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Perioperative Medicine

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80 papers 25 to 100 followers
By EFRAIN PAEZ Internal Medicine since 1988. Interested in all aspects of Medicine.
https://www.readbyqxmd.com/read/28953743/managing-opioid-addiction-risk-in-plastic-surgery-during-the-perioperative-period
#1
REVIEW
Daniel Demsey, Nicholas J Carr, Hance Clarke, Sharon Vipler
Opioid addiction is a public health crisis that affects all areas of medicine. Large numbers of the population across all racial and economic demographics misuse prescription opioids and use illicit opioids. The current understanding is that opioid misuse is a disease that requires treatment, and is not an issue of choice or character. Use of opioid medication is a necessary part of postoperative analgesia, but many physicians are unsure of how to do this safely given the risk of patients developing an opioid misuse disorder...
October 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28879623/the-risk-factors-associated-with-postoperative-hemorrhage-after-tooth-extraction-a-multi-center-retrospective-study-of-patients-receiving-oral-antithrombotic-therapy
#2
Takumi Hasegawa, Souichi Yanamoto, Akira Tachibana, Yuka Kojima, Yoshito Koyama, Michinori Maeda, Takahide Komori
The purpose of this study was to retrospectively investigate the multivariate relationships between specific risk factors and postoperative hemorrhage after tooth extraction in patients who were prescribed oral antithrombotic therapy. Risk factors for postoperative hemorrhage after tooth extraction were evaluated using univariate and multivariate analyses. Patient characteristics such as age and gender; the presence or absence of known comorbidities such as diabetes mellitus, hypertension, cerebral infarction, and alcohol consumption; and perioperative diarrhea were assessed...
September 6, 2017: Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/28870302/perioperative-pain-management-in-hip-and-knee-arthroplasty
#3
REVIEW
Christian J Gaffney, Christopher E Pelt, Jeremy M Gililland, Christopher L Peters
Total hip and knee arthroplasty is associated with significant perioperative pain, which can adversely affect recovery by increasing risk of complications, length of stay, and cost. Historically, opioids were the mainstay of perioperative pain control. However, opioids are associated with significant downsides. Preemptive use of a multimodal pain management approach has become the standard of care to manage pain after hip and knee arthroplasty. Multimodal pain management uses oral medicines, peripheral nerve blocks, intra-articular injections, and other tools to reduce the need for opioids...
October 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27816125/anesthesia-for-the-patient-with-concomitant-hepatic-and-renal-impairment
#4
REVIEW
Tricia E Brentjens, Ryan Chadha
Hepatic and renal disease are common comorbidities in patients presenting for intermediate- and high-risk surgery. With the evolution of perioperative medicine, anesthesiologists are encountering more patients who have significant hepatic and renal disease, both acute and chronic in nature. It is important that anesthesiologists have an in-depth understanding of the physiologic derangements seen with hepatic and renal disease to evaluate and manage these patients appropriately. Perioperative management requires an understanding of the physiologic perturbations associated with each disease process...
December 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27861433/understanding-phenotypes-of-obstructive-sleep-apnea-applications-in-anesthesia-surgery-and-perioperative-medicine
#5
REVIEW
Yamini Subramani, Mandeep Singh, Jean Wong, Clete A Kushida, Atul Malhotra, Frances Chung
Obstructive sleep apnea (OSA) is a prevalent sleep-disordered breathing with potential long-term major neurocognitive and cardiovascular sequelae. The pathophysiology of OSA varies between individuals and is composed of different underlying mechanisms. Several components including the upper airway anatomy, effectiveness of the upper airway dilator muscles such as the genioglossus, arousal threshold of the individual, and inherent stability of the respiratory control system determine the pathogenesis of OSA...
January 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27902502/zika-virus-and-patient-blood-management
#6
REVIEW
Lawrence T Goodnough, Marisa B Marques
Sporadic Zika virus infections had only occurred in Africa and Asia until an outbreak in Micronesia (Oceania) in 2007. In 2013 to 2014, several outer Pacific Islands reported local outbreaks. Soon thereafter, the virus was likely introduced in Brazil from competing athletes from French Polynesia and other countries that participated in a competition there. Transmission is thought to have occurred through mosquito bites and spread to the immunologically naive population. Being also a flavivirus, the Zika virus is transmitted by the Aedes mosquito that is endemic in South and Central America that is also the vector of West Nile virus, dengue, and chikungunya...
