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Perioperative Medicine

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86 papers 25 to 100 followers
By EFRAIN PAEZ Internal Medicine since 1988. Interested in all aspects of Medicine.
https://www.readbyqxmd.com/read/29200059/a-perioperative-medicine-model-for-population-health-an-integrated-approach-for-an-evolving-clinical-science
#1
Solomon Aronson, Julie Westover, Nicole Guinn, Tracy Setji, Paul Wischmeyer, Padma Gulur, Thomas Hopkins, Thorsten M Seyler, Sandhya Lagoo-Deendayalan, Mitchell T Heflin, Annemarie Thompson, Madhav Swaminathan, Ellen Flanagan
Health care delivery in the United States continues to balance on the tight rope that connects its transition from volume to value. Value in economic terms can be defined as the amount something exceeds its commodity price and is determined by extraordinary reputation, quality, and/or service, whereas its destruction can be a consequence of poor management, unfavorable policy, decreased demand, and/or increased competition. Going forward, payment for health care delivery will increasingly be based on services that contribute to improvements in individual and/or population health value, and funds to pay for health care delivery will become increasingly vulnerable to competitive market forces...
November 30, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29203506/effectiveness-of-preoperative-medical-consultations-by-internal-medicine-physicians-a-systematic-review
#2
Clarabelle T Pham, Catherine L Gibb, Robert A Fitridge, Jonathan D Karnon
OBJECTIVE: Clinics have been established to provide preoperative medical consultations, and enable the anaesthetist and surgeon to deliver the best surgical outcome for patients. However, there is uncertainty regarding the effect of such clinics on surgical, in-hospital and long-term outcomes. A systematic review of the literature was conducted to determine the effectiveness of preoperative medical consultations by internal medicine physicians for patients listed for elective surgery...
December 3, 2017: BMJ Open
https://www.readbyqxmd.com/read/29173248/2017-update-in-perioperative-medicine-6-questions-answered
#3
REVIEW
Ryan Munyon, Steven L Cohn, Barbara Slawski, Gerald W Smetana, Kurt Pfeifer
The authors performed a MEDLINE search to identify articles published between January 2016 and April 2017 that had significant impact on perioperative care. They identified 6 topics for discussion.
November 2017: Cleveland Clinic Journal of Medicine
https://www.readbyqxmd.com/read/29098342/preoperative-evaluation-of-adult-patients-before-elective-noncardiothoracic-surgery-joint-recommendation-of-the-german-society-of-anesthesiology-and-intensive-care-medicine-the-german-society-of-surgery-and-the-german-society-of-internal-medicine
#4
REVIEW
B Zwissler
Evaluation of the patient's medical history and a physical examination are the cornerstones of risk assessment prior to elective surgery, and may help to optimize the patient's preoperative medical condition and guide perioperative management. Whether performance of additional technical tests (e. g., blood chemistry, electrocardiography, spirometry, chest x‑ray) can contribute to reduction of the perioperative risk is often not well known or controversial. Similarly, there is considerable uncertainty among anesthesiologists, internists, and surgeons with respect to perioperative management of the patient's long-term medication...
November 2, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29061775/perioperative-administration-of-traditional-japanese-herbal-medicine-daikenchuto-relieves-postoperative-ileus-in-patients-undergoing-surgery-for-gastrointestinal-cancer-a-systematic-review-and-meta-analysis
#5
REVIEW
Mitsuru Ishizuka, Norisuke Shibuya, Hitoshi Nagata, Kazutoshi Takagi, Yoshimi Iwasaki, Hiroyuki Hachiya, Taku Aoki, Keiichi Kubota
AIM: Although it has been widely demonstrated that administration of Daikenchuto (DKT), a traditional Japanese herbal medicine, improves gastrointestinal (GI) motility in patients undergoing abdominal surgery, few studies have investigated the efficacy of perioperative DKT administration for relief of postoperative ileus (PI) in patients undergoing surgery for GI cancer. Therefore, the aim of this study was to investigate whether perioperative administration of DKT relieves PI in patients with GI cancer...
November 2017: Anticancer Research
https://www.readbyqxmd.com/read/29079408/dexamethasone-the-wonder-drug-in-perioperative-medicine
#6
EDITORIAL
Gildasio S De Oliveira, Mathew Thran
No abstract text is available yet for this article.
October 24, 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28953743/managing-opioid-addiction-risk-in-plastic-surgery-during-the-perioperative-period
#7
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
#8
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...
December 2017: Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/28870302/perioperative-pain-management-in-hip-and-knee-arthroplasty
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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