia. However, the optimal tonicity of maintenance intravenous fluids in hospitalized children has not been determined. The objective of this study was to estimate and compare the rates of change in serum sodium ([Na]) for patients administered either hypotonic or isotonic IV fluids for maintenance needs. METHODS: This was a masked controlled trial...
September 23, 2011: BMC Pediatrics
Urban Fläring, Per-Arne Lönnqvist, Björn Frenckner, Jan F Svensson, Ingimar Ingolfsson, Lena Wallensteen, Shayarina Stigzelius, Jan Kowalski, Rafael T Krmar
BACKGROUND: Hyponatremia is the most frequent electrolyte abnormality observed in post-operative pediatric patients receiving intravenous maintenance fluid therapy. If plasma sodium concentration (p-Na+) declines to levels below 125 mmol/L in < 48 h, transient or permanent brain damage may occur. There is an intense debate as to whether the administered volume (full rate vs. restricted rate of infusion) and the composition of solutions used for parenteral maintenance fluid therapy (hypotonic vs...
July 5, 2011: BMC Pediatrics
J B Cywinski, E Mascha, J You, M Argalious, L Kapural, E Christiansen, B M Parker
BACKGROUND: Fluid management during orthotopic liver transplantation poses unique challenges for the anesthesiologist. Maintenance of hypovolemia as indicated by low central venous pressure has been associated with reduced blood loss and improved outcomes in some studies, but with higher 30-day mortality and increased incidence of renal dysfunction in others. The primary aim was to evaluate the association of central venous pressure management after liver allograft reperfusion with immediate postoperative patient outcomes...
October 2010: Minerva Anestesiologica
Pablo G Eulmesekian, Augusto Pérez, Pablo G Minces, Desmond Bohn
OBJECTIVE: To establish the incidence and factors associated with hospital-acquired hyponatremia in pediatric surgical patients who received hypotonic saline (sodium 40 mmol/L plus potassium 20 mmol/L) at the rate suggested by the Holliday and Segar's formula for calculations of maintenance fluids. DESIGN: Prospective, observational, cohort study. SETTING: Pediatric intensive care unit. PATIENTS: : Eighty-one postoperative patients...
July 2010: Pediatric Critical Care Medicine
Jonathan J Ross, Mouloud A Denaï, Mahdi Mahfouf
OBJECTIVE: Patients emerging from cardiac surgery can display varying degrees of cardiovascular instability arising from potentially complex, multi-factorial and interlinked causes. Stabilization and control of the cardiovascular system are currently managed by healthcare experts using experiential knowledge, and, in some centers, manually inputted decision pathway algorithms. This paper describes a clinical trial undertaken to determine the basic functioning of a clinical decision support system (CDSS) designed and constructed by the authors to facilitate the control of the major cardiovascular components in the early post-operative phase...
January 2009: Artificial Intelligence in Medicine
Michael Yung, Steve Keeley
AIM: Traditional paediatric intravenous maintenance fluids are prescribed using hypotonic fluids and the weight-based 4:2:1 formula for administration rate. However, this may cause hyponatraemia in sick and post-operative children. We studied the effect of two types of intravenous maintenance fluid and two administration rates on plasma sodium concentration in intensive care patients. METHODS: A Factorial-design, double-blind, randomised controlled trial was used...
January 2009: Journal of Paediatrics and Child Health
Christopher M Burton, Nils Milman, Claus B Andersen, Hanne Marquart, Martin Iversen
We report on a male patient with bronchiectasis secondary to common variable immune deficiency (CVID) receiving lung transplantation. The patient had been diagnosed with CVID many y prior to right-sided single lung transplantation and was receiving appropriate immunoglobulin substitution therapy. He received antithymocyte globulin induction and maintenance triple therapy with cyclosporine, azathioprine and prednisolone. The early post-operative course was complicated by the development of severe acute cellular rejection and organizing pneumonia...
2007: Scandinavian Journal of Infectious Diseases
William L Baker, C Michael White
OBJECTIVE: To review the available literature addressing preventive strategies of post-cardiothoracic surgery atrial fibrillation (post-CTS atrial fibrillation). DATA SOURCES: Pertinent articles related to the etiology, risk factors, and preventive strategies were identified through a MEDLINE search (1966-March 2007) using the MeSH terms atrial fibrillation, cardiothoracic surgery, cardiac surgery, etiology, neurohormonal, sympathetic, volume, fluid, inflammation, risk factors, operative, pacing, beta-adrenergic blockers, amiodarone, sotalol, calcium-channel blockers, magnesium, HMG-CoA reductase inhibitors, statins, fatty acids, PUFA, steroids, and nonsteroidal antiinflammatory drugs...
April 2007: Annals of Pharmacotherapy
Gerd Albuszies, Peter Radermacher, Josef Vogt, Ulrich Wachter, Sandra Weber, Michael Schoaff, Michael Georgieff, Eberhard Barth
OBJECTIVE: Septic shock-associated organ dysfunction is attributed to derangements of microcirculatory perfusion and/or impaired cellular oxygen utilization. The hepatosplanchnic organs are regarded to play a pivotal role in the pathophysiology of sepsis-related organ failure. In a murine model of septic shock, we tested the hypothesis whether achieving normotensive, hyperdynamic hemodynamics characterized by a sustained increase in cardiac output would allow maintenance of regional microvascular perfusion and oxygenation and, thus, hepatic metabolic capacity...
October 2005: Critical Care Medicine
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