Sample records for accelerated perioperative care

  1. Peri-operative intensive care.

    Walsh, Sandra A; Peters, Mark J


    All good intensive care requires attention to detail of the routine elements of care. These include staffing and monitoring, drug prescription and administration, feeding and fluid balance, analgesia and sedation, organ support and reducing the risk of healthcare-associated infection. Doing this well requires an understanding of the relevant physiology and an awareness of the limited evidence base. Detailed protocols and implementation checklist are valuable in ensuring that these minimum standards are met. However, peri-operative care is not all predictable and amenable to protocolization. This is especially true following separation of conjoined twins. Despite the sophisticated imaging and multi-disciplinary planning that precede elective separation, the acute physiological changes in each twin cannot always be predicted reliably. In this article, we review briefly each element of peri-operative care and how this might vary in conjoined twins. PMID:26382268

  2. [Perioperative management of transthoracic oesophagectomies : Fundamentals of interdisciplinary care and new approaches to accelerated recovery after surgery].

    Lambertz, R; Drinhaus, H; Schedler, D; Bludau, M; Schröder, W; Annecke, T


    Locally advanced carcinomas of the oesophagus require multimodal treatment. The core element of curative therapy is transthoracic en bloc oesophagectomy, which is the standard procedure carried out in most specialized centres. Reconstruction of intestinal continuity is usually achieved with a gastric sleeve, which is anastomosed either intrathoracically or cervically to the remaining oesophagus. This thoraco-abdominal operation is associated with significant postoperative morbidity, not least because of a vast array of pre-existing illnesses in the surgical patient. For an optimal outcome, the careful interdisciplinary selection of patients, preoperative risk evaluation and conditioning are essential. The caseload of the centres correlates inversely with the complication rate. The leading surgical complication is anastomotic leakage, which is diagnosed endoscopically and usually treated with the aid of endoscopic procedures. Pulmonary infections are the most frequent non-surgical complication. Thoracic epidural anaesthesia and perfusion-orientated fluid management can reduce the rate of pulmonary complications. Patients are ventilated protecting the lungs and are extubated as early as possible. Oesophagectomies should only be performed in high-volume centres with the close cooperation of surgeons and anaesthesia/intensive care specialists. Programmes of enhanced recovery after surgery (ERAS) hold further potential for the patient's quicker postoperative recovery. In this review article the fundamental aspects of the interdisciplinary perioperative management of transthoracic oesophagectomy are described. PMID:27245922

  3. Perioperative Care of the Liver Transplant Patient.

    Keegan, Mark T; Kramer, David J


    With the evolution of surgical and anesthetic techniques, liver transplantation has become "routine," allowing for modifications of practice to decrease perioperative complications and costs. There is debate over the necessity for intensive care unit admission for patients with satisfactory preoperative status and a smooth intraoperative course. Postoperative care is made easier when the liver graft performs optimally. Assessment of graft function, vigilance for complications after the major surgical insult, and optimization of multiple systems affected by liver disease are essential aspects of postoperative care. The intensivist plays a vital role in an integrated multidisciplinary transplant team. PMID:27339683

  4. Evidence for the perioperative care of mastectomized women

    Carla Monique Lopes Mourão


    Full Text Available This study aimed to evaluate the evidence available in the literature about the perioperative care provided to women submitted to mastectomy. An integrative review of scientific literature conducted in MEDLINE, CINAHL, LILACS, and SciELO databases, published from 2000 to 2011, using the controlled descriptors: preoperative care; preoperative period; intraoperative care; intraoperative period; postoperative care; postoperative period; perioperative care; perioperative period; and mastectomy. The sample of this review consisted of seven articles. The evidence pointed as perioperative care of mastectomy the pharmacological management of pain in different surgical periods. Despite the difficulty in presenting a consensus of evidence for perioperative care of mastectomy, there was concern on the part of professionals to minimize/prevent pre-, intra- and post-operative pain. Nursing should be aware, both of the update of pharmacological treatments in pain management and the development of future research related to nursing care in the perioperative period of mastectomy.

  5. Effective Perioperative Communication to Enhance Patient Care.

    Garrett, J Hudson


    Breakdowns in health care communication are a significant cause of sentinel events and associated patient morbidity and mortality. Effective communication is a necessary component of a patient safety program, which enables all members of the interdisciplinary health care team to effectively manage their individual roles and responsibilities in the perioperative setting; set expectations for safe, high-reliability care; and measure and assess outcomes. To sustain a culture of safety, effective communication should be standardized, complete, clear, brief, and timely. Executive leadership and support helps remove institutional barriers and address challenges to support the engagement of patients in health care communication, which has been shown to improve outcomes, reduce costs, and improve the patient experience. PMID:27472971

  6. The bariatric patient: an overview of perioperative care.

    Fencl, Jennifer L; Walsh, Angela; Vocke, Dawn


    Obesity (ie, a body mass index of ≥30 kg/m(2)) is increasing in the United States. As a result, more overweight individuals are being surgically treated for weight loss, thus making it imperative for perioperative RNs to understand obesity's effects on patients' health, its contribution to significant comorbidities (eg, diabetes, cardiovascular disease, hypertension, sleep apnea, musculoskeletal issues, stroke), the perioperative care requirements (eg, specialized instruments and equipment, positioning and lifting aids), and unique needs of these patients (eg, diet, counseling). It is vital that the perioperative nurse accurately assesses the patient undergoing bariatric surgery to provide safe and appropriate nursing interventions during the perioperative continuum of care. PMID:26227516

  7. The perioperative surgical home: An innovative, patient-centred and cost-effective perioperative care model.

    Desebbe, Olivier; Lanz, Thomas; Kain, Zeev; Cannesson, Maxime


    Contrary to the intraoperative period, the current perioperative environment is known to be fragmented and expensive. One of the potential solutions to this problem is the newly proposed perioperative surgical home (PSH) model of care. The PSH is a patient-centred micro healthcare system, which begins at the time the decision for surgery is made, is continuous through the perioperative period and concludes 30 days after discharge from the hospital. The model is based on multidisciplinary involvement: coordination of care, consistent application of best evidence/best practice protocols, full transparency with continuous monitoring and reporting of safety, quality, and cost data to optimize and decrease variation in care practices. To reduce said variation in care, the entire continuum of the perioperative process must evolve into a unique care environment handled by one perioperative team and coordinated by a leader. Anaesthesiologists are ideally positioned to lead this new model and thus significantly contribute to the highest standards in transitional medicine. The unique characteristics that place Anaesthesiologists in this framework include their systematic role in hospitals (as coordinators between patients/medical staff and institutions), the culture of safety and health care metrics innate to the specialty, and a significant role in the preoperative evaluation and counselling process, making them ideal leaders in perioperative medicine. PMID:26613678

  8. Delirium: a key challenge for perioperative care.

    O'Regan, N A; Fitzgerald, J; Timmons, S; O'Connell, H; Meagher, D


    Delirium is highly prevalent, occurring in 20% of acute hospital inpatients and up to 62% of surgical patients. It is a significant predictor of poor outcomes including mortality and institutionalisation, however it is often viewed as simply a marker of underlying illness and is frequently overlooked in older adults. Although delirium is commonly comorbid with dementia, it represents a more urgent diagnosis, requiring prompt intervention. Delirium presents most commonly with hypoactive features (e.g. withdrawal and reduced spontaneous movement and speech). The common stereotype of hyperactive delirium tremens (e.g. agitation, hallucinations), although more visible, is less common. All presentations share acute disimprovement of cognitive function. Delirium is a highly predictable and preventable occurrence, however a major barrier to improving delirium care and impacting upon outcomes is that it remains poorly detected, particularly in surgical populations and especially in patients with hypoactive presentations. Routine ward-based screening for delirium, particularly in high-risk populations, and improved staff awareness of the significance of the problem can improve detection rates. Preventative strategies, particularly multicomponent approaches, have been most efficacious in improving patient outcomes. Optimising perioperative risk factors can lead to reduced incidence. Appropriate treatment of delirium requires thorough investigation, management of the underlying illness, avoidance of complications and simplification of the care environment. Studies suggest a role for pharmacological prophylaxis, particularly in relation to anaesthetic and sedative agents used intra- and post-operatively. Furthermore, gathering evidence suggests that judicious use of antipsychotic medications may be helpful in delirium prevention and treatment. PMID:23277227

  9. Perioperative care of an adolescent with postural orthostatic tachycardia syndrome

    Kernan Scott


    Full Text Available Postural orthostatic tachycardia syndrome (POTS is a disorder characterized by postural tachycardia in combination with orthostatic symptoms without associated hypotension. Symptoms include light-headedness, palpitations, fatigue, confusion, and anxiety, which are brought on by assuming the upright position and usually relieved by sitting or lying down. Given the associated autonomic dysfunction that occurs with POTS, various perioperative concerns must be considered when providing anesthetic care for such patients. We present an adolescent with POTS who required anesthetic care during posterior spinal fusion for the treatment of scoliosis. The potential perioperative implications of this syndrome are discussed.

  10. Study of Problems Arising during Perioperative Care of Postoperative Endophthalmitis

    Jingyi Lin; Yue Cai; Jiehui Huang; Ronghua Ye


    Purpose:.To discuss the problems in perioperative nursing care for patients with postoperative infectious endophthalmitis. Methods: The medical records of 34 patients (35 eyes) pre-senting with infectious endophthalmitis at Zhongshan Oph-thalmic Center,.Sun Yat-sen University between April 2002 and December 2013 were collected to analyze preoperative and postoperative nursing care for endophthalmitis after ocular surgery. Results:Thirty-four patients (35 eyes) developed complications of infectious endophthalmitis after surgery..Thirty-three cases were successfully cured and only one patient (1 eye) was un-treated due to Pseudomonas aeruginosa infection. Conclusion: Perioperative nursing care plays a pivotal role in preventing and controlling the incidence and development of postoperative infectious endophthalmitis.

  11. Coordinating perioperative care for the 'high risk' general surgical patient using risk prediction scoring.

    Hafiz, Shaziz; Lees, Nicholas Peter


    Identifying 'high risk' (> 5% mortality score) emergency general surgical patients early, allows appropriate perioperative care to be allocated by securing critical care beds and ensuring the presence of senior surgeons and senior anesthetists intraoperatively. Scoring systems can be used to predict perioperative risk and coordinate resources perioperatively. Currently it is unclear which estimate of risk correlates with current resource deployment. A retrospective study was undertaken assessing the relationship between deployment of perioperative resources: senior surgeon, senior anesthetist and critical care bed. The study concluded that almost all high risk patients with high POSSUM mortality and morbidity scores had a consultant senior surgeon present intraoperatively. Critically unwell patients with higher operative severity and perioperative morbidity scores received higher care (HDU/ICU) beds postoperatively, ensuring that they received appropriate care if their condition deteriorated. Therefore POSSUM scoring should be used perioperatively in emergency cases to coordinate appropriate perioperative care for high risk general surgical patients. PMID:26901929

  12. Perioperative Care of the Transgender Patient.

    Smith, Francis Duval


    Transgender patients are individuals whose gender identity is not related to their biological sex. Assuming a new gender identity that does not conform to societal norms often results in discrimination and barriers to health care. The exact number of transgender patients is unknown; however, these patients are increasingly seen in health care. Transgender individuals may experience provider-generated discrimination in health care facilities, including refusal of service, disrespect, and abuse, which contribute to depression and low self-esteem. Transgender therapies include mental health counseling for depression and low self-esteem, hormone therapy, and sex reassignment surgery. Health care professionals require cultural competence, an understanding of the different forms of patient identification, and adaptive approaches to care for transgender patients. VA (Veterans Affairs) hospitals provide a model for the care for transgender patients and staff. PMID:26849981

  13. Perioperative care following complex laryngotracheal reconstruction in infants and children

    Gupta Punkaj


    Full Text Available Laryngotracheal reconstruction (LTR involves surgical correction of a stenotic airway with cartilage interpositional grafting, followed by either placement of a tracheostomy and an intraluminal stent (two-stage LTR or placement of an endotracheal tube with postoperative sedation and mechanical ventilation for an extended period of time (single-stage LTR. With single-stage repair, there may be several perioperative challenges including the provision of adequate sedation, avoidance of the development of tolerance to sedative and analgesia agents, the need to use neuromuscular blocking agents, the maintenance of adequate pulmonary toilet to avoid perioperative nosocomial infections, and optimization of postoperative respiratory function to facilitate successful tracheal extubation. We review the perioperative management of these patients, discuss the challenges during the postoperative period, and propose recommendations for the prevention of reversible causes of extubation failure in this article. Optimization to ensure a timely tracheal extubation and successful weaning of mechanical ventilator, remains the primary key to success in these surgeries as extubation failure or the need for prolonged postoperative mechanical ventilation can lead to failure of the graft site, the need for prolonged Pediatric Intensive Care Unit care, and in some cases, the need for a tracheostomy to maintain an adequate airway.


    Rafiq, Mahmood; Almasry, Shadi; Abdulrahman, Anas; Al-Sohabani, Mazen; Tobias, Joseph D


    Crisponi syndrome is an autosomal recessive disorder characterized by intermittent episodes of muscular contraction of the facial muscles with trismus and excessive salivation simulating a tetanic spasm. These episodes occur in response to tactile stimulation or during crying. Associated physical and constitutional findings include characteristic facial anomalies, camptodactyly, intermittent hyperthermia, and feeding difficulties. We present a 15-month-old girl who required anesthetic care during laparoscopic fundoplication and gastric tube insertion. The perioperative implications of the disorder are reviewed and suggestions for anesthetic management provided. PMID:27487643

  15. Transforming Perioperative Care: The Case for a Novel Curriculum for Anesthesiology Resident Training.

    Alem, Navid; Cohen, Neal; Cannesson, Maxime; Kain, Zeev


    Currently, perioperative health care is undergoing transformative changes. One prospect for the specialty of anesthesiology is a reorientation of resident education to focus more on the entire spectrum of perioperative care as exemplified by the perioperative surgical home (PSH). To advance this novel paradigm for patients and anesthesiologists, one must also consider further incorporating the competencies fundamental to the PSH during residency training. As such, the purpose of this case report is to outline the successful implementation of a comprehensive PSH curriculum for anesthesiology residents. PMID:27166744

  16. Nursing care in the perioperative period for patients undergoing bariatric surgery

    Maria Beatriz Guimarães Ferreira; Márcia Marques dos Santos Felix; Cristina Maria Galvão


    This integrative review aimed to analyze the available evidence in the literature regarding nursing care in the perioperative period for patients who underwent bariatric surgery. The search for primary studies was carried out in the US National Library of Medicine National Institutes of Health, Cumulative Index to Nursing and Allied Health Literature and Latin American and Caribbean Health Sciences Literature databases. The sample was comprised of 11 primary studies, published between January...

  17. Kaizen: a process improvement model for the business of health care and perioperative nursing professionals.

    Tetteh, Hassan A


    Kaizen is a proven management technique that has a practical application for health care in the context of health care reform and the 2010 Institute of Medicine landmark report on the future of nursing. Compounded productivity is the unique benefit of kaizen, and its principles are change, efficiency, performance of key essential steps, and the elimination of waste through small and continuous process improvements. The kaizen model offers specific instruction for perioperative nurses to achieve process improvement in a five-step framework that includes teamwork, personal discipline, improved morale, quality circles, and suggestions for improvement. PMID:22201574

  18. How Well Is Quality Improvement Described in the Perioperative Care Literature? A Systematic Review

    Jones, Emma L.; Lees, Nicholas; Martin, Graham; Dixon-Woods, Mary


    Abstract Background Quality improvement (QI) approaches are widely used across health care, but how well they are reported in the academic literature is not clear. A systematic review was conducted to assess the completeness of reporting of QI interventions and techniques in the field of perioperative care. Methods Searches were conducted using Medline, Scopus, the Cochrane Central Register of Controlled Trials, the Cochrane Effective Practice and Organization of Care database, and PubMed. Two independent reviewers used the Template for Intervention Description and Replication (TIDieR) checklist, which identifies 12 features of interventions that studies should describe (for example, How: the interventions were delivered [e.g., face to face, internet]), When and how much: duration, dose, intensity), to assign scores for each included article. Articles were also scored against a small number of additional criteria relevant to QI. Results The search identified 16,103 abstracts from databases and 19 from other sources. Following review, full-text was obtained for 223 articles, 100 of which met the criteria for inclusion. Completeness of reporting of QI in the perioperative care literature was variable. Only one article was judged fully complete against the 11 TIDieR items used. The mean TIDieR score across the 100 included articles was 6.31 (of a maximum 11). More than a third (35%) of the articles scored 5 or lower. Particularly problematic was reporting of fidelity (absent in 74% of articles) and whether any modifications were made to the intervention (absent in 73% of articles). Conclusions The standard of reporting of quality interventions and QI techniques in surgery is often suboptimal, making it difficult to determine whether an intervention can be replicated and used to deliver a positive effect in another setting. This suggests a need to explore how reporting practices could be improved. PMID:27066922

  19. Safety considerations for Health care Workers involved in Cytoreductive Surgery and Perioperative chemotherapy.

    Bhatt, Aditi; Mittal, Sourabh; Gopinath, K S


    The combined modality treatment of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has gained worldwide acceptance for management of selected patients with peritoneal metastases from various cancers. Cytoreductive surgery is performed with the goal of removing all macroscopic disease and is coupled with perioperative chemotherapy (POC) in the form of HIPEC with or without EPIC (early postoperative intraperitoneal chemotherapy) to deal with the microscopic residual disease. These treatments entail the use of cytotoxic drugs in the operation theatre or in the intensive care unit where they are not commonly used and put the healthcare workers participating in the treatment at risk of exposure. CRS is performed with high voltage electrocautery generating a large amount of surgical smoke which is inhaled by the involved personnel and has potential health hazards. This article outlines the safety measures to be taken while performing CRS and POC. PMID:27065717

  20. The perioperative nursing care of patients with malignant obstructive jaundice treated with interventional therapy: clinical experience in 71 cases

    Objective: To summarize the clinical experience of perioperative nursing for patients with malignant obstructive jaundice who were treated with percutaneous transhepatic biliary drainage. Methods: Sufficient preoperative preparation,careful psychological nursing, serious postoperative observation of vital signs, enhancement of the nutritional support,care of the puncture site and drainage tube, maintenance of the electrolyte balance, correct evaluation of the jaundice, etc. were strictly carried out in all 71 patients with malignant obstructive jaundice who received percutaneous transhepatic biliary drainage. Results: Because the sufficient preoperative preparation and postoperative nursing work were seriously carried out,the obstructive jaundice was well relieved in all patients, the liver function and the living quality were markedly improved and the survival time was prolonged. Conclusion: It is of great clinical significance to intensify the perioperative nursing care for patients with malignant obstructive jaundice who are receiving interventional therapy. (authors)

  1. Computerized surveillance of opioid-related adverse drug events in perioperative care: a cross-sectional study

    Gattis Katherine G


    Full Text Available Abstract Background Given the complexity of surgical care, perioperative patients are at high risk of opioid-related adverse drug events. Existing methods of detection, such as trigger tools and manual chart review, are time-intensive which makes sustainability challenging. Using strategic rule design, computerized surveillance may be an efficient, pharmacist-driven model for event detection that leverages existing staff resources. Methods Computerized adverse drug event surveillance uses a logic-based rules engine to identify potential adverse drug events or evolving unsafe clinical conditions. We extended an inpatient rule (administration of naloxone to detect opioid-related oversedation and respiratory depression to perioperative care at a large academic medical center. Our primary endpoint was the adverse drug event rate. For all patients with a naloxone alert, manual chart review was performed by a perioperative clinical pharmacist to assess patient harm. In patients with confirmed oversedation, other patient safety event databases were queried to determine if they could detect duplicate, prior, or subsequent opioid-related events. Results We identified 419 cases of perioperative naloxone administration. Of these, 101 were given postoperatively and 69 were confirmed as adverse drug events after chart review yielding a rate of 1.89 adverse drug events/1000 surgical encounters across both the inpatient and ambulatory settings. Our ability to detect inpatient opioid adverse drug events increased 22.7% by expanding surveillance into perioperative care. Analysis of historical surveillance data as well as a voluntary reporting database revealed that 11 of our perioperative patients had prior or subsequent harmful oversedation. Nine of these cases received intraoperative naloxone, and 2 had received naloxone in the post-anesthesia care unit. Pharmacist effort was approximately 3 hours per week to evaluate naloxone alerts and confirm adverse drug

  2. Noninvasive continuous cardiac output monitoring in perioperative and intensive care medicine.

    Saugel, B; Cecconi, M; Wagner, J Y; Reuter, D A


    The determination of blood flow, i.e. cardiac output, is an integral part of haemodynamic monitoring. This is a review on noninvasive continuous cardiac output monitoring in perioperative and intensive care medicine. We present the underlying principles and validation data of the following technologies: thoracic electrical bioimpedance, thoracic bioreactance, vascular unloading technique, pulse wave transit time, and radial artery applanation tonometry. According to clinical studies, these technologies are capable of providing cardiac output readings noninvasively and continuously. They, therefore, might prove to be innovative tools for the assessment of advanced haemodynamic variables at the bedside. However, for most technologies there are conflicting data regarding the measurement performance in comparison with reference methods for cardiac output assessment. In addition, each of the reviewed technology has its own limitations regarding applicability in the clinical setting. In validation studies comparing cardiac output measurements using these noninvasive technologies in comparison with a criterion standard method, it is crucial to correctly apply statistical methods for the assessment of a technology's accuracy, precision, and trending capability. Uniform definitions for 'clinically acceptable agreement' between innovative noninvasive cardiac output monitoring systems and criterion standard methods are currently missing. Further research must aim to further develop the different technologies for noninvasive continuous cardiac output determination with regard to signal recording, signal processing, and clinical applicability. PMID:25596280

  3. Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial

    Swart Annemiek


    Full Text Available Abstract Background Recent developments in large bowel surgery are the introduction of laparoscopic surgery and the implementation of multimodal fast track recovery programs. Both focus on a faster recovery and shorter hospital stay. The randomized controlled multicenter LAFA-trial (LAparoscopy and/or FAst track multimodal management versus standard care was conceived to determine whether laparoscopic surgery, fast track perioperative care or a combination of both is to be preferred over open surgery with standard care in patients having segmental colectomy for malignant disease. Methods/design The LAFA-trial is a double blinded, multicenter trial with a 2 × 2 balanced factorial design. Patients eligible for segmental colectomy for malignant colorectal disease i.e. right and left colectomy and anterior resection will be randomized to either open or laparoscopic colectomy, and to either standard care or the fast track program. This factorial design produces four treatment groups; open colectomy with standard care (a, open colectomy with fast track program (b, laparoscopic colectomy with standard care (c, and laparoscopic surgery with fast track program (d. Primary outcome parameter is postoperative hospital length of stay including readmission within 30 days. Secondary outcome parameters are quality of life two and four weeks after surgery, overall hospital costs, morbidity, patient satisfaction and readmission rate. Based on a mean postoperative hospital stay of 9 +/- 2.5 days a group size of 400 patients (100 each arm can reliably detect a minimum difference of 1 day between the four arms (alfa = 0.95, beta = 0.8. With 100 patients in each arm a difference of 10% in subscales of the Short Form 36 (SF-36 questionnaire and social functioning can be detected. Discussion The LAFA-trial is a randomized controlled multicenter trial that will provide evidence on the merits of fast track perioperative care and laparoscopic colorectal surgery in

  4. Perioperative Care of a Patient with Refractory Idiopathic Thrombocytopenic Purpura Undergoing Total Knee Arthroplasty

    Singhal, Rohit; Gudimetla, Veera; Stewart, Andrew; Luscombe, Karen L; Charalambous, Charalambos P.


    Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder leading to low platelet count and an increased risk of bleeding. Major joint replacement surgery in a patient with ITP can be associated with severe postoperative bleeding. We present our experience of perioperative management in a patient with severe refractory chronic idiopathic thrombocytopenic purpura who successfully underwent a cemented total knee replacement.

  5. CARE07 Coordinated Accelerator Research in Europe


    Annual Meeting, at CERN, 29-31 October 2007 The CARE project started on 1st January 2004 and will end on 31st December 2008. At the end of each year, the progress and status of its activities are reported in a general meeting. This year, the meeting takes place at CERN. The CARE objective is to generate structured and integrated European cooperation in the field of accelerator research and related R&D. The programme includes the most advanced scientific and technological developments, relevant to accelerator research for particle physics. It is articulated around three Networking Activities and four Joint Activities. The Networking Activities ELAN, BENE and HHH aim to better coordinate R&D efforts at the European level and to strengthen Europe’s ability to produce intense and high-energy particle beams (electrons and positrons, muons and neutrinos, protons and ions, respectively). The Joint Activities, SRF, PHIN, HIPPI and NED, aim at technical developments on s...

  6. CARE07 Coordinated Accelerator Research in Europe


    Annual Meeting, at CERN, 29-31 October 2007 The CARE project started on 1st January 2004 and will end on 31st December 2008. At the end of each year, the progress and status of its activities are reported in a general meeting. This year, the meeting is taking place at CERN. The CARE objective is to generate structured and integrated European cooperation in the field of accelerator research and related R&D. The programme includes the most advanced scientific and technological developments, relevant to accelerator research for particle physics. It is articulated around three Networking Activities and four Joint Activities. The Networking Activities ELAN, BENE and HHH aim to better coordinate R&D efforts at the European level and to strengthen Europe’s ability to produce intense and high-energy particle beams (electrons and positrons, muons and neutrinos, protons and ions, respectively). The Joint Activities, SRF, PHIN, HIPPI and NED, aim at technical developments ...

  7. [Anesthesiological care in orthogeriatric co-management. Perioperative treatment of geriatric trauma patients].

    Luger, Thomas J; Luger, Markus F


    Elderly patients increasingly need to undergo surgery under anesthesia, especially following trauma. A timely interdisciplinary approach to the perioperative management of these patients is decisive for the long-term outcome. Orthogeriatric co-management, which includes geriatricians and anesthesiologists from an early stage, is of great benefit for geriatric patients. Patient age, comorbidities and self-sufficiency in activities of daily life are decisive for an anesthesiological assessment of the state of health and preoperative risk stratification. If necessary additional investigations, such as echocardiography must be carried out, in order to guarantee optimal perioperative anesthesiological management. Certain medical factors can delay the initiation of anesthesia and it is absolutely necessary that these are taken into consideration for surgical management. Not every form of anesthesia is equally suitable for every geriatric patient. PMID:27090913

  8. CARE05 coordinated accelerator research in Europe


    Annual Meeting at CERN, 23-25 November 2005 CARE started on 1st January 2004 and will last for five years. At the end of each year it holds a general meeting to report on the progress and status of its activities. This year, the CARE annual meeting is taking place at CERN The objective of the CARE project is to generate structured and integrated European cooperation in the field of accelerator research and related R&D. The program includes the most advanced scientific and technological developments, relevant to accelerator research for Particle Physics. It is articulated around three Networking Activities and four Joint Activities. The Networking Activities ELAN, BENE and HHH aim to better coordinate R&D efforts at the European level and to strengthen Europe's ability to evaluate and develop methods of producing intense and high energy beams of electrons, protons, muons and neutrinos. These activities are embedded in world-wide efforts towards future e+e- linear colliders, superior neutrino beam fa...

  9. Perioperative hypertension

    G. Pinna


    Full Text Available BACKGROUND Perioperative hypertension is a situation whose management is suggested by the clinical judgement much more than clinical evidences. JNC 7 guidelines give a classification of blood pressure (BP, without any mention specifically dedicated to patients undergoing surgery. The ACC/AHA guidelines recommend deferring surgery if diastolic BP is above 110 mmHg and systolic BP is above 180 mmHg. AIM OF THE STUDY In this review we considered pathogenetic, clinical and therapeutic factors related to perioperative management of hypertensive patients. DISCUSSION In actual trend of the preoperative evaluation, alone hypertension is considered as a minor risk factor. BP values ≤ 180/110 mmHg do not influence the outcomes in patients who underwent noncardiac surgery. Therefore, in these conditions it’s not necessary to delay surgery. Hypertensive picks are possible during the operation, mostly because of the intubation, but, much more dangerous, falls of pressure are possible. The intraoperative arterial pressure should be maintained within 20% of the best estimated preoperative arterial pressure, especially in patients with markedly elevated preoperative pressures. After surgery the arterial BP can increase for stress factors, pain, hypoxia and hypercapnia, hypothermia and infusional liquids overload. For all these reasons a careful monitoring is mandatory. Anti-hypertensive medication should be continued during the postoperative period in patients with known and treated hypertension, as unplanned withdrawal of treatment can result in rebounded hypertension. The decision to give anti-hypertensive drugs must be made for each patient, taking into account their normal BP and their postoperative BP. With regard to the optimal treatment of the patient with poorly or uncontrolled hypertension in the perioperative evaluation, recent guidelines suggest that the best treatment may consider cardioselective β-blockers therapy, but also clonidin by

  10. Should perioperative immunonutrition for elective surgery be the current standard of care?

    Bharadwaj, Shishira; Trivax, Brandon; Tandon, Parul; Alkam, Bilal; Hanouneh, Ibrahim; Steiger, Ezra


    Postoperative infectious complications are independently associated with increased hospital length of stay (LOS) and cost and contribute to significant inpatient morbidity. Many strategies such as avoidance of long periods of preoperative fasting, re-establishment of oral feeding as early as possible after surgery, metabolic control and early mobilization have been used to either prevent or reduce the incidence of postoperative infections. Despite these efforts, it remains a big challenge to our current healthcare system to mitigate the cost of postoperative morbidity. Furthermore, preoperative nutritional status has also been implicated as an independent risk factor for postoperative morbidity. Perioperative nutritional support using enteral and parenteral routes has been shown to decrease postoperative morbidity, especially in high-risk patients. Recently, the role of immunonutrition (IMN) in postoperative infectious complications has been studied extensively. These substrates have been found to positively modulate postsurgical immunosuppression and inflammatory responses. They have also been shown to be cost-effective by decreasing both tpostoperative infectious complications and hospital LOS. In this review, we discuss the postoperative positive outcomes associated with the use of perioperative IMN, their cost-effectiveness, current guidelines and future clinical implications. PMID:27081153

  11. Implementing a regional anesthesia block nurse team in the perianesthesia care unit increases patient safety and perioperative efficiency.