January 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28243376/preventive-gabapentin-versus-pregabalin-to-decrease-postoperative-pain-after-lumbar-microdiscectomy-a-randomized-controlled-trial
#7
Mohsin Qadeer, Muhammad Waqas, Muhammad Jawad Rashid, Syed Ather Enam, Salman Sharif, Ghulam Murtaza
STUDY DESIGN: Randomized controlled trial. PURPOSE: The purpose of this study was to compare pregabalin and gabapentin for mean postoperative visual analog score (VAS) for pain in patients undergoing single-level lumbar microdiscectomy for intervertebral disc prolapse at a tertiary care hospital. OVERVIEW OF LITERATURE: Pregabalin has a superior pharmacokinetic profile and analgesic effect at lower doses than gabapentin; however, analgesic efficacy must be established during the perioperative period after lumbar spine surgery...
February 2017: Asian Spine Journal
https://www.readbyqxmd.com/read/28372656/what-is-the-place-of-clonidine-in-anesthesia-systematic-review-and-meta-analyses-of-randomized-controlled-trials
#8
REVIEW
Miguel Carlos Sanchez Munoz, Marc De Kock, Patrice Forget
STUDY OBJECTIVE: A place for clonidine has been suggested for many indications in perioperative medicine. The aim of this systematic review and these meta-analyses is to systematically, and quantitatively, evaluate these potential indications of clonidine. DESIGN, SETTING, PATIENTS AND INTERVENTIONS: We selected and analyzed (qualitatively and, when possible, quantitatively) the available literature published on PubMed/Medline and on the Cochrane database. Inclusion criteria included: human randomized controlled trials involving adults who received perioperative systemic (oral, intramuscular, transdermal and intravenous) clonidine for every type of surgery...
May 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28597121/current-research-priorities-in-perioperative-intensive-care-medicine
#9
REVIEW
Michael A Gillies, Michael Sander, Andrew Shaw, Duminda N Wijeysundera, John Myburgh, Cesar Aldecoa, Ib Jammer, Suzana M Lobo, Naomi Pritchard, Michael P W Grocott, Marcus J Schultz, Rupert M Pearse
INTRODUCTION: Surgical treatments are offered to more patients than ever before, and increasingly to older patients with chronic disease. High-risk patients frequently require critical care either in the immediate postoperative period or after developing complications. The purpose of this review was to identify and prioritise themes for future research in perioperative intensive care medicine. METHODS: We undertook a priority setting process (PSP). A panel was convened, drawn from experts representing a wide geographical area, plus a patient representative...
June 8, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28633144/standardized-renal-endpoints-for-perioperative-clinical-trials-the-standardized-endpoints-in-perioperative-medicine-initiative
#10
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
#11
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/28649376/re-designing-the-pathway-to-surgery-better-care-and-added-value
#12
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/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/28682957/the-new-world-health-organization-recommendations-on-perioperative-administration-of-oxygen-to-prevent-surgical-site-infections-a-dangerous-reductionist-approach
#14
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/28728322/perioperative-hypertension-management-during-facelift-under-local-anesthesia-with-intravenous-hypnotics
#15
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/28733926/perioperative-management-of-endocrine-insufficiency-after-total-pancreatectomy-for-neoplasia
#16
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/28744807/the-effectiveness-of-low-dose-and-high-dose-tranexamic-acid-in-posterior-lumbar-interbody-fusion-a-double-blinded-placebo-controlled-randomized-study
#17
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/28749248/update-in-perioperative-medicine-practice-changing-evidence-published-in-2016
#18
REVIEW
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...
October 2017: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/28844370/technology-is-there-sufficient-evidence-to-change-practice-in-point-of-care-management-of-coagulopathy
#19
REVIEW
Michael Fabbro, Anne M Winkler, Jerrold H Levy
Currently, hemostasis is one of the most widely researched topics in perioperative medicine. As investigators learn more about the complexity of coagulation, developing tests with the ability to rapidly monitor coagulation and guide targeted therapy is the key to optimizing hemostasis management. There is mounting evidence that algorithmic transfusion using point-of-care (POC) testing can reduce red cell and platelet transfusions and major bleeding after cardiac surgery. Integrating these tests during cardiac surgery and trauma management is especially important because these groups use the most blood products within a health system and the risks of transfusion are well documented...
October 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28589402/the-preoperative-assessment-and-optimization-of-patients-undergoing-major-urological-surgery
#20
REVIEW
Helen W Cui, Benjamin W Turney, John Griffiths
PURPOSE OF REVIEW: Improving patient outcomes from major urological surgery requires not only advancement in surgical technique and technology, but also the practice of patient-centered, multidisciplinary, and integrated medical care of these patients from the moment of contemplation of surgery until full recovery. This review examines the evidence for recent developments in preoperative assessment and optimization that is of relevance to major urological surgery. RECENT FINDINGS: Current perioperative medicine recommendations aim to improve the short-term safety and long-term effectiveness of surgical treatments by the delivery of multidisciplinary integrated medical care...
July 2017: Current Urology Reports
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