    Russell, Rebecca Ann; Burke, Kimberly; Gattis, Katherine


    A lack of standardized nursing procedures regarding the management of patients receiving preoperative regional anesthesia in the perianesthesia setting raises a number of issues for perianesthesia nurses. In January 2010, Duke University Hospital's perianesthesia care unit implemented a regional anesthesia "block nurse" team in the preoperative holding area as a patient safety initiative. In January 2011, a retrospective data review was conducted. Results indicated that the implementation of the block nurse team not only increased patient safety but also increased perioperative efficiency and productivity, and decreased delays to operating room start times. This article describes the role of the regional anesthesia block nurse, the development of a block nurse team, and the early benefits of implementing a dedicated regional anesthesia block nurse team in the perianesthesia setting. PMID:23351242

  12. Investigation on the Perioperative Care of Flat Nail Groove Plasty%平坦甲沟成形术的围术期护理研究探讨



    Objective To analyze and investigate the perioperative nursing measures for flat nail groove plasty and the effect. Methods 76 cases of patients with ingrown toenails treated in our hospital from January, 2012 to November, 2013 were randomly divided into the control group and the perioperative group according to the treatment sequence. Control group: 38 patients were treated with routine care. Perioperative group: 38 cases were treated with more targeted perioperative nursing on the basis of rou-tine care. And patient satisfaction of two groups of patients was analyzed. Results No complications occurred in the 38 cases of the perioperative group, the difference was significant compared with the control group (P<0.05); patient satisfaction of perioperative group was significantly higher than that of the control group with statistically significance(P<0.05). Conclusion Targeted periopera-tive care given to the patients underwent flat nail groove plasty clinically can effectively prevent the occurrence of complications, and also greatly enhance patient satisfaction.%目的:对平坦甲沟成形术围术期护理措施及效果进行分析、探讨。方法对该院2012年1月-2013年11月间治疗的76例嵌甲症患者,并按治疗顺序进行随机分组。对照组:38例,予以常规护理;围术期组:38例,常规护理基础之上予以更具针对性的围术期护理。并对两组患者满意度进行对比分析。结果围术期组38例患者术后均未发生任何并发症,与对照组比较差异有统计学意义(P<0.05),围术期组患者满意度明显高于对照组,差异有统计学意义(P<0.05)。结论对临床平坦甲沟形成术患者予以针对性的围术期护理,可以有效避免并发症的发生,同时还可极大地提升患者满意度。

  13. Perioperative care of the morbidly obese patient in the lithotomy position.

    Bennicoff, Geraldine


    The lithotomy position is used daily in the OR to position patients for vaginal, rectal, and urologic procedures. Use of this position requires a careful nursing assessment to ensure that the patient can tolerate having his or her legs placed in the stirrups and to ensure that no pressure points exist for the duration of the surgery. Caring for a patient who is morbidly obese and who requires surgery in the lithotomy position can be especially challenging, and the possibility of injury to the patient or staff members should be considered. A case study involving the care of a patient who weighed almost 600 lb undergoing surgery in the lithotomy position demonstrates ways to provide safe care for this type of challenging patient. PMID:20816103

  14. Perioperative nursing care in the treatment of 56 patients with diabetic cataract%糖尿病性白内障56例围术期护理



    Objective: To investigate the perioperative nursing methods in the treatment of patients with diabetic cataract.Methods: The perioperative nursing care was given to 56 patients with diabetic cataract, such as psychological care, blood glucose monitoring and dietary guidance. Results: The postoperative visual acuity of the patients was significantly improved compared with that before surgery after being given careful nursing care and no complications occurred. Conclusion: The adequate preoperative preparation and careful postoperative nursing care is the key to ensuring smooth operation.%目的:探讨糖尿病性白内障围术期的护理方法.方法:对56例糖尿病性白内障患者进行围术期的护理,如心理护理、血糖监测、饮食指导等.结果:本组患者经过精心护理,术后视力均较术前明显提高,且无并发症的发生.结论:充分的术前准备、周密的术后护理是保证手术顺利进行的关键.

  15. Early rehabilitation after surgery program versus conventional care during perioperative period in patients undergoing laparoscopic assisted total gastrectomy

    Manash Ranjan Sahoo


    Full Text Available Objective: To evaluate the safety and efficacy of early rehabilitation after surgery program (ERAS in patients undergoing laparoscopic assisted total gastrectomy. Materials And Methods: This is a study where 47 patients who are undergoing lap assisted total gastrectomy are selected. Twenty-two (n = 22 patients received enhanced recovery programme (ERAS management and rest twenty-five (n = 25 conventional management during the perioperative period. The length of postoperative hospital stay, time to passage of first flatus, intraoperative and postoperative complications, readmission rate and 30 day mortality is compared. Serum levels of C-reactive protein pre-operatively and also on post-op day 1 and 3 are compared. Results: Postoperative hospital stay is shorter in ERAS group (78 ± 26 h when compared to conventional group (140 ± 28 h. ERAS group passed flatus earlier than conventional group (37 ± 9 h vs. 74 ± 16 h. There is no significant difference in complications between the two groups. Serum levels of CRP are significantly low in ERAS group in comparison to conventional group. [d1 (52.40 ± 10.43 g/L vs. (73.07 ± 19.32 g/L, d3 (126.10 ± 18.62 g/L vs. (160.72 ± 26.18 g/L]. Conclusion: ERAS in lap-assisted total gastrectomy is safe, feasible and efficient and it can ameliorate post-operative stress and accelerate postoperative rehabilitation in patients with gastric cancer. Short term follow up results are encouraging but we need long term studies to know its long term benefits.

  16. Influence of multi-level anaesthesia care and patient profile on perioperative patient satisfaction in short-stay surgical inpatients: A preliminary study

    Amarjeet Singh


    Full Text Available Background and goals of study: Patient satisfaction in relation to perioperative anesthesia care represents essential aspect of quality health-care management. We analyzed the influence of multi-level anesthesia care exposure and patient profile on perioperative patient satisfaction in short-stay surgical inpatients. Methods : 120 short-stay surgical inpatients who underwent laparoscopic surgery have been included in this prospective study. Pertaining to demographic parameters (age, gender, education, profession, duration of stay (preoperative room, recovery room, various patient problems and patient satisfaction (various levels, overall were recorded by an independent observer and analyzed. Overall, adults, male and uneducated patients experienced more problems. Conversely, elderly, females and educated patients were more dissatisfied. Female patients suffered more during immediate postoperative recovery room stay and were more dissatisfied than their male counterparts (p< 0.05. However, patient′s professional status had no bearing on the problems encountered and dissatisfaction levels. Preoperative and early postoperative period accounted for majority of the problems encountered among the study population. There was a positive correlation between problems faced and dissatisfaction experienced at respective levels of anesthesia care (p< 0.05. Conclusion(s : Patient′s demographic profile and problems faced during respective level of anesthesia care has a correlation with dissatisfaction. Interestingly, none of the above stated factors had any effect on overall satisfaction level.

  17. Assessment of perioperative fluid balance

    Bumbaširević V.; Marković D.; Vlajković G.; Sinđelić R.


    Careful assessment of the fluid balance is required in the perioperative period since appropriate fluid therapy is essential for successful patient's outcome. Haemodynamic monitoring allows understanding the physiology of the circulation and changes of fluid balance in the perioperative period. This is diagnostic aid and guide for fluid replacement therapy. Patient's volume status is frequently assessed by different haemodynamic variables that could be targeted as the endpoints for fluid ther...

  18. Auditing perioperative mortality.

    Deans, G. T.; Odling-Smee, W; McKelvey, S T; Parks, G. T.; Roy, D. A.


    An audit of mortality following operation was performed over ten years classifying deaths into those that were 'expected' and 'unexpected'. 'Unexpected' deaths were defined as those in which, after careful consideration of the prevailing clinical circumstances at the time of operation, the probability of death following operation was felt to be low. This definition is a more helpful assessment of surgical performance than overall perioperative mortality as it highlights cases where improvemen...

  19. Preparing the Next Generation of Perioperative Nurses.

    Chappy, Sharon; Madigan, Patricia D; Doyle, Deborah S; Conradt, Laurie A; Tapio, Nathan C


    Perioperative nursing faces a workforce crisis. There are too few perioperative nurses entering the workforce to replace those who will reach retirement age. Further, the costs of orienting perioperative nurses is high, and turnover rates in the first year after graduation are significant. To address these issues, nursing leaders at Theda Clark Medical Center, Neenah, Wisconsin, and the University of Wisconsin Oshkosh College of Nursing partnered with local medical centers to form a precepted clinical immersion program intended to orient senior baccalaureate nursing students to the perioperative setting. The students were hired after graduation, and the cost savings for orienting each new employee was estimated at $16,000 to $25,000 per student. Other benefits include identifying students who are and are not a good fit for perioperative nursing. The collaboration of health care and academic leaders is one solution for addressing the perioperative nursing workforce crisis. PMID:26746037

  20. Perioperative Nursing Care of 19 Patients with Tongue Cancer%舌癌患者19例围手术期的护理



    Objective:To investigate the nursing method of tongue cancer patients during perioperative period.Methods:19 cases of tongue cancer patients were observed and analysed before and after surgery,making deliberate nursing care plans,effective nurse-patient communication,continuing psychological nursing as well as targeted nursing measures.Results:The therapeutic effects of 19 cases of tongue cancer patients were satisfactory.Conclusion:Actively perioperative care of tongue cancer patients is an important link to ensure the success of operation and the increase of cure rate.%目的:探讨舌癌患者围手术期的护理方法.方法:对19例舌癌患者在手术前、手术后进行观察、分析,制定周密的护理计划、进行有效的护患沟通、持续的心理护理以及针对性的护理措施.结果:本组19例舌癌患者均疗效满意.结论:积极做好舌癌患者围手术期的护理,是确保手术成功、提高治愈率的重要环节.

  1. The Care Accelerator R&D Programme in Europe

    Napoly, O.; Aleksan, A.; Devred, A.; Ouden, den, M.


    CARE, an ambitious and coordinated programme of accelerator research and developments oriented towards high energy physics projects, has been launched in January 2004 by the main European laboratories and the European Commission. This project aims at improving existing infrastructures dedicated to future projects such as linear colliders, upgrades of hadron colliders and high intensity proton drivers. We describe the CARE R&D plans, mostly devoted to advancing the performance of the supercond...

  2. The CARE accelerator R&D programme in Europe

    Aleksan, R.; den Ouden, A.; Devred, A.; Garoby, R.; Garvey, T.; Ghigo, A.; Gschwendtner, E.; Losito, R.; Mais, H.; Napoly, O.; Palladino, V.; Proch, D.; Richard, F.; Rinolfi, L.; Ruggiero, F.


    CARE, an ambitious and coordinated programme of accelerator research and developments oriented towards high energy physics projects, has been launched in January 2004 by the main European laboratories and the European Commission. This project aims at improving existing infrastructures dedicated to future projects such as linear colliders, upgrades of hadron colliders and high intensity proton drivers. We describe the CARE R&D plans, mostly devoted to advancing the performance of the supercond...

  3. 下颈椎骨折伴截瘫患者围手术期护理%Perioperative care for patients with paraplegia and fracture of next cervical spine

    丁传红; 彭瑾; 杨媛


    目的 总结下颈椎骨折伴截瘫患者围手术期护理经验.方法 回顾性分析18例围手术期护理下颈椎骨折伴截瘫患者情况.结果 18例患者经围手术期精心护理,减少了术后并发症的发生.结论 围手术期精心护理能使患者主动配合手术并减少术后并发症的发生.%Objective To evaluate and summarize the clinical experience of perioperative care for patients with paraplegia and fracture of next cervical spine. Methods From April 2007 to April 2010, i8 patients with paraplegia and fracture of next cervical spine were cared in perioperative period. Results Postoperation complications of 18 patients were reduced with perioperative care. Conclusion Postoperation complications were reduced with perioperative care which could make patients actively cooperate with surgery.

  4. Perioperative Education of Patient Undergoing Cardiac Surgery

    Alexandros Zacharis; Aikaterini Kampourelli


    In recent years, the number of patients undergoing cardiac surgeries is steadily increasing. In Greece, approximately 10,500 patients per year are admitted to some kind of cardiac operation. Constant evolution of heart surgery techniques calls for adaptation of the perioperative nursing care given. Patient education, as an important part of the perioperative care, is directly related to the reduction of postoperative complications and stress management, thus promoting the patient's overall po...

  5. THE CARE PROJECT - Coordinated Accelerator Research in Europe


    A one-day presentation of the project will take place on Monday February 10th in the CERN Council Chamber. The meeting will start a 9am and is expected to end at 4:30pm. The meeting, which is open to the whole community, will present an initiative on accelerator R&D in Europe, supported by ECFA, with the aim to bid for European Union support through the Framework 6 scheme. This initiative is coordinated by a steering group (ESGARD - European Steering Group on Accelerator Research and Development), which has been set up to coordinate European efforts on accelerator R&D and the submission of such bids. The initial bids have to be submitted by April 15th. All those interested in accelerator R&D are welcome to attend. Presentation of the CARE project (Coordinated Accelerator Research in Europe) to be submitted within FP6 February 10th, at CERN in the council room Agenda Chair : C. Wyss 9:00 General presentation of FP6 and introduction of IA proposal (R. Aleksan) 9:45 Networking activities on e ...

  6. The influence of context on role behaviors of perioperative nurses.

    McGarvey, Helen E; Chambers, Mary G A; Boore, Jennifer R P


    Using a case study approach, researchers conducted a focused exploration of the role of perioperative nurses. Data were collected in three different hospitals during 358 hours of observation and 34 hours of interviews with 35 nurses. Researchers also analyzed nursing documents, including the care plans of 230 patients. Findings show that various contextual mechanisms are influential in the role performance of perioperative nurses. This study highlights the importance of providing adequate support for perioperative nurses to perform their role in an intensely stressful environment. Patient-focused leadership and the promotion of a caring philosophy are needed to strengthen perioperative nursing and, ultimately, improve patient care. PMID:15641664

  7. [Patient's Risk Factors for Perioperative Aspiration Pneumonia].

    Ishikawa, Teruhiko; Isono, Shiroh


    This article reviews patient's own risk factors for perioperative aspiration pneumonia. Maintaining the function of the lower esophageal sphincter (LES), the airway protective reflex, and the oral hygiene are the most important to prevent the pneumonia. The LES is adversely affected by excessive stomach distention, some medication given in perioperative periods, and habitual smoking, as well as pathological status such as esophageal hiatus hernia and achalasia. Postapoplectic patients may have insufficient airway protective reflex including swallowing and laryngeal reflex. It is emphasized that the perioperative oral care is increasing in its importance for the prevention of aspiration pneumonia. PMID:27004381

  8. Resectable adenocarcinoma of the oesophago-gastric junction care: Which perioperative treatment?; Prise en charge des adenocarcinomes de la jonction oesogastrique resecables: quel traitement perioperatoire?

    Crehangea, G.; Maingon, P. [Centre de Lutte Contre le Cancer Georges-Francois-Leclerc, Dept. de Radiotherapie, 21 - Dijon (France); Bonnetain, F. [Centre de Lutte Contre le Cancer Georges-Francois-Leclerc, Dept. de Biostatistiques, 21 - Dijon (France); Chauffert, B. [Centre de Lutte Contre le Cancer Georges-Francois-Leclerc, Dept. d' Oncologie Medicale, 21 - Dijon (France); Rat, P. [Centre Hospitalier Universitaire le Bocage, Service de Chirurgie Digestive, 21 - Dijon (France); Bedenne, L. [Centre Hospitalier Universitaire le Bocage, Service d' Hepatogastroenterologie, 21 - Dijon (France)


    Adenocarcinoma of the oesophago-gastric junction has an ominous prognosis. Until now, oesophageal adenocarcinoma care was close to the squamous cell cancer one whereas adenocarcinoma of the cardia was mixed with gastric cancers. Results from randomized studies mixed them without making distinctions. Nevertheless, context, natural history and clinical outcome differ. Five-year survival rate is around 40 %, all stages included. Results from several phase-III studies or meta-analysis allowed to define three therapeutic strategies applicable to adenocarcinoma of the oesophagus and the oesophago-gastric junction. In Europe, in the case of a resectable tumour, preoperative chemotherapy became a standard treatment since results from the Magic trial. In the United States, post-operative radio chemotherapy according to the 'Macdonald' scheme is used in case of a resected tumour with a R0 surgery. Actually, modern techniques of irradiation could reduce the rate of gastro-intestinal toxicities. The survival benefit from preoperative radio chemotherapy is still very controversial with high rates of postoperative morbidity and mortality. We have performed a review of the literature with a methodological analysis of data with a high level of evidence in order to advise perioperative treatment guidelines for patients with a resectable adenocarcinoma of the lower oesophagus or gastro-oesophageal junction. Results from pre- or postoperative strategies and the role of radiotherapy will need to be analysed in the future through a randomized study. (authors)

  9. Management of severe perioperative bleeding

    Kozek-Langenecker, Sibylle A; Afshari, Arash; Albaladejo, Pierre;


    The aims of severe perioperative bleeding management are three-fold. First, preoperative identification by anamesis and laboratory testing of those patients for whom the perioperative bleeding risk may be increased. Second, implementation of strategies for correcting preoperative anaemia and...... with an assessment of the quality of the evidence in order to allow anaesthetists throughout Europe to integrate this knowledge into daily patient care wherever possible. The Guidelines Committee of the European Society of Anaesthesiology (ESA) formed a task force with members of scientific...... cross-sectional surveys were selected. At the suggestion of the ESA Guideline Committee, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was initially used to assess the level of evidence and to grade recommendations. During the process of guideline development, the official...

  10. Pulmonary aspiration in perioperative medicine.

    Abdulla, Susanne


    Perioperative aspiration into the lungs is an infrequent but potentially serious cause of anesthesia-related morbidity and mortality. It is still a leading cause of death from pulmonary complications. Aspiration occurs in approximately three per 10.000 anesthetic procedures with higher incidences in special patient populations and emergency situations. Any patient with symptoms following aspiration that last for more than two hours in the recovery room should be admitted to an intensive care unit for further observation and therapy. This article reviews incidence, morbidity and mortality of perioperative aspiration as well as risk factors and preventive measures. Among preventive measures the use of drugs designed to increase gastric pH, recent developments in supraglottic airway devices and application of rapid sequence induction with cricoid pressure are discussed. Also, international fasting guidelines and clinical management following aspiration are provided. PMID:23767172

  11. What influences the practice of registered nurses in the perioperative environment?

    Chadwick, Dorothy


    This study seeks to explore what influences the practice of Registered Nurses in the perioperative environment. The term perioperative care denotes care given to patients in anaesthetics, during the surgical procedure, and immediate recovery following surgery and is generally referred to as pre-, intra-, and post-operative care. The research design was a qualitative case study involving 10 registered practitioners in the specialty of perioperative care. Case study design was chosen because of...

  12. Application of polypropylene mesh to pelvic floor reconstruction and perioperative nursing care%聚丙烯网片在盆底重建术中的应用及围术期护理

    董丽; 张娟娟; 周亚梅


    To investigate the application of polypropylene mesh to pelvic floor reconstruction and perioperative nursing method. Methods:66 patients with pelvic floor disorders underwent pelvic floor reconstruction by using polypropylene mesh under spinal - epi-dural anesthesia and they were given careful perioperative nursing care. Results:The phenomenon of postoperative pelvic organ prolapse of 66 patients disappeared and pelvic structure returned to normal basically, without local pain and complications; wound healed well and the cure rate was 100%. Conclusion: The application effect of polypropylene mesh is good in pelvic floor reconstruction and careful perioperative nursing care is the key to the success of operation.%目的:探讨聚丙烯网片在盆底重建术中的应用及围术期护理方法.方法:对66例盆底障碍性疾病患者在腰硬联合麻醉下应用聚丙烯网片行盆底重建术,并给予精心围术期护理.结果:本组66例术后盆腔器官脱垂现象消失,盆底结构基本恢复正常,伴随症状明显改善,无一例局部疼痛及并发症发生,切口愈合良好,治愈率100.0%.结论:聚丙烯网片在盆底重建术中的应用效果较好,精心围术期护理是手术成功的重要保证.

  13. The documentation practice of perioperative nurses

    Søndergaard, Susanne Friis; Lorentzen, Vibeke; Sørensen, Erik Elgaard;


    AIMS AND OBJECTIVE: The aim of this review was to explore and present the existing knowledge of the documentation practices of perioperative nurses in the operating room. BACKGROUND: Studies demonstrate that the documentation of nursing care provided is important for the continuity of patient care...... as well as patient safety. Nurses find that documenting their perioperative services is important to the surgical pathway; however, a number of studies indicate that the documentation practices of perioperative nurses are characterised by subjectivity, randomness and poor quality. DESIGN: A...... literature review with a systematic search of scientific material. METHOD: The content of the studies included was analysed using content analysis as suggested by Krippendorff. The materials were acquired by searching electronic databases. The search was performed for the period 1995-2015 and resulted in 12...

  14. Patient Empowerment Improved Perioperative Quality of Care in Cancer Patients Aged ≥ 65 Years - A Randomized Controlled Trial.

    Maren Schmidt

    Full Text Available This randomized controlled, clinical prospective interventional trial was aimed at exploring the effect of patient empowerment on short- and long-term outcomes after major oncologic surgery in elderly cancer patients.This trial was performed from February 2011 to January 2014 at two tertiary medical centers in Germany. The study included patients aged 65 years and older undergoing elective surgery for gastro-intestinal, genitourinary, and thoracic cancer. The patients were randomly assigned to the intervention group, i.e. patient empowerment through information booklet and diary keeping, or to the control group, which received standard care. Randomization was done by block randomization in blocks of four in order of enrollment. The primary outcome were 1,postoperative length of hospital stay (LOS and 2. long-term global health-related quality of life (HRQoL one year postoperatively. HRQoL was assessed using the EORTC QLQ C30 questionnaire. Secondary outcomes encompassed postoperative stress and complications. Further objectives were the identification of predictors of LOS, and HRQoL at 12 months.Overall 652 patients were included. The mean age was 72 ± 4.9 years, and the majority of patients were male (68.6%, n = 447. The ^median of postoperative length of stay was 9 days (IQR 7-14 day. There were no significant differences between the intervention and the control groups in postoperative LOS (p = 0.99 or global HRQoL after one year (women: p = 0.54, men: p = 0.94. While overall complications and major complications occurred in 74% and 24% of the cases, respectively, frequency and severity of complications did not differ significantly between the groups. Patients in the intervention group reported significantly less postoperative pain (p = 0.03 than the control group. Independent predictors for LOS were identified as severity of surgery, length of anesthesia, major postoperative complications, nutritional state, and pre-operative physical

  15. 肥胖患者妇科腹腔镜手术的围术期护理分析%Analysis of obese patients undergoing gynecologic laparoscopic surgery perioperative nursing care



    Objective:To analyze the effect of perioperative nursing care of obese patients undergoing gynecological laparoscopic operation.Methods:100 cases of obese patients were treated with gynecological laparoscopic surgery.They were divided in two groups.50 cases in control group were given routine nursing,and 50 cases in the observation group were treated with perioperative nursing care in 50 cases.The blood pressure,heart rate and complications were compared before and after surgery.Results:There were significant differences in heart rate and blood pressure before and after treatment in the control group,complications of the two groups had significant difference(P<0.05).Conclusion:The perioperative nursing care of obese patients undergoing gynecological laparoscopic surgery can improve blood pressure and heart rate and reduce complications.The effect is significant.%目的:分析肥胖患者妇科腹腔镜手术围术期护理效果。方法:收治实施妇科腹腔镜手术治疗的肥胖患者100例,分两组,对照组50例实施常规护理,观察组50例实施围术期护理,对比手术前后血压、心率以及并发症情况。结果:对照组治疗前后心率血压、两组并发症情况差异有统计学意义(P<0.05)。结论:肥胖患者实施妇科腹腔镜手术的围术期护理可改善血压心率,减少并发症,效果显著。

  16. Application of the evidence-based nursing care in the perioperative nursing care of prostate cancer patients%循证护理在前列腺癌患者围术期护理中的应用



    Objective: To evaluate the effectiveness of evidence - based nursing care in the perioperative nursing care of prostate cancer patients. Methods: 70 patients were randomly divided into an observation group and a control group ( 35 cases in each group ). The routine nursing care was taken in the control group, including the aspects of diet, rest, treatment compliance, health education, postoperative nursing care and psychological care; the evidence - based nursing care was applied in the observation group, the comprehensive assessment of patients was initially implemented to understand the patients illnesses and medical conditions, and then the nursing procedures was formulated in detail according to the results of assessment and foresight nursing procedures and preventive measures were also prepared aiming at the problems might occur in the perioperative nursing care. Results: Compared with control group, the length of hospital stay was shorter and treatment compliance and satisfaction of the patients were better and the incidence of complications was lower in the observation group, EORTC QLQ - C30 score was better ( P <0. 05 ). Conclusion: The evidence - based nursing care applied to the patients with prostate cancer surgery is more effective and it can significantly improve the patients quality of life.%目的:探讨循证护理在前列腺癌患者围术期中的实施的效果.方法:将70例患者随机分为观察组与对照组各35例.对照组采用常规护理模式进行护理,包括饮食、休息、治疗配合、健康宣教、术后护理、心理护理等;观察组实施循证护理,先给予患者针对性的综合评估,了解其机体素质、疾病状况等,然后根据评估结果进行护理程序及细节的制订,并对可能发生的问题进行预见性护理程序的制订及预防性措施的实施.结果:与对照组比较,观察组住院时间更短,治疗依从性和护理满意度更高,并发症发生率更低,EORTC QLQ-C30

  17. 78 FR 43055 - Accelerating Improvements in HIV Prevention and Care in the United States Through the HIV Care...


    ....) THE WHITE HOUSE, July 15, 2013. [FR Doc. 2013-17478 Filed 7-17-13; 11:15 am] Billing code 3295-F3 ... July 18, 2013 Part III The President Executive Order 13649--Accelerating Improvements in HIV Prevention and Care in the United States Through the HIV Care Continuum Initiative #0; #0; #0;...

  18. Stress in context perioperative

    Gonçalves, Ana Rita Veloso; Galvão, Ana Maria; Certo, Ana


    This study approaches the issue of stress in perioperative nurses. find out what stress level, the burnout level experienced and the coping strategies that they use. This is a non experimental study, quantitative, descriptive and correlational, in an transversal plane. The sample consisted with 81 participants, 27 perioperative nurses of the Northeast Local Health Unit (ULSNE) and 54 of the Trás-os-Montes and Alto Douro Central Hospital. We applied three assessment ...

  19. Clinical Observation of Breast Cancer and Diabetes Perioperative Care Ef-fect%乳腺癌合并糖尿病围术期护理效果的临床探讨



    目的:观察乳腺癌合并糖尿病围术期的治疗护理效果。方法以该院手术治疗的50例乳腺癌合并糖尿病患者为研究对象,合理控制血糖,采用乳腺癌改良根治术进行手术,围术期采用个体化的整体护理方案和措施。结果该组患者经过积极的治疗和护理,均治愈出院。围术期出现低血糖2例,切口感染和皮下积液各1例,未见其他并发症发生。结论给予乳腺癌合并糖尿病患者个体化的整体护理干预,可有效控制感染,减少并发症的发生,促进患者尽早康复。%Objective Observation treatment and care effect of perioperative of breast cancer and diabetes. Methods In 50 cases of breast cancer patients with diabetes mellitus surgery in our hospital for the study, reasonable control of blood sugar, using modified radical mastectomy surgery, perioperative use individualized holistic nursing programs and measures. Results This group of patients after active treatment and care, were cured. Perioperative hypoglycemia 2 cases, wound infection and seroma in 1 case, no other complications. Conclusion Give breast cancer patients with diabetes mellitus individualized holistic nursing intervention can effectively control the infection, reduce the incidence of complications and promote early rehabilitation of patients.

  20. Care for the Caregiver: Evaluation of Mind-Body Self-Care for Accelerated Nursing Students.

    Drew, Barbara L; Motter, Tracey; Ross, Ratchneewan; Goliat, Laura M; Sharpnack, Patricia A; Govoni, Amy L; Bozeman, Michelle C; Rababah, Jehad


    Stress affects the well-being of both nursing students and the individuals with whom they work. With the theory of cognitive appraisal as a framework for this study, it is proposed that mind-body self-care strategies promote stress management by stabilization of emotions. Outcomes will be a perception of less stress and more mindful engagement with the environment. Objective of the study was to describe an evaluation of student perceived stress and mindfulness to 1-hour per week of class time dedicated to mind-body self-care (yoga, mindful breathing, Reiki, and essential oil therapy). It was a quasi-experimental study; data collection took place at 4 time points. Participants were entry-level accelerated nursing students from 3 US universities: 50 in the treatment group, 64 in the comparison group. Data included health-promoting practices using Health-Promoting Promotion Lifestyle Profile II as a control variable, stress and mindfulness (Perceived Stress Scale [PSS] and Mindful Attention Awareness Scale [MAAS]), and demographic information; analysis using mixed-design repeated-measures analysis of variances. There was a statistically significant interaction between intervention and time on PSS scores, F(3, 264) = 3.95, P = .009, partial η = 0.043, with PSS scores of the intervention group decreasing from baseline to T3 when intervention ended whereas PSS scores of the comparison group increased from baseline. The average scores on the MAAS did not differ significantly. Evaluation of an embedded mind-body self-care module in the first nursing course demonstrated promising improvements in stress management. The findings support the appropriateness of integrating mind-body self-care content into nursing curricula to enhance students' ability to regulate stress. PMID:27078809

  1. Perioperative nursing in public university hospitals

    Sørensen, Erik Elgaard; Olsen, Ida Østrup; Tewes, Marianne;


    BACKGROUND: In recent years, perioperative nursing has received ongoing attention as part of an interprofessional collaboration. Perioperative nursing is constantly faced with new challenges and opportunities that necessitate continual updates of nursing knowledge and technical skills. In light...... of the longstanding relationship between nursing and technology, it is interesting that few studies with this focus have been performed. Therefore, our research question was: What is the content of perioperative nursing and how do nurses facilitate the interaction between nursing care and technology in highly...... specialized operating rooms in public university hospitals? METHODS: An ethnography involving participant observations and interviews was conducted during a 9-month study period. The participants comprised 24 nurses from 9 different operating wards at 2 university hospitals in different regions of Denmark...

  2. Narrative Review of Perioperative Acupuncture for Clinicians.

    Gliedt, Jordan A; Daniels, Clinton J; Wuollet, Adam


    Acupuncture is one of the oldest forms of the natural healing arts. The exact mechanisms of action are unknown at this time; however, current theories to explain the benefits experienced after acupuncture include Traditional Chinese Medicine and Western medicine concepts. Acupuncture may improve the quality of perioperative care and reduce associated complications. Perioperative acupuncture is apparently effective in reducing preoperative anxiety, postoperative nausea and vomiting, and postoperative pain. The Pericardium-6 (P-6; Nei Guan), Yintang (Extra 1), and Shenmen acupuncture points are the most studied and effective acupuncture points in reducing preoperative anxiety, postoperative nausea and vomiting, and postoperative pain experiences. Intraoperatively administered acupuncture may reduce immunosuppression in patients and lessen intraoperative anesthetic requirements, although the clinical usefulness of acupuncture in the intraoperative period remains inconclusive. Perioperative acupuncture is a promising intervention, but additional studies are needed to further understand and define acupuncture's role throughout the perioperative period and determine its clinical usefulness. The purpose of this article is to provide a brief clinical review concerning acupuncture and its application for common issues that occur in the perioperative period. PMID:26433805

  3. 腹腔镜手术治疗子宫内膜异位症围手术期护理效果%Laparoscopic Surgery for Endometriosis Perioperative Nursing Care



    目的:探讨腹腔镜手术治疗子宫内膜异位症围手术期的护理效果。方法将74例子宫内膜异位症患者分为两组,对照组采用常规护理模式护理,观察组在对照组基础上采用综合护理模式护理。结果观察组患者的总满意度为97.30%,对照组患者的总满意度为72.97%,对比差异显著(P<0.05)。结论腹腔镜手术治疗子宫内膜异位症患者在围手术期实施综合护理模式,能够明显提高患者对护理工作的满意度,值得在临床上大力推广。%Objective To investigate the laparoscopic surgery for endometriosis perioperative nursing effect.Methods74 cases of uterine endometriosis patients were divided into two groups, the control group received routine nursing care model, the observation group in the control group on the basis of a comprehensive care model of care. ResultsThe overall satisfaction of patients in the observation group was 97.30%, the total satisfaction of the patients in the control group was 72.97%.Conclusion Laparoscopic surgery endometriosis patients in the perioperative period the implementation of integrated care model can signiifcantly improve patient satisfaction with care, and worthy of clinical promoting.

  4. The CARE project - Coordinated Accelerator Research in Europe


    A one-day presentation of the project will take place on Monday February 10th in the CERN Council Chamber. The meeting will start a 9am and is expected to end at 4:30pm. The meeting, which is open to the whole community, will present an initiative on accelerator R&D in Europe, supported by ECFA, with the aim to bid for European Union support through the Framework 6 scheme. This initiative is coordinated by a steering group (ESGARD - European Steering Group on Accelerator Research and Development), which has been set up to coordinate European efforts on accelerator R&D and the submission of such bids. The initial bids have to be submitted by April 15th. All those interested in accelerator R&D are welcome to attend.

  5. Perioperative care of patients undergoing holmium laser resection of the prostate (HoLRP) compared with transurethral resection of the prostate (TURP)

    Gilling, Peter J.; Mackey, Michael; Cresswell, Michael D.; Kennett, Katie M.; Cass, Carol B.; Fraundorfer, Mark R.; Kabalin, John N.


    HoLRP is a technique which produces a defect in the prostatic fossa analogous to TURP but does so with significantly less blood loss. The perioperative outcome was assessed in a randomized clinical trial. The patients in the HoLRP arm (61 patients) had a longer resection time when compared to the TURP group (59 patients) but had less nursing contact time, shorter catheter time and a shorter hospital stay. Four patients in the TURP arm (6.8%) required blood transfusion compared to none in the HoLRP arm. Postoperative dysuria was similar in the two groups. Overall, the perioperative morbidity of HoLRP is less than that of TURP.

  6. CARE Coordinated Accelerator Research in Europe: integrating activity implemented as integrated infrastructure initiative

    Aleksan, R


    The main objective of the CARE project was to generate a structured and integrated European area in the field of accelerator research and related R&D. A set of integrating activities involving the largest European infrastructure laboratories and their user communities “active in accelerator R&D”, including industrial partners was established with the following general objectives: 1) To optimise the use of existing infrastructures for improving the European knowledge on accelerator physics  By promoting a coherent and coordinated utilization and development of infrastructures and to facilitate the access to accelerators and test facilities for carrying accelerator studies  By understanding accelerator operation and reliability issues 2) To tackle new or state-of-the-art technologies in a more co-ordinated and collaborative approach  By developing a coherent and coordinated accelerator R&D program in Europe and carrying out joint R&D projects allowing one to enhance the existing (or...

  7. Perioperative Education of Patient Undergoing Cardiac Surgery

    Alexandros Zacharis


    Full Text Available In recent years, the number of patients undergoing cardiac surgeries is steadily increasing. In Greece, approximately 10,500 patients per year are admitted to some kind of cardiac operation. Constant evolution of heart surgery techniques calls for adaptation of the perioperative nursing care given. Patient education, as an important part of the perioperative care, is directly related to the reduction of postoperative complications and stress management, thus promoting the patient's overall postoperative well-being. Aim: The aim of this review was to present the most important aspects of the patient's perioperative education and the role that the nurse has to play in it. Methods: Data from selected articles were extracted from Pubmed, Chinahl and Cohrane, as well as from non-electronically published scientific studies ranging from 1998-2010 and 2003-2008 respectively. Results: According to the literature, perioperative patient education can be implemented in various ways, such as through verbal updates, the use of audiovisual means and the provision of informative leaflets. The teaching topics can be divided into those of the preoperative and postoperative phase. Stress management prepares the patients psychologically and also enhances the therapeutic nurse-patient relationship. The teaching of breathing techniques and isometric exercises of the lower limbs, the cessation of smoking, the diet to be followed, as well as the management of medication, aim in the patients' physical preparation, in order to optimize their postoperative course. Conclusion: Perioperative patient education, regardless of how it is implemented, constitutes both an integral part of the nursing care and an independent nursing intervention per se, which strengthens the nurses' autonomy and improves the patient's postoperative course.

  8. [Assessment of perioperative fluid balance].

    Sindelić, R; Vlajković, G; Marković, D; Bumbasirević, V


    Careful assessment of the fluid balance is required in the perioperative period since appropriate fluid therapy is essential for successful patient's outcome. Haemodynamic monitoring allows understanding the physiology of the circulation and changes of fluid balance in the perioperative period. This is diagnostic aid and guide for fluid replacement therapy. Patient's volume status is frequently assessed by different haemodynamic variables that could be targeted as the endpoints for fluid therapy and resuscitation. Fluid balance is the crucial factor in the maintenance of haemodynamic stability, tissue oxygenation and organ function. When the haemodynamic monitoring is applied in a rigorous and consistent manner, it reduces mortality and length of stay as well as costs incurred. There are a number of tests which describe the effectiveness of the invasive haemodynamic monitoring procedures usage. Since the pulmonary artery catheter (PAC) had been introduced into clinical practice it was considered as a golden standard for cardiac output measurements, haemodynamic and fluid balance assessment. Nevertheless, in previous 10 years new minimally invasive and noninvasive simple techniques for haemodynamic monitoring and patient's hydroelectricity status evaluation have been developed. They can replace PAC under different clinical circumstances and some of these techniques PMID:19504992

  9. Perioperative chemotherapy and hepatic resection for resectable colorectal liver metastases.

    Beppu, Toru; Sakamoto, Yasuo; Hayashi, Hiromitsu; Baba, Hideo


    The role of perioperative chemotherapy in the management of initially resectable colorectal liver metastases (CRLM) is still unclear. The EPOC trial [the European Organization for Research and Treatment of Cancer (EORTC) 40983] is an important study that declares perioperative chemotherapy as the standard of care for patients with resectable CRLM, and the strategy is widely accepted in western countries. Compared with surgery alone, perioperative FOLFOX therapy significantly increased progression-free survival (PFS) in eligible patients or those with resected CRLM. Overall survival (OS) data from the EPOC trial were recently published in The Lancet Oncology, 2013. Here, we discussed the findings and recommendations from the EORTC 40983 trial. PMID:25713806

  10. 胃肠外科疾病合并糖尿病患者的围手术期护理%Gastrointestinal surgery patients with diabetes, the authors combined perioperative care



    Objective To gastrointestinal surgery with diabetic patients perioperative care, nursing curative effect, improve nursing level. Methods In June 2011 in July 2012 in our hospital,were 60 cases with gastrointestinal surgery combined with diabetes patients.the patients preoperative and intraoperative urgent postoperative nursing, etc are analyzed, in order to improve the patient's quality of life, fast to its body back to health. Results All of the gastrointestinal surgery with diabetes mellitus patients after timely treatment, elaborate care, make a more satisfactory effect, patients are improving hospital discharge, and no complications appeared. Conclusion Gastrointestinal surgery with diabetic patients perioperative care, has the vital significance,and improve the patient's quality of life.%目的:对胃肠外科疾病合并糖尿病患者的围术期护理进行分析,观察护理疗效,提高护理水平及患者的生活质量,促进患者身体快速恢复.方法:将2011年6月~2012年7月在我院收治的60例胃肠外科疾病合并糖尿病患者,对其术前与术中及术后等方面的护理进行分析.结果:所有的胃肠外科合并糖尿患者者经过及时治疗、精心护理,取得较为满意的效果,患者均好转出院,无并发症出现.结论:对胃肠外科伴有糖尿病患者的围术期进行护理,具有重要的意义,提高了患者的生活质量.

  11. 前纵隔肿瘤切除术30例围术期护理%Perioperative nursing care in the treatment of 30 patients with anterior mediastinal tumor by surgical operation



    目的:探讨前纵隔肿瘤切除术患者围术期的护理方法.方法:对30例行前纵隔肿瘤切除术患者加强围术期护理,密切观察病情变化,预防术后并发症.结果:本组均痊愈出院,平均住院时间为15.6 d.其中2例行二次手术,1例开胸止血,1例切除肿瘤细胞侵及器官.术后并发心律失常4例,经心内科会诊给予药物后好转;并发肺水肿3例,给予利尿剂和激素治疗后好转.结论:对前纵隔肿瘤切除术患者加强围术期护理,可有效提高手术成功率,促进患者的康复.%Objective: To explore the perioperative nursing methods in the treatment of anterior mediastinal tumor by surgical operation.Methods: 30 patients with anterior mediastinal tumor resection were given careful perioperative nursing care and close observation and the measures to prevent postoperative complications were strengthened.Results: All patients were cured and discharged from hospital.The average length of hospitalization was 15.6 days.Two patients received the second surgical operation,reoperation to stop bleeding in one patient and removal of organs invaded by tumor cell in one patient; arrhythmia occurred in 4 patients after operation and the patients had improvement after drugs therapy; pulmonary edema occurred in 3 patients, who were given diuretics and hormone treatment and got improvement.Conclusion: Strengthening perioperative nursing care can effectively improve the success rate of surgery and promote the rehabilitation of patients in the treatment of anterior mediastinal tumor by surgical operation.

  12. Optimizing Perioperative Decision Making: Improved Information for Clinical Workflow Planning

    Doebbeling, Bradley N.; Burton, Matthew M.; Eric A. Wiebke; Miller, Spencer; Baxter, Laurence; Miller, Donald; Alvarez, Jorge; Pekny, Joseph


    Perioperative care is complex and involves multiple interconnected subsystems. Delayed starts, prolonged cases and overtime are common. Surgical procedures account for 40–70% of hospital revenues and 30–40% of total costs. Most planning and scheduling in healthcare is done without modern planning tools, which have potential for improving access by assisting in operations planning support. We identified key planning scenarios of interest to perioperative leaders, in order to examine the feasib...

  13. Promoting Patient Safety With Perioperative Hand-off Communication.

    Robinson, Nancy Leighton


    Effective perioperative hand-off communication is essential for patient safety. The purpose of this quality improvement project was to demonstrate how a structured hand-off tool and standardized process could increase effective perioperative communication of essential elements of care and assist in the timely recognition of patients at risk for clinical deterioration in the initial postoperative period. A team-based pilot project used the Iowa Model of Evidence-Based Practice and the principles of Lean Six Sigma to implement Perioperative PEARLS, a perioperative specific hand-off communication tool and a standardized framework for hand-off communication. The implementation of a structured hand-off tool and standardized process supports compliance with regulatory standards of care and eliminates waste from the hand-off process. A review of pre-implementation and post-implementation data revealed evidence of safer patient care. Evidence-based perioperative hand-off communication facilitates expedited patient evaluation, rapid interventions, reduction in adverse events, and a safer perioperative environment. PMID:27235961

  14. Perioperative nursing for patients with diabetic foot receiving endovascular interventional therapy

    Objective: To study the effect of perioperative nursing on the living quality of patients with diabetic foot who are treated with endovascular interventional therapy. Methods: Specific perioperative nursing care plan was accordingly designed for 43 patients with diabetic foot. Endovascular balloon angioplasty and stent implantation were formed in these patients to treat their diabetic foot. The clinical results were observed. Results: Perioperative nursing effectively improved patient's limb blood supply, enhanced the healing of diabetic foot ulceration and increased the possibility of limb preservation. Conclusion: Endovascular therapy combined with corresponding perioperative nursing care can benefit more patients with diabetic foot. (authors)

  15. Perioperative Medicine: The Value Proposition for Anesthesia?: A UK Perspective on Delivering Value from Anesthesiology.

    Grocott, Michael P W; Mythen, Michael G


    Perioperative medicine describes the practice of patient centered, multidisciplinary, and integrated medical care of patients from the moment of contemplation of surgery until full recovery. The value proposition for perioperative medicine rests on defining benefits that outweigh the costs of change. This article discusses the concept of value in the context of healthcare and highlights a number of reasons for relative market failure. Five key opportunities for adding value in the perioperative journey are suggested: collaborative decision-making, lifestyle modification before surgery, standardization of in-hospital perioperative care, achieving full recovery after surgery, and the use of data for quality improvement. PMID:26610619

  16. Developing critical thinking in the perioperative environment.

    Jones, Jackie H


    Critical thinking is considered an essential skill for nurses by many, including major accrediting agencies, health care administrators, and AORN. This is in part because of the environment in which nurses function. Health care, medicine, technology, and nursing are dynamic and constantly changing. The perioperative environment is complex, fast paced, unique, and oftentimes unpredictable. Critical thinking skills enable perioperative nurses to function effectively and evolve in this ever-changing environment. Nursing education programs are mandated to teach critical thinking skills. It is the practice arena, however, that refines, hones, and grows these skills. This article provides an overview of critical thinking in the context of nursing, as well as strategies and interventions designed to teach critical thinking skills. PMID:20152198

  17. Risk reduction: perioperative smoking intervention

    Møller, Ann; Tønnesen, Hanne


    Smoking is a well-known risk factor for perioperative complications. Smokers experience an increased incidence of respiratory complications during anaesthesia and an increased risk of postoperative cardiopulmonary complications, infections and impaired wound healing. Smokers have a greater risk of...... postoperative intensive care admission. Even passive smoking is associated with increased risk at operation. Preoperative smoking intervention 6-8 weeks before surgery can reduce the complications risk significantly. Four weeks of abstinence from smoking seems to improve wound healing. An intensive, individual...... approach to smoking intervention results in a significantly better postoperative outcome. Future research should focus upon the effect of a shorter period of preoperative smoking cessation. All smokers admitted for surgery should be informed of the increased risk, recommended preoperative smoking cessation...

  18. Perioperative thermoregulation and heat balance.

    Sessler, Daniel I


    Core body temperature is normally tightly regulated to within a few tenths of a degree. The major thermoregulatory defences in humans are sweating, arteriovenous shunt vasoconstriction, and shivering. The core temperature triggering each response defines its activation threshold. General anaesthetics greatly impair thermoregulation, synchronously reducing the thresholds for vasoconstriction and shivering. Neuraxial anaesthesia also impairs central thermoregulatory control, and prevents vasoconstriction and shivering in blocked areas. Consequently, unwarmed anaesthetised patients become hypothermic, typically by 1-2°C. Hypothermia results initially from an internal redistribution of body heat from the core to the periphery, followed by heat loss exceeding metabolic heat production. Complications of perioperative hypothermia include coagulopathy and increased transfusion requirement, surgical site infection, delayed drug metabolism, prolonged recovery, shivering, and thermal discomfort. Body temperature can be reliably measured in the oesophagus, nasopharynx, mouth, and bladder. The standard-of-care is to monitor core temperature and to maintain normothermia during general and neuraxial anaesthesia. PMID:26775126

  19. Risk reduction: perioperative smoking intervention

    Møller, Ann; Tønnesen, Hanne


    postoperative intensive care admission. Even passive smoking is associated with increased risk at operation. Preoperative smoking intervention 6-8 weeks before surgery can reduce the complications risk significantly. Four weeks of abstinence from smoking seems to improve wound healing. An intensive, individual......Smoking is a well-known risk factor for perioperative complications. Smokers experience an increased incidence of respiratory complications during anaesthesia and an increased risk of postoperative cardiopulmonary complications, infections and impaired wound healing. Smokers have a greater risk of...... approach to smoking intervention results in a significantly better postoperative outcome. Future research should focus upon the effect of a shorter period of preoperative smoking cessation. All smokers admitted for surgery should be informed of the increased risk, recommended preoperative smoking cessation...

  20. Laparoscopic cholecystectomy perioperative management: an update

    Jakobsson, Jan


    Irene Sellbrant,1 Gustaf Ledin,2 Jan G Jakobsson2 1Department of Anaesthesia, Capio Lundby, Gothenburg, 2Department of Anaesthesia and Intensive Care, Institution for Clinical Science, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden Abstract: Laparoscopic cholecystectomy is one of the most common general surgical procedures. The aim of the present paper is to review current evidence and well-established practice for elective laparoscopic perioperative management. There is no fir...

  1. Melatonin in perioperative medicine: Current perspective

    Souvik Maitra; Dalim Kumar Baidya; Puneet Khanna


    Melatonin, a new addition to the armamentarium of anesthesiologist, has some unique properties that are highly desirable in routine peri-operative care. Available clinical data show that preoperative melatonin is as effective as benzodiazepines in reducing preoperative anxiety with minimal action on psychomotor performance and sleep wake cycle. It may be considered as a safe and effective alternative of benzodiazepines as preoperative anxiolytic. It may have opioid sparing effect, may reduce ...

  2. Perioperative acute kidney injury

    Calvert Stacey


    Full Text Available Abstract Acute kidney injury (AKI is a serious complication in the perioperative period, and is consistently associated with increased rates of mortality and morbidity. Two major consensus definitions have been developed in the last decade that allow for easier comparison of trial evidence. Risk factors have been identified in both cardiac and general surgery and there is an evolving role for novel biomarkers. Despite this, there has been no real change in outcomes and the mainstay of treatment remains preventive with no clear evidence supporting any therapeutic intervention as yet. This review focuses on definition, risk factors, the emerging role of biomarkers and subsequent management of AKI in the perioperative period, taking into account new and emerging strategies.

  3. Burnout in perioperative context

    Galvão, Ana Maria; Gonçalves, Ana Rita Veloso; Certo, Ana


    Companies in a global context are going through moments of great development of information and technologies. In these environments Burnout is highly prevalent, this syndrome is considered as one of physical and emotional stress that leads to a lack of motivation to work, leading to a progressive sense of inadequacy and failure. Objectives: What level of stress Perioperative nurses for nurses in the Region of Tras-os-Montes and Alto Douro. Methods: Non-experimental study,...

  4. An Agenda for Improving Perioperative Code Status Discussion.

    Hickey, Thomas R; Cooper, Zara; Urman, Richard D; Hepner, David L; Bader, Angela M


    Code status discussions (CSDs) clarify patient preferences for cardiopulmonary resuscitation in the event of cardiac or respiratory arrest. CSDs are a key component of perioperative care, particularly at the end of life, and must be both patient-centered and shared. Physicians at all levels of training are insufficiently trained in and inappropriately perform CSD; this may be particularly true of perioperative physicians. In this article, we describe the difficulty of achieving a patient-centered, shared perioperative CSD in the case of a medical professional with a do-not-resuscitate order. We provide a brief background in cardiopulmonary resuscitation, do-not-resuscitate, and CSD before proposing an agenda for improving perioperative CSD. PMID:27301059

  5. Accelerating a Network Model of Care: Taking a Social Innovation to Scale

    Kerry Byrne


    Full Text Available Government-funded systems of health and social care are facing enormous fiscal and human-resource challenges. The space for innovation in care is wide open and new disruptive patterns are emerging. These include self-management and personal budgets, participatory and integrated care, supported decision making and a renewed focus on prevention. Taking these disruptive patterns to scale can be accelerated by a technologically enabled shift to a network model of care to co-create the best outcomes for individuals, family caregivers, and health and social care organizations. The connections, relationships, and activities within an individual’s personal network lay the foundation for care that health and social care systems/policy must simultaneously support and draw on for positive outcomes. Practical tools, adequate information, and tangible resources are required to coordinate and sustain care. Tyze Personal Networks is a social venture that uses technology to engage and inform the individual, their personal networks, and their care providers to co-create the best outcomes. In this article, we demonstrate how Tyze contributes to a shift to a network model of care by strengthening our networks and enhancing partnerships between care providers, individuals, and family and friends.

  6. Application of fast track surgical rehabilitation nursing care to the perioperative period of laparoscopic nephrectomy%快速康复外科护理在腹腔镜肾切除术围术期中的应用



    Objective: To explore the application effect of fast track surgical rehabilitation nursing care to the perioperative period of laparoscopic nephrectomy. Methods: 162 patients who underwent laparoscopic nephrectomy were randomly divided into observation group ( n = 73 ) and control group ( n = 89 ). The fast track surgical rehabilitation nursing care was applied in the observation group and routine nursing care was taken in the control group. The clinical efficacy and peostoperative recovery of the patients were compared between the two groups. Results: The anal exhausting time, the time of eating for the first time, the time of bowel movement for the first time and postoperative hospitalization days were significantly shorter in the observation group than those in the control group ( P < 0.05 ). Conclusion: Application of fast track surgical rehabilitation nursing care to the perioperative period of laparoscopic nephrectomy can reduce hospitalization days and promote patient's postoperative rehabilitation.%目的:探讨快速康复外科护理在腹腔镜肾切除术围术期中的应用效果.方法:将162例行腹腔镜肾切除术患者随机分为观察组73例和对照组89例.观察组给予快速康复外科护理,对照组给予常规护理.比较两组临床治疗效果及术后恢复情况.结果:观察组患者术后肛门排气时间、首次进食时间、首次排便时间及术后住院时间明显少于对照组(P<0.05).结论:快速康复外科护理应用于腹腔镜肾切除术围术期,可减少患者住院时间,促进患者术后康复.

  7. EuCARD and CARE - development of accelerator technology in Poland

    Romaniuk, Ryszard


    EuCARD (2009-1013) and CARE (2004-2008) are examples of big European R&D projects for building integrated accelerator infrastructures in Europe. Several research teams from a number of European countries are participating in this consolidated effort. Here we summarize the tasks done by some teams from Poland on a more general background.

  8. Perioperative management of severe anorexia nervosa.

    Hirose, K; Hirose, M; Tanaka, K; Kawahito, S; Tamaki, T; Oshita, S


    As the prevalence of anorexia nervosa (AN) increased, surgery in severe AN patients also increased in the 2000s. We experienced a surgical case of a patient with severe AN, showing an extremely low BMI of 8.6 kg m(-2). We investigated the problems associated with this case and propose criteria to manage severe AN. We endeavour to report on the perioperative management of rare and severe symptoms and surgical indications of severely malnourished patients. All published reports were identified through comprehensive searches using PubMed, BioMedLib, and the Japan Medical Abstracts Society with the following terms and keywords: 'anorexia nervosa', 'eating disorder', 'hypoglycaemia', 'leucocytopaenia', 'gelatinous bone marrow', 'surgery', and 'operation'. In cases of AN with a BMI under 13 kg m(-2), marked hypoglycaemia, leucocytopaenia <3.0×10(9) litre(-1), or both, potentially fatal complications frequently occur. Accordingly, patients need strict nutritional support to avoid re-feeding syndrome until surgery. During the course of anaesthesia, careless loading of glucose or catecholamine may lead to disturbance of electrolytes or fatal arrhythmia. Intensive care and early feeding as soon as possible after surgery are important to prevent surgical site infection. Although not many perioperative cases of AN have been reported, clinicians must be aware of the danger and the causes of mortality in critical cases. Thus, the decision to undertake surgery must be taken carefully and close perioperative coordination among physicians, surgeons, psychiatrists, anaesthesiologists, and intensivists is essential. PMID:24366724

  9. Integrating Perioperative Content in Nursing Curricula: A Case Study Approach.

    Byrne, Michelle; Root, Susan; Culbertson, Laurie


    Perioperative nursing care requires unique specialty knowledge, skills, and abilities. National initiatives in nursing education and health care support integrating perioperative nursing content into curricular offerings in nursing schools and health care institutions. We provide an overview of the initiatives affecting nursing education, followed by a case study example and a guide to assist educators with incorporating perioperative case studies into their education plans. These resources may enhance the integration of perioperative nursing concepts in undergraduate curricula, internships, and continuing education offerings. The purpose of this article is to provide resources for nurse educators to systematically create case studies and to encourage increased exposure to perioperative concepts and competencies in a myriad of educational environments. PMID:27234794

  10. Priority patient safety issues identified by perioperative nurses.

    Steelman, Victoria M; Graling, Paula R; Perkhounkova, Yelena


    Much of the work done by perioperative nurses focuses on patient safety. Perioperative nurses are aware that unreported near misses occur every day, and they use that knowledge to prioritize activities to protect the patient. The purpose of this study was to identify the highest priority patient safety issues reported by perioperative RNs. We sent a link to an anonymous electronic survey to all AORN members who had e-mail addresses in AORN's member database. The survey asked respondents to identify top perioperative patient safety issues. We received 3,137 usable responses and identified the 10 highest priority safety issues, including wrong site/procedure/patient surgery, retained surgical items, medication errors, failures in instrument reprocessing, pressure injuries, specimen management errors, surgical fires, perioperative hypothermia, burns from energy devices, and difficult intubation/airway emergencies. Differences were found among practice settings. The information from this study can be used to inform the development of educational programs and the allocation of resources to enhance safe perioperative patient care. PMID:23531307

  11. Pulse oximetry for perioperative monitoring

    Pedersen, Tom; Møller, Ann Merete; Hovhannisyan, Karen

    Pulse oximetry is extensively used in the perioperative period and might improve patient outcomes by enabling an early diagnosis and, consequently, correction of perioperative events that might cause postoperative complications or even death. Only a few randomized clinical trials of pulse oximetry...

  12. Student Immersion in Perioperative Nursing.

    Penprase, Barbara; Monahan, Janean; Poly-Droulard, Lynda; Prechowski, Stephanie


    The aging workforce and the lack of perioperative clinical practice and theoretical content in nursing education programs are factors contributing to the perioperative nursing shortage. This article discusses the implementation of a creatively designed perioperative program, which includes a didactic course and a 210-hour clinical course, developed by the faculty members of a Michigan school of nursing in collaboration with administrators at area hospitals. The didactic content covers materials presented during the first three months of orientation for newly employed perioperative nurses. Interested baccalaureate nursing students in their senior year are selected to participate in the program after being interviewed by hospital personnel and university faculty members. To date, the program has 18 student graduates in two semesters; all have been offered positions in the perioperative setting, and 14 have accepted positions. The active learning strategies used in the course are described with examples. PMID:26849984

  13. Paradigmas e evidências da nutrição peri-operatória Paradigms and evidence of perioperative nutrition

    Maria Isabel Toulson Davisson Correia


    Full Text Available Understanding perioperative pathophysiology and implementing care regimes, through a multimodal approach, to reduce the organic response to stress after surgery and the related postoperative ileus, are major challenges. Multimodal surgical strategies such as pre-operative intake of a carbohydrate drink, instead of the usually recommended 2- to 6-hour period of nothing-bymouth, together with patient's education of the postoperative care plan, plus efficacious analgesia and early postoperative nutrition, among others, have been described to significantly impact on the previous variables. Therefore, these strategies accelerate rehabilitation and, as a consequence, decrease complications and hospital length of stay and, its related costs.

  14. Nursing care for hypertension patients in the perioperative period of dental implantation%高血压患者种植手术的围手术期护理

    刘翀; 刘欣


    目的:探讨高血压患者种植手术的围手术期护理方法。方法:回顾我院种植中心从2012年12月到2014年12月接受种植手术的高血压患者87例,根据患者的术前血压分级情况给予围手术期护理。同时跟踪调查。结果:在术后12天拆线时,患者伤口均愈合良好,术后3~6个月行二期手术时, X线片显示种植体均形成良好的骨结合。结论:采用术前服用降压药进行控制性降压并给予一定的心理辅导,术中心电监护,术后针对性护理,可提高高血压患者种植手术的安全性。高血压作为种植手术的非适应症,今年来随着种植手术的开展,患者量逐年增多,本文旨在为提高高血压患者的手术安全开展提高参考。%Objective: To explore the targeted nursing for hypertension patients in the perioperative period of dental implantation. Method: To review Implant Center in our hospital since December 2012 from De-cember 2014 to accept the implant surgery in 87 patients with hypertension, according to patients be-fore surgery blood pressure grades circumstances give perioperative care. While tracking survey. Re-sults: When stitches after 12 days, the patients wound healed well, when after 3 to 6 months the line second stage surgery, X-ray films showed good form implants are osseointegration. Conclusion:Using preoperative blood pressure medication were induced hypotension and give some psychological counsel-ing, intraoperative electrocardiographic monitoring, targeted postoperative care, patients with hyperten-sion implant surgery can improve safety. As a non-hypertensive implant surgery indications, this year with implant surgery carried out, the patient volume increased year by year, this paper aims to improve surgical safety in patients with hypertension conduct awareness reference.

  15. Perioperative respiratory care in severe scoliosis patients%重度脊柱侧弯患者围术期呼吸道护理

    黎小霞; 张伟玲; 肖萍; 黄天雯; 杨军林


    Objective To investigate perioperative nursing of respiratory system in severe scoliosis patients.Methods 26 severe scoliosis patients with respiratory function training before operation were retrospected.All of them tested pulmonary function before and after training,postoperative respiratory system nursing were also taken to maintain airway unobstructed,including respiratory rate and oxygen saturation monitoring,effective pain management and respiratory complications controlling.Results The average forced vital capacity(FVC)was 45.9%and 52.1%before and after breathing exercises,the mean forced expiratory volume in one second(FEV1)was 43.8%and 48.8%before and after breathing exercises,with lung function improvement in 69.2%patients. There were two hemopneumothorax and three mild or moderate pleural effusion occurred within 10 days after surgery,but all recovered after effective treatment and nursing.Conclusions Perioperative systematic and effective training in respiratory function and airway management can improve lung function and surgical safety,reduce the incidence of postoperative pulmonary complications,and promote early rehabilitation .%目的:探讨重度脊柱侧弯患者围手术期呼吸道护理要点。方法对26例重度脊柱侧弯患者实施矫形手术,术前指导患者进行呼吸功能训练,术后给予呼吸道管理,保持呼吸道通畅,有效疼痛管理及加强呼吸道并发症观察和护理。结果呼吸训练前后患者用力肺活量(forced vital capacity,FVC)平均为45.9%与52.1%,第1 s用力呼气容积(forced expiratory volum in one second,FEV1)平均为43.8%与48.8%;肺功能有改善患者18例,占69.2%;术后10 d内2例患者发生血、气胸,3例患者发生轻、中度胸腔积液,经有效治疗和护理均能安全渡过围手术期。结论围手术期系统、有效的呼吸功能训练以及呼吸道管理能改善患者肺功能,提高手术安全性及减少术后肺部并发

  16. Optimizing perioperative decision making: improved information for clinical workflow planning.

    Doebbeling, Bradley N; Burton, Matthew M; Wiebke, Eric A; Miller, Spencer; Baxter, Laurence; Miller, Donald; Alvarez, Jorge; Pekny, Joseph


    Perioperative care is complex and involves multiple interconnected subsystems. Delayed starts, prolonged cases and overtime are common. Surgical procedures account for 40-70% of hospital revenues and 30-40% of total costs. Most planning and scheduling in healthcare is done without modern planning tools, which have potential for improving access by assisting in operations planning support. We identified key planning scenarios of interest to perioperative leaders, in order to examine the feasibility of applying combinatorial optimization software solving some of those planning issues in the operative setting. Perioperative leaders desire a broad range of tools for planning and assessing alternate solutions. Our modeled solutions generated feasible solutions that varied as expected, based on resource and policy assumptions and found better utilization of scarce resources. Combinatorial optimization modeling can effectively evaluate alternatives to support key decisions for planning clinical workflow and improving care efficiency and satisfaction. PMID:23304284

  17. Cardiac perioperative complications in noncardiac surgery

    Radovanović Dragana; Kolak Radmila; Stokić Aleksandar; Radovanović Zoran; Jovanović Gordana


    Anesthesiologists are confronted with an increasing population of patients undergoing noncardiac surgery who are at risk for cardiac complications in the perioperative period. Perioperative cardiac complications are responsible for significant mortality and morbidity. The aim of the present study was to determine the incidence of perioperative (operative and postoperative) cardiac complications and correlations between the incidence of perioperative cardiac complications and type of surgical ...

  18. Perioperative nursing care of glottic insufficiency patients treated with autologous fat injection%声带注射自体脂肪治疗声门闭合不全的围手术期护理



    Objective To explore the nursing intervention on glottic insufficiency patients treated with autologous fat injection.Methods The data from forty-five cases of glottic insufficiency treated with autologous fat injection were reviewed and analyzed.Results The situation of dysphonia were improved among all of the cases.Conclusions Intensive perioperative nursing care can improve the function of glottal vocal for patients with glottic insufficiency.%目的 探讨声带自体脂肪注射治疗卢门闭合不全对护理工作的要求.方法 对我院45例行声带自体脂肪注射治疗声门闭合不全患者的临床资料,并对护理工作重点进行回顾、分析、总结.结果 患者的术后声音障碍得到明显改善.结论 细致周密的围手术期护理能够有效地帮助患者改善发音.

  19. 成人先天性髋关节发育不良的围手术期护理%Nursing Care of Perioperative Period in Adult Congenital Hip Dysplasia

    刘倩; 周莉; 何晓凤


    Adult congenital hip dysplasia(ACHD) is a congenital defect of acetabular disease. It may develop subluxation or luxation of hip after a long term, and osteonecrosis of the femeral head may occur at last. Now the patients with ACHD at early stage are treated with the operation of rotational osteotomy of the acetabulum, but in later period it can only be treated with the operation of total hip replacement. No matter which method is selected, nursing care of perioperative period plays a very important role in recoveries of the patients.%成人先天性髋关节发育不良是一种髋臼先天性发育缺陷的疾病,长期发展会形成髋关节半脱位、脱位,最终甚至可能出现股骨头坏死等严重合并症.对于早期患者目前主要采用髋臼旋转截骨手术治疗,而晚期出现股骨头脱位及坏死则只能通过全髋关节置换进行治疗.不论哪种手术方式,围手术期的护理时于患者的健康恢复都有着非常重要的意义.

  20. Supply chain optimization for pediatric perioperative departments.

    Davis, Janice L; Doyle, Robert


    Economic challenges compel pediatric perioperative departments to reduce nonlabor supply costs while maintaining the quality of patient care. Optimization of the supply chain introduces a framework for decision making that drives fiscally responsible decisions. The cost-effective supply chain is driven by implementing a value analysis process for product selection, being mindful of product sourcing decisions to reduce supply expense, creating logistical efficiency that will eliminate redundant processes, and managing inventory to ensure product availability. The value analysis approach is an analytical methodology for product selection that involves product evaluation and recommendation based on consideration of clinical benefit, overall financial impact, and revenue implications. PMID:21884843

  1. Melatonin in perioperative medicine: Current perspective

    Souvik Maitra


    Full Text Available Melatonin, a new addition to the armamentarium of anesthesiologist, has some unique properties that are highly desirable in routine peri-operative care. Available clinical data show that preoperative melatonin is as effective as benzodiazepines in reducing preoperative anxiety with minimal action on psychomotor performance and sleep wake cycle. It may be considered as a safe and effective alternative of benzodiazepines as preoperative anxiolytic. It may have opioid sparing effect, may reduce intraocular pressure, and have role in prevention of postoperative delirium. The short-term administration of melatonin is free from significant adverse effects also.

  2. Accelerator

    The invention claims equipment for stabilizing the position of the front covers of the accelerator chamber in cyclic accelerators which significantly increases accelerator reliability. For stabilizing, it uses hydraulic cushions placed between the electromagnet pole pieces and the front chamber covers. The top and the bottom cushions are hydraulically connected. The cushions are disconnected and removed from the hydraulic line using valves. (J.P.)

  3. TRALI in Perioperative Period-A Case Report

    G llango


    Full Text Available TRALI is a rare but fatal complication of blood transfusion usually under diagnosed and under reported. An interesting case of hemolysis and lung injury developing in a single patient following blood transfusion during perioperative period is reported hereby. Great amount of suspicion about TRALI and supportive care such as mechanical ventila-tion has saved this patient.

  4. Perioperative aspirin and clonidine and risk of acute kidney injury

    Garg, Amit X; Kurz, Andrea; Sessler, Daniel I;


    IMPORTANCE: Acute kidney injury, a common complication of surgery, is associated with poor outcomes and high health care costs. Some studies suggest aspirin or clonidine administered during the perioperative period reduces the risk of acute kidney injury; however, these effects are uncertain and ...

  5. Ethics in perioperative practice--values, integrity, and social policy.

    King, Cecil A; Broom, Catherine


    Though often difficult, ethical decision making is necessary when caring for surgical patients. Perioperative nurses have to recognize ethical dilemmas and should be prepared to take action based on the ethical code outlined in the American Nurses Association's (ANA's) Code of Ethics for Nurses with Interpretive Statements. In this final article of a nine-part series that is designed to help perioperative nurses relate the ANA code to their own area of practice, the author looks at the ninth provision, which emphasizes the responsibility of professional nursing associations to maintain the value and integrity of the profession. PMID:12528493

  6. Implementing a Perioperative RN Training Program for Recent Graduates.

    Byrd, Debra; Mullen, Linda; Renfro, David; Harris, Theodore A


    In 2010, nurse educators at one health care facility implemented a new program that emphasized placing new graduates in specialty areas, including the hemodialysis unit, the gastroenterology unit, and the OR. Managers in the OR faced staffing challenges because of the difficulty in recruiting and retaining experienced perioperative nurses and the expected retirement of a significant number of staff members. Surgical services managers agreed to participate in the new graduate program and decided to use AORN's Periop 101™ course and a series of monthly simulation training sessions to supplement the program and provide recently graduated nurses with a strong perioperative nursing foundation. In three years, a total of nine newly graduated RNs successfully completed the program. The three-year retention rate was 78%. PMID:26323221

  7. Perioperative management of the patient with rheumatoid arthritis.

    Krause, Megan L; Matteson, Eric L


    A multidisciplinary approach is required to care for patients with rheumatoid arthritis (RA) in the perioperative period. In preparation for surgery, patients must have a cardiovascular risk assessment performed due to the high risk of heart disease in patients with RA. Treatment of RA is with immunomodulatory medications, which present unique challenges for the perioperative period. Currently, there is no consensus on how to manage disease modifying antirheumatic drug (DMARD) therapy in the perioperative setting. Much of the data to guide therapy is based on retrospective cohort data. Choices regarding DMARDs require an individualized approach with collaboration between surgeons and rheumatologists. Consensus regarding biologic therapy is to hold the therapy in the perioperative period with the length of time dictated by the half-life of the medication. Special attention is required at the time of surgery for potential need for stress dose steroids. Further, there must be close communication with anesthesiologists in terms of airway management particularly in light of the risk for cervical spine disease. There are no consensus guidelines regarding the requirement for cervical spine radiographs prior to surgery. However, history and exam alone cannot be relied upon to identify cervical spine disease. Patients with RA who undergo joint replacement arthroplasty are at higher risk for infection and dislocation compared to patients with osteoarthritis, necessitating particular vigilance in postoperative follow up. This review summarizes available evidence regarding perioperative management of patients with RA. PMID:25035831

  8. Gender-affirming Surgeries in the Era of Insurance Coverage: Developing a Framework for Psychosocial Support and Care Navigation in the Perioperative Period.

    Deutsch, Madeline B


    Transgender people have a gender identity different from their birth-assigned sex. Transgender people may seek gender-affirming surgeries to align their body with their identified gender. With increasing visibility of transgender identities, and recognition of the importance of gender-affirming care, has come a policy shift toward mandated coverage or provision of blanket exclusions of these procedures by insurance companies and Medicaid. The World Professional Association for Transgender Health provides guidance to mental health professionals evaluating patients for gender-affirming surgeries, including making a diagnosis and assessing for capacity to consent. However the expansion of covered gender-affirming surgeries to safety-net populations has highlighted the need for an expanded presurgical process which includes a psychosocial assessment and care navigation. The proposed framework expands the preoperative assessment to include these components, and can be used to guide both health systems and insurance providers in the development of transgender medicine programs. PMID:27180683

  9. Perioperative acute renal failure.

    Mahon, Padraig


    PURPOSE OF REVIEW: Recent biochemical evidence increasingly implicates inflammatory mechanisms as precipitants of acute renal failure. In this review, we detail some of these pathways together with potential new therapeutic targets. RECENT FINDINGS: Neutrophil gelatinase-associated lipocalin appears to be a sensitive, specific and reliable biomarker of renal injury, which may be predictive of renal outcome in the perioperative setting. For estimation of glomerular filtration rate, cystatin C is superior to creatinine. No drug is definitively effective at preventing postoperative renal failure. Clinical trials of fenoldopam and atrial natriuretic peptide are, at best, equivocal. As with pharmacological preconditioning of the heart, volatile anaesthetic agents appear to offer a protective effect to the subsequently ischaemic kidney. SUMMARY: Although a greatly improved understanding of the pathophysiology of acute renal failure has offered even more therapeutic targets, the maintenance of intravascular euvolaemia and perfusion pressure is most effective at preventing new postoperative acute renal failure. In the future, strategies targeting renal regeneration after injury will use bone marrow-derived stem cells and growth factors such as insulin-like growth factor-1.

  10. Perioperative control of blood glucose level in cardiac surgery.

    Minakata, Kenji; Sakata, Ryuzo


    It is well recognized that poor perioperative blood glucose (BG) control can increase the risk of infection, cardiovascular accidents, and even death in patients undergoing cardiac surgery. Since it has been reported that tight BG control (80-110 mg/dL) yields better outcomes in critically ill patients, it became a standard of care to control BG using intravenous insulin infusion in ICU. However, it has been debated in terms of the optimal target range whether a strict control with intensive ...

  11. Perioperative Ethical Issues.

    Chandrakantan, Arvind; Saunders, Tracie


    Shared decision-making is a paradigm of patient engagement that is assuming greater importance in the era of value-based health care. The basic tenets include patient engagement on clinical decisions, taking into account multiple factors that influence physician and patient decision-making. Understanding and reconciling diametrically opposed views of care are important tenets of shared decision-making. Because many decisions are made preoperatively, the applicability of these principles may be useful especially in the situation of a higher risk surgical candidate. Many patients with Do-Not-Resuscitate (DNR) orders are undergoing procedures to improve quality of life. This article explores shared decision-making and DNR. PMID:26927737

  12. Using music interventions in perioperative care.

    Gooding, Lori; Swezey, Shane; Zwischenberger, Joseph B


    Anxiety and pain are common responses to surgery, and both can negatively affect patient outcomes. Music interventions have been suggested as a nonpharmacological intervention to alleviate pain and anxiety during surgical treatment. Although the data are somewhat mixed, the research suggests that music-based interventions are effective in reducing anxiety, pain perception, and sedative intake. The majority of studies have focused on interventions during the postoperative period and address pain reduction, with preoperative use of music targeting anxiety reduction the second most commonly cited objective. Most of the studies found in the literature involve passive music listening via headphones. The data suggest that researcher-selected music is most effective in reducing anxiety, primarily because it incorporates evidence-based parameters such as consistent tempo and dynamics, stable rhythms, and smooth melodic lines. Finally, the literature suggests that music therapists can serve as experts to help medical personnel identify effective implementation strategies. PMID:22948329

  13. The effects of information technology on perioperative nursing.

    Sweeney, Paula


    Numerous advances in technology during the past decade require that nurses not only be knowledgeable in nursing science but that they also become educated in information technology (IT). Perioperative IT has the potential to improve the quality of health care, reduce costs, decrease medication administration errors, reduce time spent on paperwork, increase management efficacy, and allow affordable access to health care. Nursing knowledge is needed for designing, implementing, and updating software, including an electronic health record (EHR). With the support of EHR data, nurses will be able to develop best practices for patient care and support research for evidence-based practice. When a standardized terminology, such as the Perioperative Nursing Data Set, is incorporated into an EHR, consistent documentation can be shared among systems. With advances in technology, perioperative nursing roles are expanding in relation to IT requirements and nurses are pursuing additional education. In addition to traditional methods, e-learning is an effective way to provide ongoing technological education. PMID:21040817

  14. Design and Implementation of a Perioperative Surgical Home at a Veterans Affairs Hospital.

    Walters, Tessa L; Howard, Steven K; Kou, Alex; Bertaccini, Edward J; Harrison, T Kyle; Kim, T Edward; Shafer, Audrey; Brun, Carlos; Funck, Natasha; Siegel, Lawrence C; Stary, Erica; Mariano, Edward R


    The innovative Perioperative Surgical Home model aims to optimize the outcomes of surgical patients by leveraging the expertise and leadership of physician anesthesiologists, but there is a paucity of practical examples to follow. Veterans Affairs health care, the largest integrated system in the United States, may be the ideal environment in which to explore this model. We present our experience implementing Perioperative Surgical Home at one tertiary care university-affiliated Veterans Affairs hospital. This process involved initiating consistent postoperative patient follow-up beyond the postanesthesia care unit, a focus on improving in-hospital acute pain management, creation of an accessible database to track outcomes, developing new clinical pathways, and recruiting additional staff. Today, our Perioperative Surgical Home facilitates communication between various services involved in the care of surgical patients, monitoring of patient outcomes, and continuous process improvement. PMID:26392388

  15. Effects of Perioperative Warm Care on Postoperative Cognitive Function in Elderly Patients%围术期“温暖护理”对老年患者术后认知功能的影响

    马蔚蔚; 李春娥; 汪世高; 杨希英; 张俊秀


    目的 探讨围术期“温暖护理”对老年患者术后认知功能障碍(postoperative cognitive dysfunction,POCD)的影响.方法 将40例择期行全身麻醉下腹部外科手术的老年患者[美国卒中学会(Americon Stroke Association,ASA)分级Ⅱ级,>65岁]随机分成两组,对照组仅接受常规护理,观察组在此基础上接受“温暖护理”,即手术当天巡回护士到病房接患者时对患者进行心理辅导,术中控制室温在24~26℃,麻醉开始前30 min患者覆盖保温毯,术中所输液体均加温至39~40℃,冲洗液加温至37~38℃.采用简易智力状态检查表(mini-mental state examination,MMSE)于术前及术后第1、3、7天对两组患者分别进行认知功能评分.结果 术后第1、3天两组患者的MMSE评分都低于术前,差异有统计学意义(P<0.05);术后第1、3天,研究组患者MMSE评分明显高于对照组,发生认知障碍的人数少于对照组,差异均有统计学意义(P<0.05).结论 围术期的心理护理和综合保温措施能改善老年患者术后的认知功能,降低术后认知功能障碍的发生率.%Objective To clarify the effects of perioperative warm care on the postoperative cognitive dys-function (POCD)in elderly patients. Methods Forty elderly patients (ASA Ⅱ , >65 years) undergoing selective abdominal operation were randomly divided into two groups: control group given usual care and experimental group given systematical methods to keep body temperature with mental intervention when circulating nurses received the patients before the operation. For the experimental group,the temperature of operation room was maintained at 24~26 ℃ ; the patients were covered with thermal blanket 30 min be-fore anesthesia;the intraoperative transfusion in the body was heated to 39~40℃ ;the washing fluid was heated to 37 - 38℃. Mini-mental state examination (MMSE) scores were recorded at 1 d, 3 d and 7 d after operation on cognitive function between the

  16. Communication in the perioperative setting.

    Cvetic, Elizabeth


    Poor communication in the perioperative setting contributes to an unsafe OR culture and affects patient safety and employee engagement, decision making, productivity, morale, and retention. Communication breakdowns can lead to surgical delays, patient inconvenience, and serious errors. Simplification and standardization of communication processes and the use of effective communication skills (eg, clear verbal communication, awareness of the effects of nonverbal communication, use of listening and conflict management skills) are ways to improve OR interactions and minimize or prevent errors. PMID:21884846

  17. Institute of Electronic Systems in CARE and EuCARD Projects Accelerator and FEL Research, Development and Applications in Europe

    Romaniuk, Ryszard


    There are described coordinating actions of the accelerator science in Europe in 2003-2009. The actions embrace basic science, as well as development and applications. The accelerator research was not coordinated in Europe at a global scale but was rather concentrated in a few centers owning large infrastructure. These centers include: CERN, DESY, GSI, INFN, LAL, PSI etc. Such coordinating actions enable a lot of positive processes including new possibilities for research centers in this country. It is much easier for them to extend, deepen or even start from the beginning their activities in the field of the accelerator technology. This field includes also free electron lasers. There are described two European framework projects CARE and EuCARD on accelerator technology, their extent and the participation of ISE WUT in them.

  18. Managing a chronic pain patient in the perioperative period.

    Kopf, Andreas


    The chronic pain patient with and without chronic opioid medication is at risk for under- and overtreatment perioperatively. Careful planning of the perioperative period by the anesthesiologist, the pain service and the surgeon is crucial. Epidural analgesia requires reduction of preoperative opioid doses to a maximum of 50% to avoid withdrawal as well as continuous postanesthesia care unit-monitoring for the first 24 hours. Brief cognitive behavioral interventions pre- and postoperatively contribute to successful pain management. The perioperative period may be used to re-evaluate the patient's opioid requirements. A follow-up by an experienced pain management service should be available after discharge of the chronic pain patient. Individualized assessment by a pain management team is necessary for this increasing group of patients. This report is adapted from paineurope 2013; Issue 2, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, LTD. and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: at which European health professionals can register online to receive copies of the quarterly publication. PMID:24303836

  19. Coagulation testing in the perioperative period

    Venkatesan Thiruvenkatarajan


    Full Text Available Perioperative coagulation management is a complex task that has a significant impact on the perioperative journey of patients. Anaesthesia providers play a critical role in the decision-making on transfusion and/or haemostatic therapy in the surgical setting. Various tests are available in identifying coagulation abnormalities in the perioperative period. While the rapidly available bedside haemoglobin measurements can guide the transfusion of red blood cells, blood product administration is guided by many in vivo and in vitro tests. The introduction of newer anticoagulant medications and the implementation of the modified in vivo coagulation cascade have given a new dimension to the field of perioperative transfusion medicine. A proper understanding of the application and interpretation of the coagulation tests is vital for a good perioperative outcome.

  20. Perioperative corticosteroid reduces hospital stay after fronto-orbital advancement.

    Clune, James E; Greene, Arin K; Guo, Chao-Yu; Gao, Lin Lin; Kim, Sendia; Meara, John G; Proctor, Mark R; Mulliken, John B; Rogers, Gary F


    Facial swelling is common after fronto-orbital advancement. Edema and closure of the palpebral fissures can lead to prolonged hospitalization. The purpose of this study was to determine if perioperative corticosteroid shortens hospital stay after this procedure.We retrospectively studied consecutive children younger than 2 years who underwent primary fronto-orbital advancement between 1990 and 2008. Patients were categorized into 2 groups: group 1 patients were not given corticosteroid; group 2 patients received tapered perioperative dexamethasone. Primary outcome variables included length of hospital stay and infection rate.A total of 161 patients were included in the study. Hospitalization was significantly shorter (P = 0.008) for group 2 (n = 65; median duration, 3.0 d) than group 1 (n = 96; median duration, 5.0 d). Infection rates did not differ between groups (group 1, 2.1%; group 2, 1.5%; P = 0.8).Perioperative corticosteroid shortens hospitalization after fronto-orbital advancement without increasing the incidence of postoperative infection. The cost of postoperative hospital care was reduced by 27.2%. PMID:20186083

  1. Clinical decision support for perioperative information management systems.

    Wanderer, Jonathan P; Ehrenfeld, Jesse M


    Clinical decision support (CDS) systems are being used to optimize the increasingly complex care that our health care system delivers. These systems have become increasingly important in the delivery of perioperative care for patients undergoing cardiac, thoracic, and vascular procedures. The adoption of perioperative information management systems (PIMS) has allowed these technologies to enter the operating room and support the clinical work flow of anesthesiologists and operational processes. Constructing effective CDS systems necessitates an understanding of operative work flow and technical considerations as well as achieving integration with existing information systems. In this review, we describe published examples of CDS for PIMS, including support for cardiopulmonary bypass separation physiological alarms, β-blocker guideline adherence, enhanced revenue capture for arterial line placement, and detection of hemodynamic monitoring gaps. Although these and other areas are amenable to CDS systems, the challenges of latency and data reliability represent fundamental limitations on the potential application of these tools to specific types of clinical issues. Ultimately, we expect that CDS will remain an important tool in our efforts to optimize the quality of care delivered. PMID:23690340

  2. Perioperative evaluation of cardiac surgical risk: particularities in the emergency surgery – from the guidelines to the clinical practice

    Andronescu, AM; Nechita, AC; Ittu, G; Delcea, C; Dumitrescu, G; Vintila, MM


    Rationale: Cardiac risk in patients undergoing surgery depends on many factors from the patient's cardiovascular history to the surgical procedure itself, with its particularities, the type of anesthesia, fluid exchanges and the supervision of the patient. Therefore, this risk must be carefully considered and it determines the endorsement of perioperative measures with important medical implications. Objective: Perioperative cardiac risk evaluation guidelines were published since 2010 and the...

  3. Perioperative use of statins in noncardiac surgery

    YC Chan


    Full Text Available YC Chan1, SW Cheng1, MG Irwin21Division of Vascular Surgery and 2Anaesthesiology, University of Hong Kong Medical Centre, South Wing, 14th Floor K Block, Queen Mary Hospital, Hong Kong, ChinaBackground: Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors can significantly decrease cardiovascular mortality and morbidity, irrespective of the patients’ cholesterol status. This paper reviews the effects of perioperative statin therapy in patients undergoing noncardiac surgery.Method: A systematic literature review was undertaken of all published literature on this subject using Medline and cross-referenced. All published relevant papers on the perioperative use of statins were used.Results: Perioperative statin therapy is associated with a lower perioperative morbidity and mortality in patients undergoing elective or emergency surgery. The effects are due to a combination of lipid-lowering and pleiotropic properties of statins.Conclusion: Ideally a large scale multi-centre randomized controlled trial of perioperative statin therapy should be performed but this may be difficult to conduct since there is already overwhelming evidence in the literature to suggest perioperative cardiovascular protective properties. Statins may still be under-prescribed in surgical patients.Keywords: perioperative, cardiac complications, morbidity, mortality, outcome, statins, vascular, noncardiac surgery

  4. Optimal glucose management in the perioperative period.

    Evans, Charity H; Lee, Jane; Ruhlman, Melissa K


    Hyperglycemia is a common finding in surgical patients during the perioperative period. Factors contributing to poor glycemic control include counterregulatory hormones, hepatic insulin resistance, decreased insulin-stimulated glucose uptake, use of dextrose-containing intravenous fluids, and enteral and parenteral nutrition. Hyperglycemia in the perioperative period is associated with increased morbidity, decreased survival, and increased resource utilization. Optimal glucose management in the perioperative period contributes to reduced morbidity and mortality. To readily identify hyperglycemia, blood glucose monitoring should be instituted for all hospitalized patients. PMID:25814110

  5. [Perioperative Management of PD Patients].

    Reichmann, H


    Both patients and caregivers but also treating physicians are concerned about complications along with surgical interventions. A major problem is abrupt cessation of anti-Parkinson medication, which leads to manifold disturbances, sometimes even to an akinetic crisis. There are several means to guarantee continuous dopaminergic stimulation even in patients that are not allowed to take medication orally before they undergo surgery. Amongst others rectally applied levodopa, amantadine infusions, and especially the use of a rotigotine patch are good means to overcome oral intake. Perioperative management is important due to the fact that in Germany alone each year more than 10 000 PD patients undergo surgery. Main reasons for this are fractures, but also elective interventions. Further emergency situations that cause treatment as an inpatient are psychosis, motoric disability, but also pneumonia and cardiovascular disturbances. In contrast PD patients suffer less often from cancer. PMID:27276074

  6. Perioperative management of pediatric patients on mechanical cardiac support.

    Mossad, Emad B; Motta, Pablo; Rossano, Joseph; Hale, Brittani; Morales, David L


    The population of children with end-stage heart failure requiring mechanical circulatory support is growing. These children present for diagnostic imaging studies, various interventions and noncardiac surgical procedures that require anesthetic care. This article is a review of the population demographics of children on mechanical cardiac support, the alternative devices available, and the important concepts for safe perioperative management of these patients. The discussion will be limited to devices for short- and long-term cardiac support, excluding extracorporeal membrane oxygenation (ECMO) for respiratory support. PMID:21332879

  7. A Primer on Population Health Management and Its Perioperative Application.

    Boudreaux, Arthur M; Vetter, Thomas R


    The movement toward value-based payment models, driven by governmental policies, federal statutes, and market forces, is propelling the importance of effectively managing the health of populations to the forefront in the United States and other developed countries. However, for many anesthesiologists, population health management is a new or even foreign concept. A primer on population health management and its potential perioperative application is thus presented here. Although it certainly continues to evolve, population health management can be broadly defined as the specific policies, programs, and interventions directed at optimizing population health. The Population Health Alliance has created a particularly cogent conceptual framework and interconnected and very useful population health process model, which together identify the key components of population health and its management. Population health management provides a useful rationale for patients, providers, payers, and policymakers to move collectively away from the traditional system of individual, siloed providers to a more integrated, coordinated, team-based approach, thus creating a holistic view of the patient population. The goal of population health management is to keep the targeted patient population as healthy as possible, thus minimizing the need for costly interventions such as emergency department visits, acute hospitalizations, laboratory testing and imaging, and diagnostic and therapeutic procedures. Population health management strategies are increasingly more important to leaders of health care systems as the health of populations for which they care, especially in a strong cost risk-sharing environment, must be optimized. Most population health management efforts rely on a patient-centric team approach, coordination of care, effective communication, robust outcomes data analysis, and continuous quality improvement. Anesthesiologists have an opportunity to help lead these efforts in

  8. Development of accelerator technology in Poland, Impact of European CARE and EuCARD projects

    Romaniuk, R.


    The development of accelerator technology in Poland is strictly combined with the cooperation with specialist accelerator centers of global character, where the relevant knowledge is generated, allowing to build big and modern machines. These are relatively costly undertakings of interdisciplinary character. Most of them are financed from the local resources. Only the biggest machines are financed commonly by many nations like: LHC in CERN, ILC in Fermi Lab, E-XFEL in DESY. A similar financin...

  9. Stress Dose Steroids: Myths and Perioperative Medicine.

    MacKenzie, C Ronald; Goodman, Susan M


    Perioperative medication management for patients with systemic autoimmune inflammatory diseases has focused on strategies to improve outcomes and mitigate risks. The emphasis has been to minimize the risk of infection associated with most antirheumatic medications, while attempting to avoid flares of disease precipitated by medication withdrawal. Management of glucocorticoids in the perioperative period has been based on an assumption that supraphysiologic increases in dose were always necessary to avoid hypotension and shock in glucocorticoid treated patients, and alternative strategies were rarely considered despite the known infectious, metabolic, and wound healing risks associated with glucocorticoid administration. This paper will review current recommendations for perioperative glucocorticoid administration for glucocorticoid treated patients with systemic inflammatory autoimmune diseases and discuss glucocorticoid physiology to analyze the basis for these recommendations and consider alternative perioperative management strategies. PMID:27351679

  10. Perioperative Glucose Control in Neurosurgical Patients

    Daniel Agustín Godoy; Mario Di Napoli; Alberto Biestro; Rainer Lenhardt


    Many neurosurgery patients may have unrecognized diabetes or may develop stress-related hyperglycemia in the perioperative period. Diabetes patients have a higher perioperative risk of complications and have longer hospital stays than individuals without diabetes. Maintenance of euglycemia using intensive insulin therapy (IIT) continues to be investigated as a therapeutic tool to decrease morbidity and mortality associated with derangements in glucose metabolism due to surgery. Suboptimal per...

  11. Update in perioperative medicine: practice-changing evidence published in 2015.

    Sundsted, Karna K; Mohabbat, Arya B; Regan, Dennis W; Salonen, Bradley R; Daniels, Paul R; Mauck, Karen F


    Evidence in perioperative medicine is published in a wide variety of journals, given the multidisciplinary nature of its practice which spans medicine and its subspecialties, as well as surgery and anesthesiology. It can be difficult to identify new and important evidence, as perioperative practice continues to evolve in multiple areas such as medication management, anticoagulation and cardiac risk stratification, among others. New, high-quality evidence is published each year, and must be placed into the context of not only existing literature, but also practical real-world patient care. We sought to systematically identify, critically evaluate and concisely summarize the practice implications of 10 articles published in 2015 for the practicing perioperative clinician. PMID:27400757

  12. Perioperative nursing care and rehabilitation for patients with traumatic elbow joint stiffness%创伤性肘关节僵硬的围手术期护理及康复治疗

    王红莉; 孔祥燕


    Background The elbow joint is a composite joint consisted of the humeroulnar joint , humeroradial joint ,and proximal radioulnar joint .The causes for elbow joint stiffness include joint capsule scar contracture ,ectopic ossification around the joint and long‐term immobilization .The conservative treatment can be applied to early elbow joint stiffness .The open elbow release surgery is applicable for patients who do not respond to conservative therapy .Although satisfactory range of motion is obtained after complete release ,the loss of range of motion may occur again if the patients don′t exercise due to pain .The assistance of hinged external fixator helps to prevent joint capsule scar contracture ,promote early function exercise ,and effectively prevent relapse of elbow joint stiffness .In this study ,we reported the perioperative nursing care and rehabilitation in 8 cases who presented good outcomes after open release surgery combined with hinged external fixator for traumatic elbow joint stiffness in the department of traumatic orthopedics in the Peking University‐affiliated People′s Hospital from January 2010 to March 2014 .Methods General data:8 cases including 3 males and 5 females with a mean age of 38 .3 years ranged from 17‐61 years were included in the group .4 cases had primary injury caused by dislocation of elbow joint .1 case had radial head fracture .1 had supracondylar fracture of humerus .2 had intercondylar fracture .The time from the initial injury to the surgery ranged from 10‐36 months ,with a mean of 18 .2 months .According to Morrey classification of elbow joint stiffness ,2 cases had very severe stiffness (range of motion ≤30°);6 cases had severe stiffness (range of motion 30°‐60°) .According to Mayo scale for elbow function ,the score ranged from 45‐75 ,with a mean of 53 .8 .Three cases of them had complicated entrapment of the ulnar nerve .Surgery method:All patients of the group were subject to general anesthesia

  13. Perioperative nursing care and rehabilitation for patients with traumatic elbow joint stiffness%创伤性肘关节僵硬的围手术期护理及康复治疗

    王红莉; 孔祥燕


    study ,we reported the perioperative nursing care and rehabilitation in 8 cases who presented good outcomes after open release surgery combined with hinged external fixator for traumatic elbow joint stiffness in the department of traumatic orthopedics in the Peking University‐affiliated People′s Hospital from January 2010 to March 2014 .Methods General data:8 cases including 3 males and 5 females with a mean age of 38 .3 years ranged from 17‐61 years were included in the group .4 cases had primary injury caused by dislocation of elbow joint .1 case had radial head fracture .1 had supracondylar fracture of humerus .2 had intercondylar fracture .The time from the initial injury to the surgery ranged from 10‐36 months ,with a mean of 18 .2 months .According to Morrey classification of elbow joint stiffness ,2 cases had very severe stiffness (range of motion ≤30°);6 cases had severe stiffness (range of motion 30°‐60°) .According to Mayo scale for elbow function ,the score ranged from 45‐75 ,with a mean of 53 .8 .Three cases of them had complicated entrapment of the ulnar nerve .Surgery method:All patients of the group were subject to general anesthesia .The surgery with medial and lateral approaches were performed to release the capsular ligament and tendon ,and remove the ectopic ossification .Normal release was performed for the prepositioned ulnar nerve .The center of rotation of the elbow joint was positioned under fluoroscopy .2‐mm Kirschner wire was inserted in the center of rotation .Stryker Dynamic Joint Distractor (DJD II) was used for external fixation .2 screws for external fixation were inserted from the humerus and ulna ,respectively .The screws should be in parallel with the Kirschner wire in the same plane .The screws were connected with the external fixator using clamp .The elbow joint gap was open by rotating the retractor .Key points for nursing :(1) Psychological nursing before surgery :The patients were subject to health education

  14. Laparoscopic cholecystectomy perioperative management: an update

    Sellbrant I


    Full Text Available Irene Sellbrant,1 Gustaf Ledin,2 Jan G Jakobsson2 1Department of Anaesthesia, Capio Lundby, Gothenburg, 2Department of Anaesthesia and Intensive Care, Institution for Clinical Science, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden Abstract: Laparoscopic cholecystectomy is one of the most common general surgical procedures. The aim of the present paper is to review current evidence and well-established practice for elective laparoscopic perioperative management. There is no firm evidence for best anesthetic technique, further high quality studies assessing short as well as more protracted outcomes are needed. Preventive multi-modal analgesia, combining non-opioid analgesics, paracetamol, nonsteroidal anti-inflammatory drugs or coxib, and local anesthesia, has a long history. Local anesthesia improves postoperative pain and facilitates discharge on the day of surgery. Whether transversus abdominis plane-block has clinically important advantages compared to local infiltration analgesia needs further studies. Single intravenous dose steroid, dexamethasone, reduces postoperative nausea and vomiting, pain, and enhances the recovery process. Multi-modal analgesia is reassuringly safe thus having a positive benefit versus risk profile. Adherence to modern guidelines avoiding prolonged fasting and liberal intravenous fluid regime supports rapid recovery. The effects of CO2 insufflation must be acknowledged and low intra-abdominal pressure should be sought in order to reduce negative cardiovascular/respiratory effects. There is no firm evidence supporting heating and humidification of the insufflated gas. The potential risk for CO2/gas entrainment into vasaculture, gas emboli, or subcutaneous/intra-thoracic into the pleural space must be kept in mind. Laparoscopic cholecystectomy in ASA 1-2 patients following a multi-modal enhanced recovery protocol promotes high success rate for discharge on the day of surgery. Keywords: laparoscopic

  15. Development of accelerator technology in Poland, Impact of European CARE and EuCARD projects

    Romaniuk, R


    The development of accelerator technology in Poland is strictly combined with the cooperation with specialist accelerator centers of global character, where the relevant knowledge is generated, allowing to build big and modern machines. These are relatively costly undertakings of interdisciplinary character. Most of them are financed from the local resources. Only the biggest machines are financed commonly by many nations like: LHC in CERN, ILC in Fermi Lab, E-XFEL in DESY. A similar financing solution has to be implemented in Poland, where a scientific and political campaign is underway on behalf of building two big machines, a Polish Synchrotron in Kraków and a Polish FEL in Świerk. Around these two projects, there are realized a dozen or so smaller ones.

  16. Development of free electron laser and accelerator technology in Poland (CARE and EuCARD projects)

    Romaniuk, Ryszard


    The development of accelerator technology in Poland is strictly combined with the cooperation with specialist accelerator centers of global character, where the relevant knowledge is generated, allowing to build big and modern machines. These are relatively costly undertakings of interdisciplinary character. Most of them are financed from the local resources. Only the biggest machines are financed commonly by many nations like: LHC in CERN, ILC in Fermi Lab, E-XFEL in DESY. A similar financing solution has to be implemented in Poland, where a scientific and political campaign is underway on behalf of building two big machines, a Polish Synchrotron in Kraków and a Polish FEL in Świerk. Around these two projects, there are realized a dozen or so smaller ones.

  17. Perbandingan Persepsi Perawat dengan Pasien tentang Perilaku Caring Perawat Perioperatif di Ruang Rawat Bedah Rumah Sakit Umum Binjai

    Nindya, Dessy


    Perioperative nurse of caring behavior is a surgical nurse and intervention stance in providing nursing care for patients at the surgical pre and post operation phase operation. This research aims to identify the perceptions of nurse caring about the behavior of perioperative nursing care in surgery, a patient's perception about the behaviors identified the caring nurse perioperative in the outpatient surgery. The research design used in this research is descriptive design comparative. This r...

  18. 76 FR 28988 - Medicare Program; Accelerated Development Sessions for Accountable Care Organizations-June 20, 21...


    ... Information and Agenda Faculty at each ADS will be senior leadership from organizations that have already... curriculum on core competencies for ACO development within four main areas: leadership and priority-setting... the total cost of care. Individual sessions and faculty will help participants complete...

  19. Perioperative care to patients with extramammary Paget’s disease treated with resection of tumor of vulva expansion and flap repair%外阴肿瘤扩大切除与皮瓣修复术治疗乳房外Paget病患者围手术期的护理

    陈少红; 陈海燕


    Objective To summarize perioperative points for nursing patients with extramammary Paget’s disease undergoing resection of tumor of vulva expansion and flap repair.Method Eleven patients with extramammary Paget’s disease were managed with resection of tumor of vulva expansion and flap repair,and with perioperative care as well.Results The tumors in all of the patients were removed completely and the flaps survived.All patients were discharged for hospitalization of(4.5±0.7)days.No flap infection or necrosis occurred.Conclusion The measures for nursing the patients with extramammary Paget’s disease undergoing resection of tumor of vulva expansion and flap repair may include preoperative preparation,mental care,postoperative observation of flaps, prevention of complications,health education,instruction on nutrition and formation of proper life style,which may be beneficial for the smooth manipulation of resection as well as for the postoperative rehabilitation.%  目的总结外阴肿瘤扩大切除与皮瓣修复术治疗乳房外Paget病患者围手术期的护理要点。方法给予11例乳房外Paget病患者实施外阴肿瘤扩大切除与皮瓣修复术,同时配合做好围手术期护理工作。结果11例患者手术顺利,术后恢复良好,皮瓣全部成活,平均(4.5±0.7)d后I期愈合出院。术后未出现皮瓣感染、坏死等并发症。结论外阴肿瘤扩大切除与皮瓣修复术应做好患者术前准备、心理护理,术后做好皮瓣的观察,预防并发症,并加强健康宣教,指导患者加强营养及建立良好生活方式,其有利于患者手术顺利进行及促进患者术后恢复。

  20. Anaesthetic Considerations in the Perioperative Management of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy.

    Sheshadri, Deepak B; Chakravarthy, Murali R


    Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy has emerged as one of the primary modalities of treatment of diffuse peritoneal malignancies. It is a complex surgical procedure with the patients facing major and potentially life threatening alterations of haemodynamic, respiratory, metabolic and thermal balance with significant fluid losses and the perioperative management is challenging for anaesthesiologists and intensive care physicians. Though the alterations are short lived, these patients require advanced organ function monitoring and support perioperatively. The anaesthesiologist is involved in the management of haemodynamics, respiratory function, coagulation, haematologic parameters, fluid balance, thermal variations, and metabolic and nutritional support perioperatively. The chemotherapy instillate used are known to cause nephrotoxicity, cardiotoxicity, dyselectrolytemia and lactic acidosis. The preoperative polypharmacy for pain control, previous surgery and/or chemotherapy, malnourished status secondary to feeding problems and tumour wasting syndrome make the task all the more challenging. The anaesthesiologist also needs to consider the perioperative care from a quality of life perspective and proper preoperative counselling is important. The present overview summarizes the challenges faced by the anaesthesiologist regarding the pathophysiological alterations during the Cytoreductive surgery and Hyperthermic intraperitoneal chemotherapy in the preoperative, intraoperative and postoperative periods. PMID:27065715

  1. The Science And Art Of Delivery: Accelerating The Diffusion Of Health Care Innovation.

    Parston, Greg; McQueen, Julie; Patel, Hannah; Keown, Oliver P; Fontana, Gianluca; Al Kuwari, Hanan; Al Kuwari, Hannan; Darzi, Ara


    There is a widely acknowledged time lag in health care between an invention or innovation and its widespread use across a health system. Much is known about the factors that can aid the uptake of innovations within discrete organizations. Less is known about what needs to be done to enable innovations to transform large systems of health care. This article describes the results of in-depth case studies aimed at assessing the role of key agents and agencies that facilitate the rapid adoption of innovations. The case studies-from Argentina, England, Nepal, Singapore, Sweden, the United States, and Zambia-represent widely varying health systems and economies. The implications of the findings for policy makers are discussed in terms of key factors within a phased approach for creating a climate for change, engaging and enabling the whole organization, and implementing and sustaining change. Purposeful and directed change management is needed to drive system transformation. PMID:26643638

  2. Perioperative morbidity of intracavitary gynecologic brachytherapy

    The purpose was to define the incidence and severity of perioperative morbidity and its subsequent management with standard tandem and ovoid insertions to evaluate pretreatment and treatment factors associated with an increased risk of perioperative morbidity. Intraoperative complications were seen in 3% of implants and included two perforations and a vaginal laceration in two patients. Twenty-four percent of implants (16 patients) developed temperatures of > 100.5 (range 100.6 to 103), although only one patient required implant removal because of fever. Management of fever included antibiotics in 35% and acetaminophen only in 65%. Five implants were removed emergently secondary to presumed sepsis, exacerbation of chronic obstructive pulmonary disease, hypotension, change in mental status, and myocardial infarction/congestive heart failure. No patient developed a deep-vein thrombosis, pulmonary embolism, gastrointestinal obstruction, or died of a postoperative complication. Univariate analysis of pretreatment and treatment factors revealed older age and spinal/epidural anesthesia to be associated with increased perioperative morbidity, and older age and higher ASA classification to be associated with severe complications requiring removal of implant. Multivariate analysis revealed only older age to be significantly related to perioperative morbidity. Fever of > 100.5 was seen in 24% of implants and can be managed successfully without removal of the implant in 96% of cases. Use of antibiotics preoperatively and intraoperatively did not reduce the risk of perioperative temperature elevation. Use of routine diphenoxylate hydrochloride prophylaxis was tolerated without ileus or gastrointestinal obstruction clinically. Although routine deep-vein thrombosis prophylaxis is reasonable, the data would support a low risk of deep-vein thrombosis for untreated patients. Severe perioperative morbidity necessitated premature implant removal in only 5% of cases. 24 refs., 2 tabs

  3. Perioperative morbidity of intracavitary gynecologic brachytherapy

    Lanciano, R.; Corn, B.; Martin, E.; Schulthesis, T.; Hogan, W.M.; Rosenblum, N. [Fox Chase Cancer Center, Philadelphia, PA (United States)


    The purpose was to define the incidence and severity of perioperative morbidity and its subsequent management with standard tandem and ovoid insertions to evaluate pretreatment and treatment factors associated with an increased risk of perioperative morbidity. Intraoperative complications were seen in 3% of implants and included two perforations and a vaginal laceration in two patients. Twenty-four percent of implants (16 patients) developed temperatures of > 100.5 (range 100.6 to 103), although only one patient required implant removal because of fever. Management of fever included antibiotics in 35% and acetaminophen only in 65%. Five implants were removed emergently secondary to presumed sepsis, exacerbation of chronic obstructive pulmonary disease, hypotension, change in mental status, and myocardial infarction/congestive heart failure. No patient developed a deep-vein thrombosis, pulmonary embolism, gastrointestinal obstruction, or died of a postoperative complication. Univariate analysis of pretreatment and treatment factors revealed older age and spinal/epidural anesthesia to be associated with increased perioperative morbidity, and older age and higher ASA classification to be associated with severe complications requiring removal of implant. Multivariate analysis revealed only older age to be significantly related to perioperative morbidity. Fever of > 100.5 was seen in 24% of implants and can be managed successfully without removal of the implant in 96% of cases. Use of antibiotics preoperatively and intraoperatively did not reduce the risk of perioperative temperature elevation. Use of routine diphenoxylate hydrochloride prophylaxis was tolerated without ileus or gastrointestinal obstruction clinically. Although routine deep-vein thrombosis prophylaxis is reasonable, the data would support a low risk of deep-vein thrombosis for untreated patients. Severe perioperative morbidity necessitated premature implant removal in only 5% of cases. 24 refs., 2 tabs.

  4. Perioperative pain management in hip arthroscopy; what options are there?

    Bech, N H; Hulst, A H; Spuijbroek, J A; van Leuken, L L A; Haverkamp, D


    Hip arthroscopy is a fast growing orthopedic field of expertise. As in any field of surgery adequate postoperative pain management regimes are of utmost importance. The purpose of this review is to provide an overview of current knowledge on anesthetic options for perioperative pain management for hip arthroscopy. We searched the Pubmed/Medline and Embase database for literature and included 10 studies for our analysis. Because of the variety of pain scales and different ways of measured pain no meta-analysis could be performed and a descriptive review is performed. There are several types of pain regimens that can mostly be divided in two groups: local anesthetics and nerve blocks. Included studies show a rather large variation in reported visual analogue scale scores, post anesthesia care unit admission time and opioid usage. There are several anesthetic options available for hip arthroscopy. Different studies use different dosages, anesthetic regimens and different protocols; this partly explains the differences between studies with similar techniques. Peripheral nerve blocks seems promising but regarding current literature no clear recommendation can be made about what the best perioperative pain management option is, an overview of all reported techniques is given. PMID:27583156

  5. Angioedema: Classification, management and emerging therapies for the perioperative physician.

    Misra, Lopa; Khurmi, Narjeet; Trentman, Terrence L


    Angioedema is a rare condition which manifests as sudden localised, non-pitting swelling of certain body parts including skin and mucous membranes. It is vital that anaesthesiologists understand this condition, as it may present suddenly in the perioperative period with airway compromise. To identify literature for this review, the authors searched the PubMed, Medline, Embase, Scopus and Web of Science databases for English language articles covering a 10-year period, 2006 through 2016. Angioedema can be either mast-cell mediated or bradykinin-induced. Older therapies for histaminergic symptoms are well known to anaesthesiologists (e.g., adrenaline, anti-histamines and steroids), whereas older therapies for bradykinin-induced symptoms include plasma and attenuated androgens. New classes of drugs for bradykinin-induced symptoms are now available, including anti-bradykinin, plasma kallikrein inhibitor and C1 esterase inhibitors. These can be used prophylactically or as rescue medications. Anaesthesiologists are in a unique position to coordinate perioperative care for this complex group of patients. PMID:27601734

  6. Status of the Next European Dipole (NED) Activity of the Collaborated Accelerator Research in Europe (CARE) Project

    Devred, Arnaud; Baynham, D Elwyn; Boutboul, T; Canfer, S; Chorowski, M; den Ouden, A; Fabbricatore, P; Farinon, S; Fessia, P; Fydrych, J; Félice, H; Greco, Michela; Greenhalgh, J; Leroy, D; Loveridge, P W; Michel, F; Oberli, L R; Pedrini, D; Polinski, J; Previtali, V; Quettier, L; Rifflet, J M; Rochford, J; Rondeaux, F; Sanz, S; Sgobba, Stefano; Sorbi, M; Toral-Fernandez, F; Van Weelderen, R; Vincent-Viry, O; Volpini, G; Védrine, P


    Plans for LHC upgrade and for the final focalization of linear colliders call for large aperture and/or high-performance dipole and quadrupole magnets that may be beyond the reach of conventional NbTi magnet technology. The Next European Dipole (NED) activity was launched on January 1st, 2004 to promote the development of high-performance, Nb3Sn wires in collaboration with European industry (aiming at a non-copper critical current density of 1500 A/mm2 at 4.2 K and 15 T) and to assess the suitability of Nb3Sn technology to the next generation of accelerator magnets (aiming at an aperture of 88 mm and a conductor peak field of 15 T). It is integrated within the Collaborated Accelerator Research in Europe (CARE) project, involves seven collaborators, and is partly funded by the European Union. We present here an overview of the NED activity and we report on the status of the various work packages it encompasses.

  7. Assistência ao paciente obeso mórbido submetido à cirurgia bariátrica: dificuldades do enfermeiro Asistencia al paciente obeso mórbido sometido a la cirugía bariátrica: dificultades del enfermero Perioperative care for morbid obese patient undergoing bariatric surgery: challenges for nurses

    Denise Spósito Tanaka


    Full Text Available OBJETIVO: Identificar as dificuldades de enfermeiros de centro cirúrgico ao assistir pacientes obesos mórbidos submetidos à cirurgia bariátrica no período transoperatório. MÉTODOS: A amostra constou de 70 enfermeiros com experiência em assistência ao paciente obeso mórbido. Os dados foram coletados durante o 7º Congresso Brasileiro de Enfermeiros de Centro Cirúrgico, Recuperação Anestésica e Centro de Material e Esterilização por meio de um questionário. RESULTADOS: A análise dos resultados apontou como dificuldades aquelas relacionadas ao espaço físico, materiais e equipamentos e à assistência de enfermagem específica ao paciente obeso mórbido. CONCLUSÃO: O conhecimento específico, a especialização e a experiência em Centro Cirúrgico darão o conforto, a segurança física e emocional necessárias a estes pacientes.OBJETIVO: Identificar las dificultades de enfermeros de centro quirúrgico en el cuidado a pacientes obesos mórbidos sometidos a cirugía bariátrica en el período transoperatorio. MÉTODOS: La muestra constó de 70 enfermeros con experiencia en asistencia al paciente obeso mórbido. Los datos fueron recolectados por medio de un cuestionario durante el 7º Congreso Brasileño de Enfermeros de Centro Quirúrgico, Recuperación Anestésica y Centro de Material y Esterilización. RESULTADOS: El análisis de los resultados identificó como dificultades aquellas relacionadas al espacio físico, materiales y equipos y a la asistencia de enfermería específica al paciente obeso mórbido. CONCLUSIÓN: El conocimiento específico, la especialización y la experiencia en Centro Quirúrgico darán el confort, la seguridad física y emocional que necesitan estos pacientes.OBJECTIVE: To identify the challenges for nurses during the perioperative for patients undergoing bariatric surgery. METHODS: The sample consisted of 70 nurses who had experience in providing care for morbid obese patients. Data were collected

  8. Less noise, more hacking: how to deploy principles from MIT's hacking medicine to accelerate health care.

    DePasse, Jacqueline W; Carroll, Ryan; Ippolito, Andrea; Yost, Allison; Santorino, Data; Chu, Zen; Olson, Kristian R


    Medical technology offers enormous potential for scalable medicine--to improve the quality and access in health care while simultaneously reducing cost. However, current medical device innovation within companies often only offers incremental advances on existing products, or originates from engineers with limited knowledge of the clinical complexities. We describe how the Hacking Medicine Initiative, based at Massachusetts Institute of Technology has developed an innovative "healthcare hackathon" approach, bringing diverse teams together to rapidly validate clinical needs and develop solutions. Hackathons are based on three core principles; emphasis on a problem-based approach, cross-pollination of disciplines, and "pivoting" on or rapidly iterating on ideas. Hackathons also offer enormous potential for innovation in global health by focusing on local needs and resources as well as addressing feasibility and cultural contextualization. Although relatively new, the success of this approach is clear, as evidenced by the development of successful startup companies, pioneering product design, and the incorporation of creative people from outside traditional life science backgrounds who are working with clinicians and other scientists to create transformative innovation in health care. PMID:25096225

  9. Relacionamento terapêutico com criança no período perioperatório: utilização do brinquedo e da dramatização Relación terapéutica com el nino en el período perioperatorio Therapeutic relationship with child in perioperative nursing care

    Fabiana Faleiros


    Full Text Available Este estudo de caso tem o objetivo de analisar o relacionamento terapêutico desenvolvido entre aluna de enfermagem e uma criança de 3 anos , durante o período perioperatório, utilizando o brinquedo e a dramatização para facilitar a explicação dos procedimentos e dos objetos do hospital para a criança.Ouso do brinquedo mostrou-se uma forma adequada para comunicar-se efetivamente com a criança, e para prepará-la para a intervenção cirúrgica, pois, através da dramatização, ela participou ativamente dos procedimentos, mostrando que compreendia e aceitava o que estava acontecendo,nãoapresentando em nenhum momento medo ou ansiedade diante do ambiente do hospital e dos procedimentos cirúrgicos. Ao final do relacionamento, a mãe e a equipe cirúrgica avaliaram positivamente o preparo da criança para a cirurgia.El presente estudio tiene como finalidad analizar el proceso de relación terapéutica entre alumna de enfermería y una niña de 3 años de edad durante el período perioperatorio. Utilizando técnicas de comunicación terapéutica y medidas terapéuticas de enfermería, la alumna desarrolló empatía con la niña y su madre, proponiendo ayudarlas a superar sus dificultades frente sus miedos y ansiedad debida ala hospitalización y cirugia. La madre y equipo cirúgica han evaluado la preparación para la cirugia positivamente.The purpose of this study was to analyse the therapeutic relationship between a nursing student and a 3 years old child during perioperative period . Through the use of careful development assessments, preoperative tours, and therapeutic play techniques her fears and anxiety because of hospitalization and surgery were reduced and the surgical experience was lived by the child in a constructive manner. Parents and peri-operative team have evaluated positively the preparation and assessment of the child for surgery.

  10. Perioperative Glucose Control in Neurosurgical Patients

    Daniel Agustín Godoy


    Full Text Available Many neurosurgery patients may have unrecognized diabetes or may develop stress-related hyperglycemia in the perioperative period. Diabetes patients have a higher perioperative risk of complications and have longer hospital stays than individuals without diabetes. Maintenance of euglycemia using intensive insulin therapy (IIT continues to be investigated as a therapeutic tool to decrease morbidity and mortality associated with derangements in glucose metabolism due to surgery. Suboptimal perioperative glucose control may contribute to increased morbidity, mortality, and aggravate concomitant illnesses. The challenge is to minimize the effects of metabolic derangements on surgical outcomes, reduce blood glucose excursions, and prevent hypoglycemia. Differences in cerebral versus systemic glucose metabolism, time course of cerebral response to injury, and heterogeneity of pathophysiology in the neurosurgical patient populations are important to consider in evaluating the risks and benefits of IIT. While extremes of glucose levels are to be avoided, there are little data to support an optimal blood glucose level or recommend a specific use of IIT for euglycemia maintenance in the perioperative management of neurosurgical patients. Individualized treatment should be based on the local level of blood glucose control, outpatient treatment regimen, presence of complications, nature of the surgical procedure, and type of anesthesia administered.

  11. [Perioperative acute kidney injury and failure].

    Chhor, Vibol; Journois, Didier


    Perioperative period is very likely to lead to acute renal failure because of anesthesia (general or perimedullary) and/or surgery which can cause acute kidney injury. Characterization of acute renal failure is based on serum creatinine level which is imprecise during and following surgery. Studies are based on various definitions of acute renal failure with different thresholds which skewed their comparisons. The RIFLE classification (risk, injury, failure, loss, end stage kidney disease) allows clinicians to distinguish in a similar manner between different stages of acute kidney injury rather than using a unique definition of acute renal failure. Acute renal failure during the perioperative period can mainly be explained by iatrogenic, hemodynamic or surgical causes and can result in an increased morbi-mortality. Prevention of this complication requires hemodynamic optimization (venous return, cardiac output, vascular resistance), discontinuation of nephrotoxic drugs but also knowledge of the different steps of the surgery to avoid further degradation of renal perfusion. Diuretics do not prevent acute renal failure and may even push it forward especially during the perioperative period when venous retourn is already reduced. Edema or weight gain following surgery are not correlated with the vascular compartment volume, much less with renal perfusion. Treatment of perioperative acute renal failure is similar to other acute renal failure. Renal replacement therapy must be mastered to prevent any additional risk of hemodynamic instability or hydro-electrolytic imbalance. PMID:24656890

  12. Perioperative nursing for laparoscopic liver resection

    CHEN Li-jia; WEN Guo-fen


    Sir Run Run Shaw Hospital (SRRSH) has developed a form of laparoscopic hepatectomy, resecting by curettage and suction. Such resection has been carried out successfully in 6 patients who had liver tumors. The results are satisfactory. And after the operation, there is a very effective perioperative nursing ensuring the patient's recovery.

  13. Periop erative treatment of liver transplantation

    Shengbin Zhang ∗; Rui Liu; Shipeng Song; Weiqing Wang; Jin Zhao; Xiaoshi Dong


    A case of liver transplantation in the department of general surgery of the third affiliated hospital of Inner Mongolia medical school was collected and analyzed on the basis of diagnosis, physical examination and treatment. Liver transplantation was very complicated, accompanied by various postoperative complications. So this paper aims to share experience of perioperative management of liver transplantation among physicians.

  14. 临床路径结合中医理念在腰椎间盘突出症患者围术期护理中的应用%Application of clinical pathway combined with tradional Chinese Medicine on perioperative nursing care forpatients with lumbar disc herniation

    崔爱评; 贺建华; 李雪梅; 巩向丽


    Object To explore the influence of clinical pathway combined with tradional Chinese Medicine on perioperative nursing care for patients with lumbar disc herniation in order to improve the quality of postoperative recovery. Methods 120 cases of patients with lumbar disc herniation surgery were randomly divided into experimental group and control group, each group of 60 patients. the patients in control group were given conventional treatment with the perioperative nurising care, while patients in the experimental group were given care with model of clinical pathway combined with traditional chinese medicine. the lumbar disc herniation clinical symptom scores were observed and recorded including Joa scale score, average hospitalization days, the satisfaction of nursing care, nursing complaint rate, the condition of complications and the acquisition of health knowledge. Results the Joa scores of the experimental group was higher than that of the control group (P<0.05), and the difference was statistically significant. The satisfaction of nursing staff and the acquisition of health knowledge in the experimental group were both higher than that in the control group (P<0.05). the average hospitalization days in the experimental group were lower than that in the control group (P<0.05), and the difference was statistically significant. The nursing complaints rate of experimental group was significantly lower than that of the control group. Conclusion the implementation of clinical pathway combined with tradional chinese Medicine in patients with lumbar disc herniation, can shorten the hospitalization days, and improve the nursing quality and efficiency. it has important implications for clinical practice.%目的:探讨临床路径结合中医理念对腰椎间盘突出症患者围术期护理的影响,以期提高患者术后恢复质量。方法将120例腰椎间盘突出症手术患者随机分为试验组和对照组,每组60例,对照组给予围手术期院

  15. Perioperative pain management in hip and knee replacement surgery.

    Barrington, John W; Halaszynski, Thomas M; Sinatra, Raymond S; Expert Working Group On Anesthesia And Orthopaedics Critical Issues In Hip And Knee Replacement Arthroplasty, For The


    Many patients who undergo hip or knee replacement surgery today experience high levels of postoperative pain. Data from clinical studies and analyses of hospital records have demonstrated that severe postoperative pain is associated with an increased risk for complications, slowing of the rehabilitation process, delayed return to normal functioning, progression to persistent pain states, prolonged length of hospital stay, elevated rates of readmission, and higher overall costs. Orthopedic surgeons may now play a more active role in reducing the severity of pain following surgery, decreasing both opioid use and the incidence of opioid-related adverse events, and eliminating breakthrough pain and analgesic gaps. The benefits of multimodal regimens that include a combination of agents acting synergistically have been established unequivocally, and many analgesic and anesthetic agents are now available, as well as treatment options that differ according to route of administration. It is therefore possible to individualize treatment based on the type of procedure and patient need. One exciting advance that offers effective, safe, and efficient analgesia for many kinds of surgical procedures is the introduction of an extended-release local anesthetic (liposomal bupivacaine) for infiltration. This new option, which can be administered directly into the knee or hip by an orthopedic surgeon, is an example of the changing paradigm in perioperative analgesia, where commitment, communication, and coordination across all members of the clinical care team- including the surgeon, anesthesiologist, pharmacist, physical therapist, and nursing staff-are fundamental elements of an improved standard of care. An Expert Working Group on Anesthesia and Orthopaedics: Critical Issues in Hip and Knee Replacement Arthroplasty (April 13, 2013; Dallas, Texas) evaluated current approaches to perioperative pain management and proposed new regimens to help achieve optimal outcomes in these

  16. Clinical performance feedback and quality improvement opportunities for perioperative physicians

    Kaye AD


    Full Text Available Alan David Kaye,1 Olutoyin J Okanlawon,2 Richard D Urman21Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, 2Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston MA, USAAbstract: Clinical performance feedback is an important component of the ongoing development and education of health care practitioners. For physicians, feedback about their clinical practice and outcomes is central to developing both confidence and competence at all stages of their medical careers. Cultural and financial infrastructures need to be in place, and the concept of feedback needs to be readily embraced and encouraged by clinical leadership and other stakeholders. The "buy-in" includes the expectation and view that feedback occurs on a routine basis, and those engaged in the process are both encouraged to participate and held accountable. Feedback must be part of an overarching quality improvement and physician education agenda; it is not meant to be an isolated, fragmented initiative that is typically undermined by lack of resources or systemic barriers to gaining improvement within programs. Effective feedback should be an integral part of clinical practice. Anesthesiologists and other perioperative physicians are identifying specialty-specific indicators that can be used when creating a broader quality improvement agenda. Placing a more immediate formal feedback strategy that focuses on goal-oriented behavior is rapidly becoming a mainstay. Physicians may use their individual feedback reports for reflection and designing personal development plans as lifelong learners and leaders in improving patient care.Keywords: physician education, outcomes measurement, performance improvement, anesthesiology

  17. Perioperative intensive insulin therapy using artificial endocrine pancreas in patients undergoing pancreatectomy

    Maeda, Hiromichi; Okabayashi, Takehiro; Yatabe, Tomoaki; Yamashita, Koichi; Hanazaki, Kazuhiro


    Perioperative glycemic control is important for reducing postoperative infectious complications. However, clinical trials have shown that efforts to maintain normoglycemia in intensive care unit patients result in deviation of glucose levels from the optimal range, and frequent attacks of hypoglycemia. Tight glycemic control is even more challenging in those undergoing pancreatic resection. Removal of lesions and surrounding normal pancreatic tissue often cause hormone deficiencies that lead ...

  18. Perioperative modifications of respiratory function.

    Duggan, Michelle


    Postoperative pulmonary complications contribute considerably to morbidity and mortality, especially after major thoracic or abdominal surgery. Clinically relevant pulmonary complications include the exacerbation of underlying chronic lung disease, bronchospasm, atelectasis, pneumonia and respiratory failure with prolonged mechanical ventilation. Risk factors for postoperative pulmonary complications include patient-related risk factors (e.g., chronic obstructive pulmonary disease (COPD), tobacco smoking and increasing age) as well as procedure-related risk factors (e.g., site of surgery, duration of surgery and general vs. regional anaesthesia). Careful history taking and a thorough physical examination may be the most sensitive ways to identify at-risk patients. Pulmonary function tests are not suitable as a general screen to assess risk of postoperative pulmonary complications. Strategies to reduce the risk of postoperative pulmonary complications include smoking cessation, inspiratory muscle training, optimising nutritional status and intra-operative strategies. Postoperative care should include lung expansion manoeuvres and adequate pain control.

  19. TRALI in the perioperative period

    Berdai MA; Labib S; Harandou M


    Mohamed Adnane Berdai, Smael Labib, Mustapha HarandouChild and Mother Intensive Care Unit, University Hospital Hassan II, Fes, MoroccoBackground: Transfusion-related acute lung injury (TRALI) is one of the leading causes of transfusion-related morbidity and mortality. Although it is a serious complication of blood transfusion, it is still underestimated because of underrecognition and misdiagnosis, which can lead to inappropriate management.Case report: We report the case of a 34-year-old fem...

  20. Realization of CARE and EuCARD Projects in ISE-WUT, Accelerator and FEL Research, Development and Applications in Europe

    Romaniuk, R.


    There are described coordinating actions of the accelerator science in Europe in 2003-2009. The actions embrace basic science, as well as development and applications. The accelerator research was not coordinated in Europe at a global scale but was rather concentrated in a few centers owning large infrastructure. These centers include: CERN, DESY, GSI, INFN, LAL, PSI etc. Such coordinating actions enable a lot of positive processes including new possibilities for research centers in this country. It is much easier for them to extend, deepen or even start from the beginning their activities in the field of the accelerator technology. This field includes also free electron lasers. There are described two European framework projects CARE and EuCARD on accelerator technology, their extent and the participation of ISE WUT in them.

  1. Perioperative Variables Contributing to the Rupture of Intracranial Aneurysm: An Update

    Tumul Chowdhury


    Full Text Available Background. Perioperative aneurysm rupture (PAR is one of the most dreaded complications of intracranial aneurysms, and approximately 80% of nontraumatic SAHs are related to such PAR aneurysms. The literature is currently scant and even controversial regarding the issues of various contributory factors on different phases of perioperative period. Thus this paper highlights the current understanding of various risk factors, variables, and outcomes in relation to PAR and try to summarize the current knowledge. Method. We have performed a PubMed search (1 January 1991–31 December 2012 using search terms including “cerebral aneurysm,” “intracranial aneurysm,” and “intraoperative/perioperative rupture.” Results. Various risk factors are summarized in relation to different phases of perioperative period and their relationship with outcome is also highlighted. There exist many well-known preoperative variables which are responsible for the highest percentage of PAR. The role of other variables in the intraoperative/postoperative period is not well known; however, these factors may have important contributory roles in aneurysm rupture. Preoperative variables mainly include natural course (age, gender, and familial history as well as the pathophysiological factors (size, type, location, comorbidities, and procedure. Previously ruptured aneurysm is associated with rupture in all the phases of perioperative period. On the other hand intraoperative/postoperative variables usually depend upon anesthesia and surgery related factors. Intraoperative rupture during predissection phase is associated with poor outcome while intraoperative rupture at any step during embolization procedure imposes poor outcome. Conclusion. We have tried to create such an initial categorization but know that we cannot scale according to its clinical importance. Thorough understanding of various risk factors and other variables associated with PAR will assist in better

  2. Perioperative Nerve Blockade: Clues from the Bench

    M. R. Suter


    Full Text Available Peripheral and neuraxial nerve blockades are widely used in the perioperative period. Their values to diminish acute postoperative pain are established but other important outcomes such as chronic postoperative pain, or newly, cancer recurrence, or infections could also be influenced. The long-term effects of perioperative nerve blockade are still controversial. We will review current knowledge of the effects of blocking peripheral electrical activity in different animal models of pain. We will first go over the mechanisms of pain development and evaluate which types of fibers are activated after an injury. In the light of experimental results, we will propose some hypotheses explaining the mitigated results obtained in clinical studies on chronic postoperative pain. Finally, we will discuss three major disadvantages of the current blockade: the absence of blockade of myelinated fibers, the inappropriate duration of blockade, and the existence of activity-independent mechanisms.

  3. Detrimental effects of perioperative blood transfusion

    Nielsen, Hans Jørgen


    Evidence suggests that perioperative allogeneic blood transfusion increases the risk of infectious complications after major surgery and of cancer recurrence after curative operation. This has been attributed to immunosuppression. Several authors have suggested that filtered whole blood and/or red...... cell concentrate, or leucocyte- and buffy coat-reduced red cells in artificial medium or their own plasma, may reduce postoperative immunosuppression. It was also anticipated that the use of autologous blood might minimize the risk of perioperative transfusion, but studies have unexpectedly shown...... similar postoperative infectious complications and cancer recurrence and/or survival rates in patients receiving autologous blood donated before operation and those receiving allogeneic blood. Future studies should identify common risk factors associated with blood storage....


    Thales Paulo BATISTA


    Full Text Available Gastric cancer is one of the most common cancers and a main cause of cancer-related death worldwide, since the majority of patients suffering of this malignancy are usually faced with a poor prognosis due to diagnosis at later stages. In order to improve treatment outcomes, the association of surgery with chemo and/or radiotherapy (multimodal therapy has become the standard treatment for locally advanced stages. However, despite several treatment options currently available for management of these tumors, perioperative chemotherapy has been mainly accepted for the comprehensive therapeutic strategy including an appropriated D2-gastrectomy. This manuscript presents a (nonsystematic critical review about the use of perioperative chemotherapy, with a special focus on the drugs delivery.

  5. Detrimental effects of perioperative blood transfusion

    Nielsen, Hans Jørgen


    similar postoperative infectious complications and cancer recurrence and/or survival rates in patients receiving autologous blood donated before operation and those receiving allogeneic blood. Future studies should identify common risk factors associated with blood storage.......Evidence suggests that perioperative allogeneic blood transfusion increases the risk of infectious complications after major surgery and of cancer recurrence after curative operation. This has been attributed to immunosuppression. Several authors have suggested that filtered whole blood and/or red...... cell concentrate, or leucocyte- and buffy coat-reduced red cells in artificial medium or their own plasma, may reduce postoperative immunosuppression. It was also anticipated that the use of autologous blood might minimize the risk of perioperative transfusion, but studies have unexpectedly shown...

  6. Perioperative lung protective ventilation in obese patients

    Fernandez-Bustamante, Ana; Hashimoto, Soshi; Serpa Neto, Ary; Moine, Pierre; Vidal Melo, Marcos F.; Repine, John E.


    The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent respiratory comorbidities (i.e. sleep apnea, asthma), and concerns of postoperative respiratory depression and other pulmonary complications. The number of surgical patients with obesity is increa...

  7. Developing behavioral objectives for perioperative staff development.

    Beitz, J M


    Behavioral objectives (i.e., clear statements that describe intended instructional outcomes) are a crucial component of educational planning for perioperative staff development. Properly written objectives promote positive learning outcomes such as increased motivation, better retention of information, and improved instructional accountability. This article describes the advantages of using behavioral objectives, gives a historical perspective of their development, presents a practical "how-to" approach to formulating them, and delineates their link to the selection of appropriate evaluation methods. PMID:8827333

  8. Peri-operative cognitive dysfunction and protection

    Steinmetz, J; Rasmussen, L S


    Cognition may decline after surgery. Postoperative delirium, especially when hyperactive, may be easily recognised, whereas cognitive dysfunction is subtle and can only be detected using neuropsychological tests. The causes for these two conditions are largely unknown, although they share risk...... factors, the predominant one being age. Ignorance of the causes for postoperative cognitive dysfunction contributes to the difficulty of conducting interventional studies. Postoperative cognitive disorders are associated with increased mortality and permanent disability. Peri-operative interventions can...

  9. Contribution of perioperative imaging to radioguided surgery

    Radioguided surgery has been investigated and applied to almost any neoplastic disease that is surgically treated. The impact of radioguided surgery on the surgical management of cancer patients includes relevant and real-time information to the surgeon regarding the location and extent of the disease, as well as regarding the assessment of surgical resection margins. Despite the fact that sentinel lymph node biopsy has been worldwide accepted as a highly accurate staging method for various solid cancers (among which breast cancer and cutaneous melanoma), some potential intraoperative drawbacks still remain. This article provides an update on currently available perioperative techniques regarding the use of radiotracers for radioguided surgery and sentinel lymph node mapping and biopsy, in particular in combination with vital dyes or other agents. The integration of computer technology and data processing makes it possible to integrate anatomic and functional images together with 3D rendering systems. This facilitates the targeted-tissue perioperative localization, especially in anatomically complex areas. Furthermore, we provide an update on advances in the integration of intraoperative imaging devices as well as optical tracers for the surgical management of patients. Evidence is emerging that these devices, together with new potential tracers, may improve intraoperative identification of sentinel nodes and/or tumors. A detailed presentation on a portable gamma camera in breast cancer patients, and the application of perioperative imaging devices in gynaecological cancers are included. Other important procedures, such as ROLL and RSL for occult lesion excision in the breast and other organs, are extensively discussed

  10. Making a difference: using the safe surgery checklist to initiate continuing education for perioperative nurses in low-income settings.

    Leifso, Genelle


    The WHO Safe Surgery Checklist (2008) patient safety focus and communication prompts are widely accepted. In many low-income regions (as defined by the World Bank and accepted by the World Health Organization) perioperative nurses have little or no formal training; continuing and in-service education are virtually unknown; nor does an articulated "culture of safety" exist. In 2009 the Canadian Network for International Surgery (CNIS) piloted a two-day perioperative nursing course, in Addis Ababa, Ethiopia, using lectures, case studies, skills sessions, and role-play exercises based on the SSSL Checklist outline and protocols. Canadian instructors (who are certified after taking the Canadian Network for International Surgery-sponsored Instructor's Course) have since returned and taught at additional sites in Ethiopia and Uganda. Course participants now include perioperative nurses, anaesthetists, and junior surgical residents--mirroring the interdisciplinary teamwork that is crucial to safe perioperative patient care. The course's facilitated discussions focus on workplace and practice issues in order to allow for appropriate evaluation and planning of future educational initiatives. Participants complete pre- and post-course questionnaires, which evaluate baseline and post-course knowledge, and further follow-up is completed four months after course completion. This article explains the need for aiding in the expansion of perioperative nursing knowledge and skill in low-income settings and provides the author's personal perspective and experience in responding to this need. Her experience as facilitator in a pilot project and subsequent course development described. The objective is to discuss ways that other perioperative nurses can work to make a positive difference on professional practice and patient care in low-income regions. PMID:24791444

  11. Strategies for decreasing patient anxiety in the perioperative setting.

    Bailey, Laila


    Perioperative patient anxiety is a pervasive problem that can have far-reaching effects. Among these effects are increased postoperative pain, increased risk for infection, and longer healing times. Many factors affect perioperative patient anxiety, including the need for surgery, perceived loss of control, fear of postoperative pain, and alteration of body image. This systematic review of current literature was undertaken to identify evidence-based interventions for decreasing patient anxiety in perioperative practice. According to the current research literature, perioperative education and music therapy can be used to successfully reduce surgical patients' anxiety. PMID:20888947

  12. ICD-10 Medical Coding: The Role of Perioperative Services in Addressing Implementation Challenges.

    Wing, Toni L


    The International Classification of Diseases, 10th Revision (ICD-10) was adopted in the United States on October 1, 2015. Replacing the outdated ICD, Ninth Revision, Clinical Modification (ICD-9-CM) coding system was long overdue, and the updated classifications were needed to accurately collect data and improve patient care. However, the complexity of ICD-10 may present substantial challenges for health information management coders and affect hospital revenue collection. Because the OR generates a large share of a hospital's overall revenue, perioperative services personnel must take a critical look at ICD-10 changes and address adoption challenges to minimize the negative effects ICD-10 may have on surgical revenue and help personnel identify perioperative services' important role in ICD-10 implementation. PMID:26849983

  13. Anesthesia and perioperative management of colorectal surgical patients - A clinical review (Part 1

    Santosh Patel


    Full Text Available Colorectal surgery is commonly performed for colorectal cancer and other pathology such as diverticular and inflammatory bowel disease. Despite significant advances, such as laparoscopic techniques and multidisciplinary recovery programs, morbidity and mortality remain high and vary among surgical centers. The use of scoring systems and assessment of functional capacity may help in identifying high-risk patients and predicting complications. An understanding of perioperative factors affecting colon blood flow and oxygenation, suppression of stress response, optimal fluid therapy, and multimodal pain management are essential. These fundamental principles are more important than any specific choice of anesthetic agents. Anesthesiologists can significantly contribute to enhance recovery and improve the quality of perioperative care.

  14. Liver Transplant From Unexpected Donation After Circulatory Determination of Death Donors: A Challenge in Perioperative Management.

    Blasi, A; Hessheimer, A J; Beltrán, J; Pereira, A; Fernández, J; Balust, J; Martínez-Palli, G; Fuster, J; Navasa, M; García-Valdecasas, J C; Taurá, P; Fondevila, C


    Unexpected donation after circulatory determination of death (uDCD) liver transplantation is a complex procedure, in particular when it comes to perioperative recipient management. However, very little has been published to date regarding intraoperative and immediate postoperative care in this setting. Herein, we compare perioperative events in uDCD liver recipients with those of a matched group of donation after brain death liver recipients. We demonstrate that the former group of recipients suffers significantly greater hemodynamic instability and derangements in coagulation following graft reperfusion. Based on our experience, we recommend a proactive recipient management strategy in uDCD liver transplantation that involves early use of vasopressor support; maintaining adequate intraoperative levels of red cells, platelets, and fibrinogen; and routinely administering tranexamic acid before graft reperfusion. PMID:26601629

  15. TRALI in the perioperative period

    Berdai MA


    Full Text Available Mohamed Adnane Berdai, Smael Labib, Mustapha HarandouChild and Mother Intensive Care Unit, University Hospital Hassan II, Fes, MoroccoBackground: Transfusion-related acute lung injury (TRALI is one of the leading causes of transfusion-related morbidity and mortality. Although it is a serious complication of blood transfusion, it is still underestimated because of underrecognition and misdiagnosis, which can lead to inappropriate management.Case report: We report the case of a 34-year-old female, who presented with hemorrhagic shock during cesarean section and was transfused with packed red blood cells and fresh frozen plasma. Three hours after the end of transfusion, while still intubated, the patient developed acute respiratory failure, with diffuse crackles at auscultation and bilateral lung infiltrations on chest radiography. The ratio of the arterial partial pressure of O2 and the fraction of inspired O2 (PaO2/FiO2 was 51. The diagnosis of TRALI was made after excluding other possible causes of acute lung injury. She was managed symptomatically with ventilatory support and vasopressors. The patient later died secondary to multiple organ failure.Conclusion: The diagnosis of TRALI relies on the exclusion of other causes of acute pulmonary edema following transfusion. All plasma-containing blood products have been involved in the genesis of this syndrome. This is a relatively common and serious adverse transfusion reaction that requires prompt diagnosis and management. Challenges are ahead as preventive strategies have reduced but not eliminated the onset of TRALI.Keywords: acute lung injury, transfusion related acute lung injury, anti-human leukocyte antigen antibody, pulmonary edema, transfusion accident

  16. Acerto pós-operatório: avaliação dos resultados da implantação de um protocolo multidisciplinar de cuidados peri-operatórios em cirurgia geral Acerto project: outcome evaluation after the implementation of a multidisciplinary protocol of peri-operative care in general surgery

    José Eduardo de Aguilar-Nascimento


    Full Text Available OBJETIVO: O objetivo do presente estudo foi avaliar os resultados clínicos iniciais após a implementação do projeto Acerto Pós-operatório (ACERTO em pacientes operados num serviço universitário de cirurgia geral. MÉTODO: 161 pacientes foram prospectivamente observados durante dois períodos: o primeiro, entre janeiro a junho de 2005 (n=77 formado por pacientes submetidos a condutas convencionais (período PRÉ-ACERTO e o segundo, entre agosto a dezembro de 2005 (n=84, formado por pacientes submetidos a um novo protocolo de condutas peri-operatório estabelecidas pelo projeto ACERTO (período PÓS-ACERTO. A coleta de dados nos dois períodos ocorreu sem o conhecimento dos profissionais do serviço. As variáveis observadas foram: indicação de suporte nutricional pré-operatório, tempo de jejum pré e pós operatório, volume de hidratação, uso de sondas e drenos, tempo de internação e morbidade pós-operatória. RESULTADOS: Na fase pós-ACERTO, o percentual de pacientes desnutridos que receberam suporte nutricional foi trêsês vezes maior (78,6%; 11/14 vs. 23,5%; 4/17; p BACKGROUND: The aim of this study was to evaluate the initial results after the implementation of the ACERTO project in patients submitted to abdominal operations at the Julio Muller Universitary Hospital. METHODS: 161 consecutive patients were studied in two different periods: from January to July 2005 and from August to December 2005 (n=84; POST-ACERTO phase. The patients received either traditional peri-operative management (n=77; PRE-ACERTO phase or a multidisciplinary protocol of peri-operative care (n=84; POST-ACERTO phase established by the ACERTO project. During both periods, the surgical staff was unaware of the prospective data collection. RESULTS: The number of malnourished patients receiving pre-operative nutritional support was higher after the implementation of the project (78.6%; 11/14 vs. 23.5%; 4/17; p <0.01.This second phase was associated with

  17. [Perioperative disorders of mental functions].

    Tonković, Dinko; Adam, Visnja Nesek; Kovacević, Marko; Bogović, Tajana Zah; Drvar, Zeljko; Baronica, Robert


    Mental disorders are characterized by disturbances of thought, perception, affect and behavior, which occur as a result of brain damage. Recognizing and treating these conditions is necessary not only for psychiatrists but for all physicians. Disorder of mental function is one of the most common associated conditions in intensive care unit (ICU) patients. However, disturbances of mental function often remain unrecognized. In ICU patients, different types of mental function disorders may develop. They range from sleep disorders, severe depression, anxiety, posttraumatic stress disorder (PTSD) to cognitive disorders including delirium. The causes of mental dysfunction in ICU patients can be divided into environmental and medical. Cognitive disorders are related to mental processes such as learning ability, memory, perception and problem solving. Cognitive disorders are usually not prominent in the early postoperative period and in many cases are discovered after hospital discharge because of difficulties in performing everyday activities at home or at work. The etiology of postoperative cognitive impairment is unclear. Older age, previous presence of cognitive dysfunction, severity of disease, and polypharmacy with more than four drugs are some of the risk factors identified. Delirium is a multifactorial disorder. It is an acute confusional state characterized by alteration of consciousness with reduced ability to focus, sustain, or shift attention. It is considered as the most common form of mental distress in ICU patients. Nearly 30% of all hospitalized patients pass through deliriant phase during their hospital stay. Delirium can last for several days to several weeks. Almost always it ends with complete withdrawal of psychopathological symptoms. Sometimes it can evolve into a chronic brain syndrome (dementia). The causes are often multifactorial and require a number of measures to ease the symptoms. Delirious patient is at risk of complications of immobility and

  18. Autism spectrum disorder (ASD) and its perioperative management.

    Taghizadeh, Neda; Davidson, Andrew; Williams, Katrina; Story, David


    Autism spectrum disorder (ASD) is now diagnosed in more than 1 in 100 children, so it is not surprising that anesthetists are increasingly providing care for children with this diagnosis. The diagnostic classification for ASD has recently changed and our understanding of the causes and management of ASD are also changing rapidly. This review provides a timely update to increase understanding and awareness of the problems that children with ASD experience, and to minimize perioperative problems. Current literature on premedication and the increasing use of alpha-2 agonists such as clonidine and dexmedetomidine as well as the use of old favorites midazolam and ketamine is reviewed. Some simple strategies that will improve care and decrease anxiety, like social stories, the use of tablet computers, other comfort items or games for distraction, and using favorite drinks to disguise the bitter taste of medications, are described. Remember, the parents are their child's expert and will know what agitates and settles them. Talking to them prior to the day of the procedure is ideal. The importance of staff training and having a clinical practice guideline available at every institution cannot be overstated. PMID:26248302

  19. Perioperative interstitial brachytherapy for recurrent keloid scars

    Purpose: Evaluation of the results of perioperative interstitial brachytherapy with low dose-rate (L.D.R.) Ir-192 in the treatment of keloid scars. Patients and methods: We performed a retrospective analysis of 73 histologically confirmed keloids (from 58 patients) resistant to medico surgical treated by surgical excision plus early perioperative brachytherapy. All lesions were initially symptomatic. Local control was evaluated by clinical evaluation. Functional and cosmetic results were assessed in terms of patient responses to a self-administered questionnaire. Results: Median age was 28 years (range 13-71 years). Scars were located as follows: 37% on the face, 32% on the trunk or abdomen, 16% on the neck, and 15% on the arms or legs. The mean delay before loading was four hours (range, 1-6 h). The median dose was 20 Gy (range, 15-40 Gy). Sixty-four scars (from 53 patients) were evaluated. Local control was 86% (follow-up, 44.5 months; range, 14-150 months). All relapses occurred early within 2 years posttreatment. At 20 months, survival without recurrence was significantly lower when treated lengths were more than 6 cm long. The rate was 100% for treated scars below 4.5 cm in length, 95% (95% CI: 55-96) for those 4.5-6 cm long, and 75% (95% CI: 56-88) beyond 6 cm (p = 0.038). Of the 35 scars (28 patients) whose results were reassessed, six remained symptomatic and the esthetic results were considered to be good in 51% (18/35) and average in 37% (13/35) (median follow-up, 70 months; range, 16-181 months). Conclusion: Early perioperative L.D.R. brachytherapy delivering 20 Gy at 5 mm reduced the rate of recurrent keloids resistant to other treatments and gave good functional results. (authors)

  20. A systematic review of peri-operative melatonin

    Andersen, L P H; Werner, M U; Rosenberg, J;


    We systematically reviewed randomised controlled trials of peri-operative melatonin. We included 24 studies of 1794 participants that reported eight peri-operative outcomes: anxiety; analgesia; sleep quality; oxidative stress; emergence behaviour; anaesthetic requirements; steal induction; and......%, respectively. Qualitative reviews suggested the melatonin improved sleep quality and emergence behaviour, and might be capable of reducing oxidative stress and anaesthetic requirements....

  1. Perioperative beta blockers in patients having non-cardiac surgery

    Bangalore, Sripal; Wetterslev, Jørn; Pranesh, Shruthi;


    American College of Cardiology and American Heart Association (ACC/AHA) guidelines on perioperative assessment recommend perioperative beta blockers for non-cardiac surgery, although results of some clinical trials seem not to support this recommendation. We aimed to critically review the evidenc...

  2. Effect of perioperative insulin infusion on surgical morbidity and mortality

    Gandhi, Gunjan Y; Murad, M Hassan; Flynn, Errol David;


    To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of perioperative insulin infusion on outcomes important to patients.......To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of perioperative insulin infusion on outcomes important to patients....

  3. [Perioperative conflicts between anaesthesiologists and surgeons: ethics and professionalism].

    Bazin, J-E; Attias, A; Baghdadi, H; Baumann, A; Bizouarn, P; Claudot, F; Eon, B; Fieux, F; Frot, C; Guibet Lafaye, C; Muzard, O; Nicolas-Robin, A; Orjubin, V; Otero-Lopez, M; Pelluchon, C; Pereira, J; Roussin, F; Vigué, B; Beydon, L


    In the perioperative period, several potential conflicts between anaesthetists/intensive care specialists and surgeons may exist. They are detrimental to the quality of patient care and to the well-being of the teams. They are a source of medical errors and contribute to burn-out. Patients can become the victims of such conflicts, which deserve ethical reflection. Their resolution through analysis and shared solutions is necessary. This article seeks to analyse these conflicts, taking into account their specificities and constraints. In order to understand this context, it is important to consider the specificities of each group involved and the records of such situations. Several factors can prevent these conflicts, first and foremost the patients themselves and the quality of the care that is provided. Medical deontology aims mainly at preventing and resolving these conflicts. Generally speaking, the quality approach which is increasingly applied in health care institutions (involving declarations of adverse events, morbidity/mortality reviews, benchmarking, analysis and improvement of practices, etc.) also contributes to the prevention and resolution of disagreements. The teaching of communication techniques that begins with the initial training, the evaluation of team behaviours (through simulation training for example), the respect of others' constraints, particularly when it comes to learning, as well as transparency regarding conflicts of interests, are all additional elements of conflict prevention. Lastly, conflicts may at times be caused by deviant behaviours, which must be met with a clear and uncompromising collective and institutional approach. This article concludes by offering a standardised approach for conflict resolution. PMID:24821342

  4. Clinical implication of perioperative inflammatory cytokine alteration.

    Hsing, Chung-Hsi; Wang, Jhi-Joung


    Cytokines are key modulators of inflammatory responses, and play an important role in the defense and repair mechanisms following trauma. After traumatic injury, an immuno-inflammatory response is initiated immediately, and cytokines rapidly appear and function as a regulator of immunity. In pathologic conditions, imbalanced cytokines may provide systemic inflammatory responses or immunosuppression. Expression of perioperative cytokines vary by different intensities of surgical trauma and types of anesthesia and anesthetic agents. Inflammatory cytokines play important roles in postoperative organ dysfunction including central nervous system, cardiovascular, lung, liver, and kidney injury. Inhibition of cytokines could protect against traumatic injury in some circumstances, therefore cytokine inhibitors or antagonists might have the potential for reducing postoperative tissue/organ dysfunction. Cytokines are also involved in wound healing and post-traumatic pain. Application of cytokines for the improvement of surgical wound healing has been reported. Anesthesia-related immune response adjustment might reduce perioperative morbidity because it reduces proinflammatory cytokine expression; however, the overall effects of anesthetics on postoperative immune-inflammatory responses needs to be further investigated. PMID:25837846

  5. Developing a perioperative educational video web site.

    O'Dowd Bell, Lynn


    Nurses frequently have to adjust to changes in technology, particularly in the OR, but cataloging the wealth of resources commonly used in the OR (eg, equipment, supplies, how to use them) has not kept pace. To address this, I worked with the information systems administrative coordinator at the University of Texas Medical Branch, Galveston, to design and implement a perioperative intranet site that includes videos and fact sheets about equipment and supplies and that can be accessed by all perioperative staff members. This required promoting the idea and getting stakeholder sign-on, soliciting videotapes and DVDs and screening all submissions for appropriateness, choosing and formatting applicable resources for use on the site, working with members of the information systems department to create a web site after the video library was assembled, and helping staff members use and accept the site as a valuable educational resource. This intranet web site has been available to staff members for two years, and data from a recent survey of staff members and from mandatory intranet inservice compliance programs show evidence of its effectiveness. PMID:22464619

  6. 16 Cases of Depression in Patients with Free Tissue Flap to Repair Facial Defects Perioperative Care%16例抑郁患者行游离组织瓣移植修复颌面部缺损的围手术期护理

    任凌; 易力; 陶秀健


    Objective To investigate 16 cases underwent preoperative assessment of depression free tissue flap to repair facial defects perioperative care. Methods Zung's Self-Rating Depression Scale (SDS), on the admission of patients to do screening for depressive symptoms in caregivers of patients given nursing intervention. Results In 16 cases,Preoperative evaluation of patients with severe depression score of 51,Assessment score the remaining 15 patients were lower than 50 ,Free flap transplantation in 16 patients were successful,The average hospitalization time 16.7 days and discharged the functions of the patients were able to meet the basic needs of life. Conclusion Think before surgery, timely and effective psychological interventions, wel prepared, after close observation, rational functional training is the key to successful operation.%目的:探讨16例术前评估抑郁患者行游离组织瓣移植修复颌面部缺损的围手术期护理。方法应用 Zung 氏抑郁自评量表(SDS),对入院患者做筛查,护理人员针对有抑郁症状的患者给予护理干预。结果16例患者除术前评估为重度抑郁的患者得分为51分外,其余15例患者的评估得分均低于50分。16例患者游离移植皮瓣均成活,平均住院天数为16.7天,出院时各项功能均能满足基本生活需要。结论认为术前、术后及时有效的心理干预、充分的准备,术后密切的观察,合理的功能训练是手术成功的关键。

  7. Diaphragmatic pacing stimulation in spinal cord injury: anesthetic and perioperative management

    Miguel L. Tedde


    Full Text Available OBJECTIVE: The standard therapy for patients with high-level spinal cord injury is long-term mechanical ventilation through a tracheostomy. However, in some cases, this approach results in death or disability. The aim of this study is to highlight the anesthetics and perioperative aspects of patients undergoing insertion of a diaphragmatic pacemaker. METHODS: Five patients with quadriplegia following high cervical traumatic spinal cord injury and ventilator-dependent chronic respiratory failure were implanted with a laparoscopic diaphragmatic pacemaker after preoperative assessments of their phrenic nerve function and diaphragm contractility through transcutaneous nerve stimulation. NCT01385384. RESULTS: The diaphragmatic pacemaker placement was successful in all of the patients. Two patients presented with capnothorax during the perioperative period, which resolved without consequences. After six months, three patients achieved continuous use of the diaphragm pacing system, and one patient could be removed from mechanical ventilation for more than 4 hours per day. CONCLUSIONS: The implantation of a diaphragmatic phrenic system is a new and safe technique with potential to improve the quality of life of patients who are dependent on mechanical ventilation because of spinal cord injuries. Appropriate indication and adequate perioperative care are fundamental to achieving better results.

  8. Perioperative risk stratification for a patient with severe obstructive sleep apnoea undergoing laparoscopic banding surgery.

    Weinberg, Laurence; Tay, Stan; Lai, Chung Fei; Barnes, Maree


    Despite the increasing prevalence of obstructive sleep apnoea (OSA), there is limited evidence to guide appropriate preoperative investigations, inpatient or outpatient surgery allocation, and the anticipated level of postoperative care. With reference to our institution's perioperative risk stratification, we describe the case of a 46-year-old Caucasian male with a body mass index of 51 kg/m(2) admitted for laparoscopic band insertion. Management based on our guidelines involved a preoperative polysomnography where the patient was confirmed to have severe OSA. His postoperative care was then managed in the high dependency care unit. He was discharged home on day 2 with no further sequelae. We provide evidence that adoption of this model of care can simplify clinical decision making and resource allocation with favourable patient outcomes. PMID:23370960

  9. Perioperative employee annual evaluations: a 30-second process.

    Olmstead, John; Falcone, Deborah; Lopez, Jacy; Sharpe, Lorraine; Michna, Jody


    In response to complaints about the annual evaluation tool used at The Community Hospital in Munster, Indiana, the surgical services management team created a tool to rate the perioperative RNs on skills pertinent to the surgical services department. The hospital-wide evaluation tool uses vague criteria, which are regularly challenged by employees who disagree with their manager's evaluation. The new Surgical Services Employee Evaluation takes a manager approximately 30 seconds to complete and can be added to the generic hospital evaluation form to make the employee evaluation more accurate and meaningful. The tool evaluates three major categories: teamwork, patient care, and job preparation. Use of this additional tool has greatly reduced postevaluation employee complaints, and the tool is now being used in other departments, with slight department-specific variations. Employees now express less frustration with annual evaluations, and managers report a high degree of satisfaction with the tool because it helps them in the difficult task of employee evaluation and counseling. PMID:23178010

  10. [An Overview of Incidence and Outcome of Perioperative Pulmonary Aspiration].

    Nakazawa, Koichi; Shinoda, Ken


    Examination of the literature suggests that the incidence of aspiration pneumonia in the perioperative period is relatively infrequent. Since Mendelson's report of aspiration pneumonitis in 1946, the factors that contribute to the likelihood of aspiration have been identified, and numerous attempts for preventions for regurgitation or pulmonary aspiration have been made. The low incidence of major morbidity of anesthesia-related pulmonary aspiration may be due to adopting quality measures, applying practice guidelines for preoperative fasting, and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. More systematic preoperative checking and more careful selection of patients are necessary when a supraglottic airway is used in preference to a tracheal tube. Second generation supraglottic airways may not reduce the risk of regurgitation, but may reduce the chance of aspiration if the mask position is correct and drain tube works well. Because the mortality and morbidity of aspiration pneumonia remain relatively high, the preoperative risk evaluation is very important to avoid regurgitation or aspiration. PMID:27004379

  11. Managing Opioid-Tolerant Patients in the Perioperative Surgical Home.

    Wenzel, John T; Schwenk, Eric S; Baratta, Jaime L; Viscusi, Eugene R


    Management of acute postoperative pain is important to decrease perioperative morbidity and improve patient satisfaction. Opioids are associated with potential adverse events that may lead to significant risk. Uncontrolled pain is a risk factor in the transformation of acute pain to chronic pain. Balancing these issues can be especially challenging in opioid-tolerant patients undergoing surgery, for whom rapidly escalating opioid doses in an effort to control pain can be associated with increased complications. In the perioperative surgical home model, anesthesiologists are positioned to coordinate a comprehensive perioperative analgesic plan that begins with the preoperative assessment and continues through discharge. PMID:27208711

  12. Perioperative neonatal and paediatric blood transfusion

    Avnish Bharadwaj


    Full Text Available Paediatric patients undergoing surgical procedures commonly require some volume of blood or blood component replacement in the perioperative period. Paediatric patients undergoing major surgery associated with substantial blood loss should be evaluated pre-operatively. Pre-operative correction of anaemia may be done considering the age, plasma volume status, clinical status and comorbidities. Maximum allowable blood loss (MABL for surgery must be calculated, and appropriate quantity of blood and blood components should be arranged. Intraoperative monitoring of blood loss should be done, and volume of transfusion should be calculated in a protocol based manner considering the volemia and the trigger threshold for transfusion for the patient and the MABL. Early haemostasis should be achieved by judicious administration of red blood cells, blood components and pharmacological agents.

  13. [Correlation between pholcodine and perioperative anaphylaxis].

    Dumancić, Jelena; Marković, Asja Stipić


    A large number of individuals experiencing anaphylactic reaction to neuromuscular blocking agents have not previously been in contact with them. The search for a substance inducing sensitization to muscle relaxants has led Norwegian and Swedish scientists to pholcodine, a cough suppressant, which is widely used in Europe and worldwide. Ammonium ion is an epitope common to pholcodine and neuromuscular blocking agents and it is the basis of their cross-reactivity. Based on the results of published studies that pointed to a connection of the use of pholcodine and perioperative anaphylactic reaction, pholcodine was withdrawn from the Norwegian market and subsequent research revealed a reduction of anaphylactic reactions in that country. In its latest report, the European Medicines Agency made a decision not to withdraw pholcodine mixtures from the market but it urged further research with the aim to clarify the cross-reactivity between pholcodine and neuromuscular blocking agents. PMID:23437637

  14. [Current Status of Perioperative Rehabilitation in Patients who Undergo Esophagectomy for Cancer].

    Oikawa, Masato; Hanada, Masatoshi; Hidaka, Shigekazu; Nagayasu, Takeshi; Kozu, Ryo


    The esophagectomy for esophageal cancer is major surgery and has the highest rate of postoperative pulmonary complications. Respiratory physiotherapy in patients undergoing esophagectomy has been applied to improve oxygenation and airway secretion clearance. Recently, the utility and effectiveness of enhanced recovery after surgery for gastroenterological surgery have been reported in Japan, and patients should be encouraged to participate in early mobilization. Perioperative rehabilitation which includes early mobilization reduces postoperative complications and improves fast-track recovery after esophagectomy. These interventions play important role in postoperative care. PMID:26975645

  15. Critical care issues in cervical cancer management.

    Mirhashemi, R; Janicek, M F; Schoell, W M


    Radical pelvic surgery in gynecologic oncology patients poses a challenge to the surgeon and the ancillary team in charge of the peri-operative care. The high frequency of medical problems observed in this patient population, in conjunction with the stresses of radical surgery, necessitates careful monitoring of patients' medical status. A comprehensive team approach in the perioperative period is critical to patient care. Early intervention and anticipation of potential problems for the patient at risk in the postoperative period minimizes morbidity and mortality. This article will review the essentials of critical care as it relates to patients undergoing radical pelvic operations. PMID:10225307

  16. Perioperative Landiolol Administration reduces Atrial Fibrillation after Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

    Sakamoto, Atsuhiro; Hamasaki, Toshimitsu; Kitakaze, Masafumi


    Introduction Postoperative atrial fibrillation (POAF) is one of the most common complications after cardiac surgery. Patients who develop POAF have a prolonged stay in the intensive care unit and hospital and an increased risk of postoperative stroke. Many guidelines for the management of cardiac surgery patients, therefore, recommend perioperative administration of beta-blockers to prevent and treat POAF. Landiolol is an ultra-short acting beta-blocker, and some randomized controlled trials ...

  17. European Society of Cardiology 2009 guidelines for preoperative cardiac risk assessment and perioperative cardiac management in noncardiac surgery. Key messages for clinical practice

    Sanne E. Hoeks


    Full Text Available Patients undergoing noncardiac surgery are at risk of adverse perioperative and long-term outcome. When considering a patient for noncardiac surgery, a careful preoperative clinical risk evaluation and subsequent risk-reduction strategies are essential to reduce postoperative complications. To assist physicians with decision making, clinical guidelines are developed. The aim of clinical guidelines is to improve patient care by providing recommendations about appropriate healthcare in specific circumstances. Development of clinical guidelines is an important component in improving the quality of care. By translating the best available scientific evidence into specific recommendations, guidelines can serve as a useful tool to achieve effective and efficient patient care. In 2009, the first European Society of Cardiology guidelines on perioperative care were developed. This decisionmaking process integrates clinical markers, early coronary evaluation, functional capacity, and the type of surgery involved.

  18. Ten Years Experiences With Preoperative Evaluation Clinic for Day Admission Cardiac and Major Vascular Surgical Patients: Model for "Perioperative Anesthesia and Surgical Home".

    Silvay, George; Zafirova, Zdravka


    Admission on the day of surgery for elective cardiac and noncardiac surgery is the prevalent practice in North America and Canada. This approach realizes medical, psychological and logistical benefits, and its success is predicated on an effective outpatient preoperative evaluation. The establishment of a highly functional preoperative clinic with a comprehensive set up and efficient logistical pathways is invaluable. This notion in recent years has included the entire perioperative period, and the concept of a perioperative anesthesia/surgical home (PASH) is gaining popularity. The anesthesiologists as perioperative physicians can organize and lead the entire process from the preoperative evaluation, through the hosptial discharge. The functions of the PASH include preoperative optimization of medical conditions and psychological preparation of the patients and their support system; the care in the operating room and intensive care unit; pain management; respiratory therapy; cardiac rehabilitation; and specialized nutrition. Along with oversight of the medical issues, the preoperative visit is an opportune time for counseling, clarification of expectations and discussion of research, as well as for utilization of various informatics systems to consolidate the pertinent information and distribute it to relevant health care providers. We review the scientific foundation and practical applications of a preoperative visit and share our experience with the development of the preoperative evaluation clinic, designed specifically for cardiac and major vascular patients scheduled for day admission surgery. The ultimate goal of preoperative evaluation clinic is to ensure a safe, efficient, and cost-effective perioperative care for patients undergoing a complex type of surgery. PMID:26620138

  19. Colour coding scrubs as a means of improving perioperative communication.

    Litak, Dominika


    Effective communication within the operating department is essential for achieving patient safety. A large part of the perioperative communication is non-verbal. One type of non-verbal communication is 'object communication', the most common form of which is clothing. The colour coding of clothing such as scrubs has the potential to optimise perioperative communication with the patients and between the staff. A colour contains a coded message, and is a visual cue for an immediate identification of personnel. This is of key importance in the perioperative environment. The idea of colour coded scrubs in the perioperative setting has not been much explored to date and, given the potential contributiontowards improvement of patient outcomes, deserves consideration. PMID:21834289

  20. Pharmacological modification of the perioperative stress response in noncardiac surgery.

    Priebe, Hans-Joachim


    The perioperative period is associated with alterations in the neuroendocrine, metabolic, and immune systems, referred to as "stress response." The resultant increased sympathetic activity and elevated serum concentrations of catecholamines may adversely affect the cardiovascular system, resulting in cardiovascular instability (hypertension, tachycardia, and arrhythmia), morbidity (myocardial ischemia, myocardial infarction, and stroke), and mortality (cardiac death and fatal stroke), particularly in patients at an elevated cardiovascular risk and with reduced cardiovascular reserve. Various strategies have been used to ameliorate the adverse perioperative cardiovascular sequelae of the perioperative stress response. Effective pharmacologic blunting of the stress response plays a crucial role in perioperative cardiac risk reduction strategies. In this context, the role of beta-adrenoceptor blockers, alpha2-adrenoceptor agonists, and statins has been extensively examined. This chapter evaluates the available evidence with respect to treatment efficacy of these commonly prescribed drugs in patients undergoing noncardiac surgery. PMID:27396805

  1. Esophagectomy : outcomes and perioperative course of esophageal cancer surgery

    Verhage, R. J. J.


    The incidence of esophageal cancer is still rising steadily. Surgery with neoadjuvant chemo(radio)therapy constitutes the mainstay of therapy. Still associated with high morbidity and mortality rates, it is essential to further improve medical and surgical therapy strategies. The studies presented in this thesis focus on perioperative morbidity and prognosis associated with esophagectomy. In a comparative study, it was found that patients who were treated with perioperative chemotherapy exper...

  2. Quantifizierung des perioperativen Risikos [Quantifications of perioperative risk

    Ohmann, C; Lorenz, Wilfried


    In this paper standardized and quantitative definitions of perioperative risk and risk factor using probabilities are given. A calculation of risk and risk factors is performed using data from a study on perioperative risk in colon resection and a study on a preoperative risk check in general surgery. The problem of one risk factor, a combination of two risk factors and the use of many risk factors to quantify preoperative risk is discussed. Confidence intervals are recommended as a standard ...

  3. Perioperative nursing in public university hospitals: an ethnography

    Sørensen, Erik Elgaard; Olsen, Ida Østrup; Tewes, Marianne; Uhrenfeldt, Lisbeth


    Background In recent years, perioperative nursing has received ongoing attention as part of an interprofessional collaboration. Perioperative nursing is constantly faced with new challenges and opportunities that necessitate continual updates of nursing knowledge and technical skills. In light of the longstanding relationship between nursing and technology, it is interesting that few studies with this focus have been performed. Therefore, our research question was: What is the content of peri...

  4. Perioperative management of percutaneous laser lumber disc decompression

    Objective: To explore the significance of perioperative management of percutaneous laser lumbar disc decompression. Methods: Retrospective analysis was carried out in 86 patients with lumbar disc herniation in order to evaluate the results of preoperative and postoperative managements. Results: All patients passed through operative period safely. Total efficiency rate reach 78% (67/86). Conclusions: It can be ensuring operative effect and decreasing the operative complication for the patients with lumbar disc herniation by intensifying the perioperative management. (authors)

  5. Anxiety and Depression among maxillofacial cancer patients during perioperative period

    Miloseva, Lence; Vukosavljevic-Gvozden, Tanja; Milosev, Vladimir


    Aim of the study: The aim of this study was to examine changes in psychological distress, such as depression and anxiety, and quality of life (QOL) during the perioperative period in maxillofacial cancer patients undergoing surgery. We also investigated the relationship between patient’s psychological distress and QOL. We hypothesized that perioperative psychological distress would affect QOL.Thus, maxillofacial cancer patients with lower psychological distress would experience better QOL ...

  6. Correlation analysis of compromised immune function with perioperative sepsis in HIV-positive patient

    Li Liu


    Full Text Available Objective: To investigate the relationship between immune function and perioperative sepsis in HIV-positive patients. Methods: Retrospective analysis of 144 HIV-positive patients surgically treated from Oct 2008 to Dec 2010 in Shanghai Public Health Clinical Center. The patients were divided into four groups based on their CD4+ T cells counts in preoperative period: group A (0 – 99 cell/ul, group B (100 – 199 cell/ul,group C (200 – 349 cell/ul,group D (≥350 cell/ul. All patients had received standardized surgical procedures, careful surgical routines were applied. To reduce operational damage, conventional antibi-otics, anti-TB, anti-fugal, antiretroviral therapies were used to prevent infection and promptly treatment of complications. Results among 144 HIV-positive patients (male 133 and female 11, aged 42.6 ± 12.5, 80 patients got perioperative sepsis (14 cases in preoperative period and 66 cases in postoperative period. 64 cases did not get sepsis. The average CD4+ T cell count was 276.97 ± 137.91 in preoperative period of patients without sepsis, which was significant higher than the patients with preoperative sepsis (151.29 ± 110.64 and patients with postope- rative sepsis(161.14 ± 128.45 (F = 13.91, P < 0.05. There were statistic differences of perioperative sepsis among A group (82.6%, B group (69.8%, C group (40.5% and D group (26.9% (χ2 = 23.680, P < 0.01. Three cases died of MODS in group A , each one died of MODS in group B and group C. There was no death in group D. There was negative correlation between the incidence of sepsis and levels of CD4+T cells (r = –0.987, P = 0.013. Conclusions With the decrease of preoperative CD4+T cells, the risk of perioperative sepsis had notable increase. Complete evaluation of surgical risk and suitable perioperative treatments may obtain better effect for the patients infected HIV.

  7. Nursing Care of the Laryngeal Mask Airway in Pediatric Cataract Surgery

    Aihuan Chen; Ronghua Ye; Yanchan Liu; Weici Liu; Jingyi Lin


    Purpose:To investigate the important experience of nursing care of the laryngeal mask airway (LMA) in children under-going cataract surgery. Methods: Fifty-five children undergoing cataract surgery were anesthetized by inhaling sevoflurane through a LMA and re-ceived perioperative nursing care. The safety of perioperative nursing for these children was also evaluated. Results:Through perioperative nursing care and psychological counseling for children with LMA,.all patients were anes-thetized without complications and underwent successful surgeries..No severe postoperative complications were ob-served. Conclusion: Nursing care specific for LMA is a vital part of the success of anesthesia and pediatric cataract surgery.

  8. [Team Approaches for and Future Challenges to Promoting Perioperative Oral Management].

    Aimono, Yuka; Kamoshida, Toshiro; Nakashima, Takafumi; Sato, Wataru; Sakamoto, Risa; Saito, Yoshiko; Kikuchi, Sakiko; Ishii, Hideyuki; Maruyama, Tsunehiko; Aoyama, Yoshifumi


    When the medical fee system was revised in 2012, the category of perioperative oral management was newly organized. However, the calculation of additional fees for such management required referral from medical to dental departments. In addition, requests for such management were limited, possibly owing to an increased burden on doctors engaged in outpatient services. This study examined the usefulness of an approach to promote patients' use of dental services by increasing their awareness of the importance of oral management. In this approach, pharmacists explained doctors' instructions to patients at a chemotherapy center within the study facility. Explanations were provided to 114 patients, 75 (65.8%) of whom subsequently used dental services in the facility. For patients using dental services, oral care was performed most frequently (40; 53.3%), followed by invasive procedures (23; 30.7%). Furthermore, the facility's ethics committee approved a survey to measure the satisfaction of patients undergoing chemotherapy at the center. Of the 110 patients invited to participate in the survey, 77(70.0%) did not respond. Researchers concluded the low response rate was associated with patients' belief that dental services were intended primarily for treating oral cavities and their lack of awareness of the importance of preventive dental care. However, in 2014, the number of calculations of additional fees for perioperative oral management markedly increased each month after the above-mentioned approach, from 62 (January) to 162 (December). Both the hospital-to family and family-to-hospital dentist referral rates significantly increased, from 11.2% and 10.7%, respectively (June 2013), to 21.0% and 41.9%, respectively(June 2014). Future evaluations of the outcomes of perioperative oral management and promoting cooperation between medical and dental communities may be necessary. PMID:27067687

  9. Does intravenous sildenafil clinically ameliorate pulmonary hypertension during perioperative management of congenital heart diseases in children? - A prospective randomized study

    Vipul Krishen Sharma


    Full Text Available Background: Pulmonary hypertension (PHT, if present, can be a significant cause of increased morbidity and mortality in children undergoing surgery for congenital heart diseases (CHD. Various techniques and drugs have been used perioperatively to alleviate the effects of PHT. Intravenous (IV sildenafil is one of them and not many studies validate its clinical use. Aims and Objectives: To compare perioperative PaO 2 - FiO 2 ratio peak filling rate (PFR, systolic pulmonary artery pressure (PAP - systolic aortic pressure (AoP ratio, extubation time, and Intensive Care Unit (ICU stay between two groups of children when one of them is administered IV sildenafil perioperatively during surgery for CHDs. Materials and Methods: Patients with ventricular septal defects and proven PHT, <14 years of age, all American Society of Anesthesiologists physical status III, undergoing cardiac surgery, were enrolled into two groups - Group S (IV sildenafil and Group C (control - over a period of 14 months, starting from October 2013. Independent t-test and Mann-Whitney U-test were used to compare the various parameters between two groups. Results: PFR was higher throughout, perioperatively, in Group S. PAP/AoP was 0.3 and 0.4 in Group S and Group C, respectively. In Group S, mean group extubation time was 7 ± 7.34 h, whereas in Group C it was 22.1 ± 10.6. Postoperative ICU stay in Group S and Group C were 42.3 ± 8.8 h and 64.4 ± 15.9 h, respectively. Conclusion: IV sildenafil, when used perioperatively, in children with CHD having PHT undergoing corrective surgery, improves not only PaO 2 - FiO 2 ratio and PAP - AoP ratio but also reduces extubation time and postoperative ICU stay.

  10. Pulmonary Impedance and Pulmonary Doppler Trace in the Perioperative Period.

    Tousignant, Claude; Van Orman, Jordan R


    Pulmonary hypertension and associated vascular changes may frequently accompany left-sided heart disease in the adult cardiac surgical population. Perioperative assessment of right ventricular function using echocardiography is well established. In general, understanding the constraints upon which the right ventricle must work is mostly limited to invasive monitoring consisting of pulmonary artery pressures, cardiac output, and pulmonary vascular resistance. The latter 2 measurements assume constant (mean) flows and pressures. The systolic and diastolic pressures offer a limited understanding of the pulsatile constraints, which may become significant in disease. In normal physiology, pressure and flow waves display near-similar contours. When left atrial pressure and pulmonary vascular resistance are increased, changes in pulmonary arterial compliance will result in elevated impedance to right ventricular ejection. Pressure reflections, the result of strong reflectors, return more quickly in a noncompliant system. They augment pulmonary artery pressure causing a premature reduction in flow. As a result, pressure and flow waves will now be dissimilar. The impact of vascular changes on right ventricular ejection can be assessed using pulmonary artery Doppler spectral imaging. The normal flow velocity profile is rounded at its peak. Earlier peaks and premature reductions in flow will make it appear more triangular. In some cases, the flow pattern may appear notched. The measurement of acceleration time, the time from onset to peak flow velocity is an indicator of constraint to ejection; shortened times have been associated with increased pulmonary vascular resistance and pressure. Understanding the changes in the pulmonary arterial system in disease and the physics of the hemodynamic alterations are essential in interpreting pulmonary artery Doppler data. Analyzing pulmonary artery Doppler flow signals may assist in the evaluation of right ventricular function in

  11. Perioperative hyperglycemia is associated with postoperative neurocognitive disorders after cardiac surgery

    Zhang X


    Full Text Available Xiaopeng Zhang,1 Xiaowei Yan,2 Jennifer Gorman,2 Stuart N Hoffman,3 Li Zhang,1 Joseph A Boscarino2 1Department of Anesthesiology, Geisinger Medical Center, 2Center for Health Research, Geisinger Clinic, 3Department of Neurology, Geisinger Medical Center, Danville, PA, USA Objective: Neurocognitive disorders commonly occur following cardiac surgery. However, the underlying etiology of these disorders is not well understood. The current study examined the association between perioperative glucose levels and other risk factors and the onset of neurocognitive disorders in adult patients following coronary artery bypass and/or valvular surgery. Methods: Adult patients who underwent their first cardiac surgery at a large tertiary care medical center were identified and those with neurocognitive disorders prior to surgery were excluded. Demographic, perioperative, and postoperative neurocognitive outcome data were extracted from the Society for Thoracic Surgery database, and from electronic medical records, between January 2004 and June 2009. Multiple clinical risk factors and measures associated with insulin resistance, such as hyperglycemia, were assessed. Multivariable Cox competing risk survival models were used to assess hyperglycemia and postoperative neurocognitive disorders at follow up, adjusting for other risk factors and confounding variables. Results: Of the 855 patients included in the study, 271 (31.7% had new onset neurocognitive disorders at follow-up. Age, sex, New York Heart Failure (NYHF Class, length of postoperative intensive care unit stay, perioperative blood product transfusion, and other key factors were identified and assessed as potential risk factors (or confounders for neurocognitive disorders at follow-up. Bivariate analyses suggested that new onset neurocognitive disorders were associated with NYHF Class, cardiopulmonary bypass, history of diabetes, intraoperative blood product use, and number of diseased coronary vessels

  12. Algorithmic Summaries of Perioperative Blood Pressure Fluctuations.

    Toddenroth, Dennis; Ganslandt, Thomas; Drescher, Caroline; Weith, Thomas; Prokosch, Hans-Ulrich; Schuettler, Juergen; Muenster, Tino


    Automated perioperative measurements such as cardiovascular monitoring data are commonly compared to established upper and lower thresholds, but could also allow for more complex interpretations. Analyzing such time series in extensive electronic medical records for research purposes may itself require customized automation, so we developed a set of algorithms for quantifying different aspects of temporal fluctuations. We implemented conventional measures of dispersion, summaries of absolute gradients between successive values, and Poincaré plots. We aggregated the severity and duration of hypotensive episodes by calculating the average area under different mean arterial pressure (MAP) thresholds. We applied these methods to 30,452 de-identified MAP series, and analyzed the similarity between alternative indices via hierarchical clustering. To explore the potential utility of these propositional metrics, we computed their statistical association with presumed complications due to cardiovascular instability. We observed that hierarchical clustering reliably segregated features that had been designed to quantify dissimilar aspects. Summaries of temporary hypotension turned out to be significantly increased among patient subgroups with subsequent signs of a complicated recovery. These associations were even stronger for measures that were specifically geared to capturing short-term MAP variability. These observations suggest the potential capability of our proposed algorithms for quantifying heterogeneous aspects of short-term MAP fluctuations. Future research might also target a wider selection of outcomes and other attributes that may be subject to intraoperative variability. PMID:27577440


    V. N. Amirdzhanova


    Full Text Available The paper considers the joint management of rheumatoid arthritis patients needing endoprosthetic replacement of the large joints of the lower extremities by rheumatologists and orthopedic traumatologists.Due to the fact that there are no conventional standards or guidelines for the perioperative management of patients with rheumatic diseases, adopted by international rheumatology associations, the authors generalize their experience in managing the patients in terms of international approaches and guidelines from different countries. The medical assessment and reduction of cardiovascular risks, the prevention of infectious complications, hemorrhages, and lower extremity deep vein thrombosis, and the specific features of management of patients with osteoporosis are under consideration. The authors' experience in managing the patients receiving antirheumatic therapy with nonsteroidal antiinflammatory and disease-modifying antirheumatic drugs, such as methotrexate, leflunomide, sulfasalazine, and hydroxychloroquine, is detailed. Recommendations for managing patients taking glucocorticoids and biologic agents (tumor necrosis factor-α inhibitors, anti-B-cell therapy, and interleukin-6 receptor inhibitors in the preoperative andpostoperative periods are given.

  14. Evaluation of perioperative risk in elderly patients.

    Aubrun, F; Gazon, M; Schoeffler, M; Benyoub, K


    From a medical point of view, aging is characterized by a potential failure to maintain homeostasis under conditions of physiological stress. This failure is associated with an increase in vulnerability. Physiological changes associated with aging are progressive but concomitant injury or diseases may rapidly worsen the health status of the patient. Increasing age independently predicts morbidity and mortality. Hypertension and dyspnea are probably two of the most frequent risk factors in elderly patients. The history of the elderly patient should assess functional status, including cardiovascular reserve sufficient to withstand very stressful operations. The type of surgery has important implications for perioperative risk and emergency surgery, particularly in the elderly, is associated with a high risk of morbidity. Elderly patients who are otherwise acceptable surgical candidates should not be denied surgery based solely on their age and concerns for postoperative renal, cardiovascular, cognitive or pulmonary complications. Renal impairment becomes more prevalent with advancing age as the glomerular filtration rate decreases. The surgical site is the single most important predictor of pulmonary complications. Concerning postoperative comfort and neurological complications, age is the highest risk factor for developing dementia. Pain is underassessed and undermanaged. The elderly are at higher risk of adverse consequences from unrelieved or undertreated pain. PMID:22269928

  15. Prevention of the renarrowing of coronary arteries using drug-eluting stents in the perioperative period: an update

    Juan V Llau


    Full Text Available Juan V Llau1, Raquel Ferrandis1, Pilar Sierra2, Aurelio Gómez-Luque31Department of Anaesthesiology and Critical Care Medicine, Hospital Clínic Universitari, València, Spain; 2Department of Anaesthesiology, Fundació Puigvert, Barcelona, Spain; 3Department of Anaesthesiology and Critical Care Medicine, Hospital Clínico Universitario, Málaga, SpainAbstract: The management of patients scheduled for surgery with a coronary stent, and receiving 1 or more antiplatelet drugs, has many controversies. The premature discontinuation of antiplatelet drugs substantially increases the risk of stent thrombosis (ST, myocardial infarction, and cardiac death, and surgery under an altered platelet function could also lead to an increased risk of bleeding in the perioperative period. Because of the conflict in the recommendations, this article reviews the current antiplatelet protocols after positioning a coronary stent, the evidence of increased risk of ST associated with the withdrawal of antiplatelet drugs and increased bleeding risk associated with its maintenance, the different perioperative antiplatelet protocols when patients are scheduled for surgery or need an urgent operation, and the therapeutic options if excessive bleeding occurs.Keywords: stent thrombosis, antiplatelet agents, aspirin, clopidogrel, surgical bleeding, perioperative management

  16. Perioperative challenges in management of a deaf and dumb patient posted for high-risk cardiac surgery.

    Chowdhry, Vivek; Padhi, Manoranjan; Mohanty, B B; Biswal, Suvakanta


    Perioperative management of deaf and dumb patients can be a challenging task. For smooth postoperative recovery, proper care should begin in the preoperative period. Understanding the patients' needs and training him to follow the instructions requires to involve a communication specialist. Judicious use of sedatives and analgesics is essential to keep the patient pain-free and comfortable. Postoperatively, the patient should be kept awake, enough to understand the internal need of the body and to make a meaningful response to external stimuli. Adequate preoperative planning and coordinated team efforts with involvement of specialists can help in delivering better postoperative care. PMID:27397473

  17. Perioperative nursing for patients receiving endovascular therapy for ruptured abdominal aortic aneurysm

    Objective: To discuss the nursing strategy and practical measures for patients with ruptured abdominal aortic aneurysm during the perioperative period of endovascular intervention. Methods: Endovascular therapy was carried out in 34 patients with ruptured abdominal aortic aneurysm,who were encountered in our department during the period of July 1997 to September 2008. The clinical data were retrospectively analyzed and the nursing points were summarized. Results: The average hospitalization days of the 34 patients were (14 ± 5) days, the mortality rate within 30 days was 23.5% (8/34). No nursing-related complications occurred. Conclusion: A comprehensive understanding of the mechanism, development and clinical evolution of ruptured abdominal aortic aneurysm is very important for nursing care. For nursing staff, well mastering the relevant nursing technique, carefully guarding against any nursing errors and lessening patient's suffering as far as possible, all these are the task of primary importance. (authors)

  18. Perioperative use of cerebral and renal near-infrared spectroscopy in neonates

    Koch, Henrik W; Hansen, Tom G


    BACKGROUND: Neonates undergoing surgery and intensive care still carry a significant morbidity and mortality often related to hypoxic/ischemic events; some of which may go undetected by conventional monitoring. Near-infrared spectroscopy (NIRS) is a noninvasive, continuous method of measuring...... regional tissue oxygen saturation, and may be used to supplement conventional monitoring to improve neonatal perioperative care. However, high costs and lack of evidence regarding improved outcomes have minimized wider perinatal use of NIRS. The aim of this study was to investigate the applicability of...... NIRS in neonates and premature infants undergoing noncardiac surgeries. METHOD: Neonates were monitored with both cerebral and renal NIRS for 24 h after induction of anesthesia and compared with systemic blood pressure (BP), peripheral oxygen saturation (SpO2 ), and heart rate (HR). RESULTS: A total of...

  19. Clinical review: Practical recommendations on the management of perioperative heart failure in cardiac surgery

    A. Mebazaa; A.A. Pitsis; A. Rudiger; W. Toller; D. Longrois; S.E. Ricksten; I. Bobek; S. de Hert; G. Wieselthaler; U. Schirmer; L.K. von Segesser; M. Sander; D. Poldermans; M. Ranucci; P.C. Karpati; P. Wouters; M. Seeberger; E.R. Schmid; W. Weder; F. Follath


    Acute cardiovascular dysfunction occurs perioperatively in more than 20% of cardiosurgical patients, yet current acute heart failure (HF) classification is not applicable to this period. Indicators of major perioperative risk include unstable coronary syndromes, decompensated HF, signifi cant arrhyt

  20. Clinical review: Practical recommendations on the management of perioperative heart failure in cardiac surgery

    A. Mebazaa (Alexandre); A.A. Pitsis (Antonis); A. Rudiger (Alain); W. Toller (Wolfgang); D. Longrois (Dan); S.E. Ricksten; I. Bobek (Ilona); S. de Hert (Stefan); G. Wieselthaler (Georg); U. Schirmer (Uwe); L.K. von Segesser (Ludwig); M. Sander (Michael); D. Poldermans (Don); M. Ranucci (Marco); P.C.J. Karpati (Peter); P.J. Wouters (Pieter); M. Seeberger (Manfred); E.R. Schmid (Edith); W. Weder (Walter); F. Follath


    textabstractAcute cardiovascular dysfunction occurs perioperatively in more than 20% of cardiosurgical patients, yet current acute heart failure (HF) classification is not applicable to this period. Indicators of major perioperative risk include unstable coronary syndromes, decompensated HF, signifi

  1. Relationship between perioperative glycemic control and postoperative infections

    Kazuhiro Hanazaki; Hiromichi Maeda; Takehiro Okabayashi


    Perioperative hyperglycemia in critically ill surgery patients increases the risk of postoperative infection (POI), which is a common, and often costly, surgical complication. Hyperglycemia is associated with abnormalities in leukocyte function, including granulocyte adherence, impaired phagocytosis, delayed chemotaxis,and depressed bactericidal capacity. These leukocyte deficiencies are the cause of infection and improve with tight glycemic control, which leads to fewer POIs in critically ill surgical patients. Tight glycemic control, such as intensive insulin therapy, has a risk of hypoglycemia.In addition, the optimal targeted blood glucose range to reduce POI remains unknown. Since 2006, we have investigated tight perioperative blood glucose control using a closed-loop artificial endocrine pancreas system,to reduce POI and to avoid hypoglycemia. In this Topic Highlight, we review the relationship between perioperative glycemic control and POI, including the use of the artificial pancreas.

  2. Transdermal rotigotine for the perioperative management of restless legs syndrome

    Högl Birgit


    Full Text Available Abstract Background Immobilisation, blood loss, sleep deficiency, and (concomitant medications during perioperative periods might lead to acute exacerbation of symptoms in patients with the restless legs syndrome (RLS. Continuous transdermal delivery of the dopamine agonist rotigotine provides stable plasma levels over 24 h and may provide RLS patients with a feasible treatment option for perioperative situations. To assess the feasibility of use of rotigotine transdermal patch for the perioperative management of moderate to severe RLS, long-term data of an open-label extension of a rotigotine dose-finding study were retrospectively reviewed. Methods The data of all 295 patients who had entered the 5-year study were screened independently by two reviewers for the occurrence of surgical interventions during the study period. The following data were included in this post-hoc analysis: patient age, sex, surgical intervention and outcome, duration of hospital stay, rotigotine maintenance dose at the time of surgery, rotigotine dose adjustment, and continuation/discontinuation of rotigotine treatment. All parameters were analysed descriptively. No pre-specified efficacy assessments (e.g. IRLS scores were available for the perioperative period. Results During the study period, 61 surgical interventions were reported for 52 patients (median age, 63 years; 67% female; the majority of patients (85% had one surgical intervention. The mean rotigotine maintenance dose at time of surgery was 3.1 ± 1.1 mg/24 h. For most interventions (95%, rotigotine dosing regimens were maintained during the perioperative period. Administration was temporarily suspended in one patient and permanently discontinued in another two. The majority (96% of the patients undergoing surgery remained in the study following the perioperative period and 30 of these patients (61% completed the 5-year study. Conclusions Although the data were obtained from a study which was

  3. 宫颈癌围术期的护理%Perioperative nursing in cervical cancer



    目的 探讨宫颈癌围术期的护理方法,以提高手术成功率.方法 观察并总结92例宫颈癌患者手术治疗围术期的护理.结果 通过心理护理,饮食护理,对症护理等提高手术成功率,患者均治愈出院.结论 规范而正确的护理是保证宫颈癌手术成功的关键之一.%Objective To investigate the methods of perioperative nursing in cervical cancer and improve the rate of surgical success. Methods The perioperative nursing in cervical cancer on ninety - two patients was observed and summed up. Results The rate of surgical success has improved by psychological caring, dieting nursing and correct nursing methods. All patients have been cured. Conclusion The key to ensure the success of surgical in cervical cancer is normative and correct nursing.

  4. Practical recommendations for patient blood management and the reduction of perioperative transfusion in joint replacement surgery.

    Bruce, Warwick; Campbell, David; Daly, David; Isbister, James


    Data from the Australian Better Safer Transfusion programme show that about one-third of patients undergoing hip or knee arthroplasty receive perioperative blood transfusions, placing them at increased risk for adverse clinical outcomes. Other concerns associated with allogeneic blood transfusion include the quality of stored red cell concentrates, the cost of provision of blood and the predicted local demographics, which mean that fewer donors will need to support a greater number of recipients. In view of the multiple challenges associated with allogeneic blood transfusion and its provision, we developed practical management recommendations for perioperative bleeding in joint replacement surgery, based on available evidence and expert consensus opinion, that aim to promote a new, responsible approach to transfusion management. Key recommendations are as follows. Patients' medical health, including haemoglobin and iron levels, needs to be evaluated and optimized preoperatively. Anticoagulant and antiplatelet therapy should be stopped if possible, unless indicated for secondary cardiovascular prevention or coronary stent patency, in which case careful consideration is required. If substantial blood loss is anticipated, intraoperative management with antifibrinolytic agents is recommended for bleeding prophylaxis. Normothermia should be maintained. Pharmacological and non-pharmacological measures are recommended for post-operative thromboprophylaxis. A blood management programme should be instituted for haemodynamically stable patients. PMID:23116065

  5. Preventing "a bridge too far": promoting earlier identification of dislodged dental appliances during the perioperative period.

    Denny, John T; Yeh, Sloane; Mohiuddin, Adil; Denny, Julia E; Fratzola, Christine H


    The presence of fixed partial dentures presents a unique threat to the perioperative safety of patients that require orotracheal intubation or placement of instruments into the gastrointestinal (GI) tract. There are many chances for the displacement of a fixed partial denture: instrumentation of the airway for intubation, or introduction of temporary devices, such as gastroscopes or transesophageal echo probes. If dislodged, the fixed partial dentures can enter the hypopharynx, esophagus or lungs and cause perforations with their sharp tines. Oral or esophageal perforation can lead to potentially fatal mediastinitis. We describe a case of a patient with a fixed partial denture who underwent cardiac surgery with intubation and transesophageal echocardiography (TEE). His partial denture was intact after the procedure. After extubation, he reported that his teeth were missing. Multiple procedures were required to remove his dislodged partial dentures. In sign-out reports, verbal descriptions of the patient's partial dentures were not adequate in this case. A picture of the patient's denture and oral pharynx pre-operatively would have provided a more accurate template for the post-operative team to refer to when caring for the patient. This may have avoided the multiple potentially risky procedures the patient had to undergo. We describe a suggested protocol utilizing a pre-operative photo to reduce the incidence of unrecognized partial denture dislodgement in the perioperative period. Because the population is aging, this will become a more frequent issue confronting practitioners. This protocol could mitigate this complication. PMID:25436029

  6. Alteration of the oral environment in patients undergoing esophagectomy during the perioperative period

    Masami Yoshioka


    Full Text Available Objective: During the perioperative period, oral ingestion is changed considerably in esophagectomy patients. The aim of this study was to investigate oral environment modifications in patients undergoing esophageal cancer treatments due to changes in dietary intake and swallowing functions. Material and Methods: Thirty patients who underwent operation for removal of esophageal cancer in Tokushima University Hospital were enrolled in this study. Results: It was found that 1 the flow rate of resting saliva decreased significantly at postoperative period by deprived feeding for one week, although it did not recover several days after oral ingestion began, 2 the accumulation of dental plaque and the number of mutans streptococci in saliva decreased significantly after operation, while both increased relatively quick when oral ingestion began, and 3 the swallowing function decreased significantly in the postoperative period. Conclusions: These results suggest that dental professionals should emphasize the importance of oral health care and provide instructions on plaque control to patients during the perioperative period of esophageal cancer treatment.

  7. An interprofessional training course in crises and human factors for perioperative teams.

    Stephens, Tim; Hunningher, Annie; Mills, Helen; Freeth, Della


    Improving patient safety and the culture of care are health service priorities that coexist with financial pressures on organisations. Research suggests team training and better team processes can improve team culture, safety, performance, and clinical outcomes, yet opportunities for interprofessional learning remain scarce. Perioperative practitioners work in a high pressure, high-risk environment without the benefits of stable team membership: this limits opportunities and momentum for team-initiated collaborative improvements. This article describes an interprofessional course focused on crises and human factors which comprised a 1-day event and a multifaceted sustainment programme for perioperative practitioners, grouped by surgical specialty. Participants reported increased understanding and confidence to enact processes and behaviours that support patient safety, including: team behaviours (communication, coordination, cooperation and back-up, leadership, situational awareness); recognising different perspectives and expectations within the team; briefing and debriefing; after action review; and using specialty-specific incident reports to generate specialty-specific interprofessional improvement plans. Participants valued working with specialty colleagues away from normal work pressures. In the high-pressure arena of front-line healthcare delivery, improving patient safety and theatre efficiency can often be erroneously considered conflicting agendas. Interprofessional collaboration amongst staff participating in this initiative enabled general and specialty-specific interprofessional learning that transcended this conflict. PMID:27314407

  8. Perioperative clinical variables and long-term survival following vascular surgery

    Santiago; Garcia; Edward; O; McFalls


    Cardiovascular disease is the leading cause of death in patients with peripheral arterial disease(PAD). Coro-nary artery disease(CAD) is highly prevalent, and often times coexist, in patients with PAD. The management of patients with PAD that requires a high-risk vascular surgical procedure for intermittent claudication, critical limb ischemia or expanding abdominal aortic aneurysm requires risk stratification with the revised cardiac risk index, optimization of medical therapies, and limited use of cardiac imaging prior to surgery. Preventive re-vascularization in patients with stable CAD, with the sole intention to mitigate the risk of cardiac complica-tions in the peri-operative period, is not effective and may be associated with significant bleeding and throm-botic risks, in particular if stents are used. A strategy of universal use of cardiac troponins in the perioperative period for active surveillance of myocardial ischemia may be more reasonable and cost-effective than the current standard of care of widespread use of cardiac imaging prior to high-risk surgery. An elevated cardiactroponin after vascular surgery is predictive of long-term mortality risk. Medical therapies such as aspirin and statins are recommended for patients with post-operative myocardial ischemia. Ongoing trials are as-sessing the role of novel anticoagulants. Additional research is needed to define the role of cardiac imaging and invasive angiography in this population.

  9. Perioperative intensive insulin therapy using artificial endocrine pancreas in patients undergoing pancreatectomy

    Hiromichi Maeda; Takehiro Okabayashi; Tomoaki Yatabe; Koichi Yamashita; Kazuhiro Hanazaki


    Perioperative glycemic control is important for reducing postoperative infectious complications. However,clinical trials have shown that efforts to maintain normoglycemia in intensive care unit patients result in deviation of glucose levels from the optimal range, and frequent attacks of hypoglycemia. Tight glycemic control is even more challenging in those undergoing pancreatic resection. Removal of lesions and surrounding normal pancreatic tissue often cause hormone deficiencies that lead to the destruction of glucose homeostasis, which is termed pancreatogenic diabetes. Pancreatogenic diabetes is characterized by the occurrence of hyperglycemia and iatrogenic severe hypoglycemia, which adversely effects patient recovery.Postoperatively, a variety of factors including surgical stress, inflammatory cytokines, sympathomimetic drug therapy, and aggressive nutritional support can also affect glycemic control. This review discusses the endocrine aspects of pancreatic resection and highlights postoperative glycemic control using a closed-loop system or artificial pancreas. In previous experiments,we have demonstrated the reliability of the artificial pancreas in dogs with total pancreatectomy, and its postoperative clinical use has been shown to be effective and safe, without the occurrence of hypoglycemic episodes, even in patients after total pancreatectomy.Considering the increasing requirement for tight perioperative glycemic control and the recognized risk of hypoglycemia, we propose the use of an artificial endocrine pancreas that is able to monitor continuously blood glucose concentrations with proven accuracy, and administer automatically substances to return blood glucose concentration to the optimal narrow range.

  10. Perioperative Complications After Living Kidney Donation: A National Study.

    Lentine, K L; Lam, N N; Axelrod, D; Schnitzler, M A; Garg, A X; Xiao, H; Dzebisashvili, N; Schold, J D; Brennan, D C; Randall, H; King, E A; Segev, D L


    We integrated the US transplant registry with administrative records from an academic hospital consortium (97 centers, 2008-2012) to identify predonation comorbidity and perioperative complications captured in diagnostic, procedure, and registry sources. Correlates (adjusted odds ratio, aOR) of perioperative complications were examined with multivariate logistic regression. Among 14 964 living kidney donors, 11.6% were African American. Nephrectomies were predominantly laparoscopic (93.8%); 2.4% were robotic and 3.7% were planned open procedures. Overall, 16.8% of donors experienced a perioperative complication, most commonly gastrointestinal (4.4%), bleeding (3.0%), respiratory (2.5%), surgical/anesthesia-related injuries (2.4%), and "other" complications (6.6%). Major Clavien Classification of Surgical Complications grade IV or higher affected 2.5% of donors. After adjustment for demographic, clinical (including comorbidities), procedure, and center factors, African Americans had increased risk of any complication (aOR 1.26, p = 0.001) and of Clavien grade II or higher (aOR 1.39, p = 0.0002), grade III or higher (aOR 1.56, p 50 (aOR 0.55, p < 0.0001) was associated with lower risk. Complications after live donor nephrectomy vary with baseline demographic, clinical, procedure, and center factors, but the most serious complications are infrequent. Future work should examine underlying mechanisms and approaches to minimizing the risk of perioperative complications in all donors. PMID:26700551

  11. Fluvastatin and perioperative events in patients undergoing vascular surgery

    O. Schouten (Olaf); H. Boersma (Eric); S.E. Hoeks (Sanne); R. Benner (Robbert); H. van Urk (Hero); M.R.H.M. van Sambeek (Marc); H.J.M. Verhagen (Hence); N.A. Khan (Nisar Ahmed); M. Dunkelgrun (Martin); J.J. Bax (Jeroen); D. Poldermans (Don)


    textabstractBACKGROUND: Adverse cardiac events are common after vascular surgery. We hypothesized that perioperative statin therapy would improve postoperative outcomes. METHODS: In this double-blind, placebo-controlled trial, we randomly assigned patients who had not previously been treated with a

  12. Relationship between perioperative glycemic control and postoperative infections

    Hanazaki, Kazuhiro; Maeda, Hiromichi; Okabayashi, Takehiro


    Perioperative hyperglycemia in critically ill surgery patients increases the risk of postoperative infection (POI), which is a common, and often costly, surgical complication. Hyperglycemia is associated with abnormalities in leukocyte function, including granulocyte adherence, impaired phagocytosis, delayed chemotaxis, and depressed bactericidal capacity. These leukocyte deficiencies are the cause of infection and improve with tight glycemic control, which leads to fewer POIs in critically i...

  13. Perioperative blood loss and diclofenac in major arthroplastic surgery

    Ljiljana Gvozdenović


    Full Text Available Introduction: Contemporary literature indicates precaution over the perioperative use of non-steroidal anti-inflammatory drugs, since they can potentially increase perioperative blood loss related to their mechanism of action. The aim of this study was to assess the influence of non-steroidal anti-inflammatory drugs on perioperative blood loss undergoing hip arthroplasty and its correlation with general and regional anesthesia.Methods: This prospective study included 120 patients who had undergone elective unilateral total hip arthroplasty. Patients were allocated into four groups. Groups 1 and 2 were pretreated with diclofenac and operated in general and regional anesthesia. Group 3 and 4 weren’t pretreated with any non-steroidal anti-inflammatory drug and were, as well, operated in general and regional anesthesia. Diclofenac was administered orally two times a day 75 mg (total 150 mg and also as intramuscular injection (75 mg preoperatively and 12 hours later on a day of surgery.Results: The perioperative blood loss in the rst 24 hours showed an increase of 29.4% in the diclofenac group operated in general anesthesia and increase of 26.8% in patients operated in regional anesthesia (P < 0.05 compared to control group. Statistical data evaluation of patients operated in general anesthesia compared to regional anesthesia, the overall blood loss in the rst 24 h after surgery, showed an increase of 6.4% in the diclofenac group and increase of 3.6% in placebo group. This was not statistically significant.Conclusion: Pretreatment with non-steroidal anti-inflammatory drugs (diclofenac before elective unilateral total hip arthroplasty increases the perioperative blood loss signficantly. Early discontinuation of non-selective non-steroidal anti-inflammatory drugs is advised.

  14. Predicting perioperative venous thromboembolism in Japanese gynecological patients.

    Masae Ikeda

    Full Text Available OBJECTIVE: To develop a convenient screening method that can predict perioperative venous thromboembolism (VTE and identify patients at risk of fatal perioperative pulmonary embolism (PE. METHODS: Patients hospitalized for gynecological abdominal surgery (n = 183 underwent hematology tests and multidetector computed tomography (MDCT to detect VTE. All statistical analyses were carried out using the SPSS software program (PASWV19.0J. RESULTS: The following risk factors for VTE were identified by univariate analysis: plasmin-alpha2-plasmin inhibitor complex (PIC, thrombin-antithrombin III complex (TAT, and prolonged immobility (all p<0.001; age, neoadjuvant chemotherapy (NAC, malignancy, hypertension, past history of VTE, and hormone therapy (all p<0.01; and hemoglobin, transverse tumor diameter, ovarian disease, and menopause (all p<0.05. Multivariate analysis using these factors revealed that PIC, age, and transverse tumor diameter were significant independent determinants of the risk of VTE. We then calculated the incidence rate of perioperative VTE using PIC and transverse tumor diameter in patient groups stratified by age. In patients aged ≤40 years, PIC ≥1.3 µg/mL and a transverse tumor diameter ≥10 cm identified the high-risk group for VTE with an accuracy of 93.6%. For patients in their 50 s, PIC ≥1.3 µg/mL identified a high risk of VTE with an accuracy of 78.2%. In patients aged ≥60 years, a transverse tumor diameter ≥15 cm (irrespective of PIC or PIC ≥1.3 µg/mL identified the high-risk group with an accuracy of 82.4%. CONCLUSIONS: We propose new screening criteria for VTE risk that are based on PIC, transverse tumor diameter, and age. Our findings suggest the usefulness of these criteria for predicting the risk of perioperative VTE and for identifying patients with a high risk of fatal perioperative PE.

  15. Temperature Management After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

    Donnino, Michael W; Andersen, Lars W; Berg, Katherine M; Reynolds, Joshua C; Nolan, Jerry P; Morley, Peter T; Lang, Eddy; Cocchi, Michael N; Xanthos, Theodoros; Callaway, Clifton W; Soar, Jasmeet


    For more than a decade, mild induced hypothermia (32 °C-34 °C) has been standard of care for patients remaining comatose after resuscitation from out-of-hospital cardiac arrest with an initial shockable rhythm, and this has been extrapolated to survivors of cardiac arrest with initially nonshockable rhythms and to patients with in-hospital cardiac arrest. Two randomized trials published in 2002 reported a survival and neurological benefit with mild induced hypothermia. One recent randomized trial reported similar outcomes in patients treated with targeted temperature management at either 33 °C or 36 °C. In response to these new data, the International Liaison Committee on Resuscitation Advanced Life Support Task Force performed a systematic review to evaluate 3 key questions: (1) Should mild induced hypothermia (or some form of targeted temperature management) be used in comatose post-cardiac arrest patients? (2) If used, what is the ideal timing of the intervention? (3) If used, what is the ideal duration of the intervention? The task force used Grading of Recommendations Assessment, Development and Evaluation methodology to assess and summarize the evidence and to provide a consensus on science statement and treatment recommendations. The task force recommends targeted temperature management for adults with out-of-hospital cardiac arrest with an initial shockable rhythm at a constant temperature between 32 °C and 36 °C for at least 24 hours. Similar suggestions are made for out-of-hospital cardiac arrest with a nonshockable rhythm and in-hospital cardiac arrest. The task force recommends against prehospital cooling with rapid infusion of large volumes of cold intravenous fluid. Additional and specific recommendations are provided in the document. PMID:26449873

  16. Perioperative Adverse Respiratory Events in Overweight/Obese Children: Systematic Review.

    Kiekkas, Panagiotis; Stefanopoulos, Nikolaos; Bakalis, Nick; Kefaliakos, Antonios; Konstantinou, Evangelos


    Childhood obesity is associated with numerous respiratory disorders, which may be aggravated when general anesthesia is administered. This systematic review aimed to investigate and synthesize the published literature on the associations between childhood obesity and perioperative adverse respiratory events (PAREs). By using key terms, observational studies published between 1990 and 2014 in English-language journals indexed by Cumulative Index for Nursing and Allied Health Literature, PubMed, Web of Science, Cochrane Database, and EMBASE were searched for reports of relevant associations. Nine articles were considered eligible for inclusion. In all studies, significant univariate and multivariate associations were reported between obesity and increased risk for PAREs in pediatric patients, mainly for hypoxemia, upper airway obstruction, and difficult mask ventilation. Appropriate strategies for preventing PAREs in obese children need to be followed by health care professionals. Multicenter studies are also recommended for ensuring high generalizability of reported associations and elucidating underlying mechanisms that link obesity to PAREs. PMID:26847776

  17. Perioperative management of patients for osteo-odonto-kreatoprosthesis under general anaesthesia: A retrospective study

    Rakesh Garg


    Full Text Available An osteo-odonto-keratoprosthesis (OOKP procedure is indicated in patients with failed corneal transplant but having intact retina for visual improvement. We studied perioperative concerns of patients who underwent the staged OOKP procedure. This was a retrospective analysis of patients who underwent OOKP. The information regarding symptoms, associated comorbidities, perioperative events including anaesthetic management were collected. Eight patients (five females and three males underwent the staged OOKP procedure. The median age was 18 years. The median weight was 45 kg. The median duration of loss of vision was 4 years. The aetiology of blindness included Stevens-Johnson′s syndrome (SJS (7 and chemical burn (1. Four patients had generalized skin problem due to SJS. All cases were managed under general anaesthesia, and airway management included nasotracheal intubation for stage I and orotracheal intubation for stage II. The median mallampati classification was I prior to OOKP stage I procedure while it changed to II at stage II procedure. Two patients required fibreoptic nasotracheal intubation. One patient had excessive oozing from the mucosal harvest site and was managed conservatively. In one patient, tooth harvesting was done twice as the first tooth was damaged during creating a hole in it. We conclude that OOKP requires multidisciplinary care. Anaesthesiologist should evaluate the airway carefully and disease-associated systemic involvements. The use of various drugs requires caution and steroid supplementation should be done. Airway difficulty should be anticipated, mandating thorough evaluation. Re-evaluation of airway is prudent as it may become difficult during the staged OOKP procedure.

  18. Perioperative management of patients for osteo-odonto-kreatoprosthesis under general anaesthesia: A retrospective study.

    Garg, Rakesh; Khanna, Puneet; Sinha, Renu


    An osteo-odonto-keratoprosthesis (OOKP) procedure is indicated in patients with failed corneal transplant but having intact retina for visual improvement. We studied perioperative concerns of patients who underwent the staged OOKP procedure. This was a retrospective analysis of patients who underwent OOKP. The information regarding symptoms, associated comorbidities, perioperative events including anaesthetic management were collected. Eight patients (five females and three males) underwent the staged OOKP procedure. The median age was 18 years. The median weight was 45 kg. The median duration of loss of vision was 4 years. The aetiology of blindness included Stevens-Johnson's syndrome (SJS) (7) and chemical burn (1). Four patients had generalized skin problem due to SJS. All cases were managed under general anaesthesia, and airway management included nasotracheal intubation for stage I and orotracheal intubation for stage II. The median mallampati classification was I prior to OOKP stage I procedure while it changed to II at stage II procedure. Two patients required fibreoptic nasotracheal intubation. One patient had excessive oozing from the mucosal harvest site and was managed conservatively. In one patient, tooth harvesting was done twice as the first tooth was damaged during creating a hole in it. We conclude that OOKP requires multidisciplinary care. Anaesthesiologist should evaluate the airway carefully and disease-associated systemic involvements. The use of various drugs requires caution and steroid supplementation should be done. Airway difficulty should be anticipated, mandating thorough evaluation. Re-evaluation of airway is prudent as it may become difficult during the staged OOKP procedure. PMID:21808400

  19. Approaches and perioperative management in periacetabular osteotomy surgery

    Søballe, Kjeld; Troelsen, Anders


    detached, and the femoral nerve and vessels are protected by the iliopsoas and sartorius muscles. This approach is safe, minimizes blood loss and transfusion requirements, is associated with a short duration of surgery, and allows for optimal correction of the acetabular fragment. Follow-ups (range, 3.9 to...... 8.1 years) of 209 PAOs performed using this approach have shown Kaplan-Meier survivorship rates of 94.7% at 5 years and 88.6% at 8.1 years, with conversion to total hip arthroplasty as the end point. Perioperative management includes a patient education program, optimized pain treatment strategies...... (local infiltration analgesia), and a progressive mobilization and exercise program. The transsartorial approach coupled with a specific perioperative management program has proved successful for PAO surgery....

  20. Perioperative Management of Multiple Noncardiac Implantable Electronic Devices.

    Ramos, Juan A; Brull, Sorin J


    The number of patients with noncardiac implantable electronic devices is increasing, and the absence of perioperative management standards, guidelines, practice parameters, or expert consensus statements presents clinical challenges. A 69-year-old woman presented for latissimus dorsi breast reconstruction. The patient had previously undergone implantation of a spinal cord stimulator, a gastric pacemaker, a sacral nerve stimulator, and an intrathecal morphine pump. After consultation with device manufacturers, the devices with patient programmability were switched off. Bipolar cautery was used intraoperatively. Postoperatively, all devices were interrogated to ensure appropriate functioning before home discharge. Perioperative goals include complete preoperative radiologic documentation of device component location, minimizing electromagnetic interference, and avoiding mechanical damage to implanted device components. PMID:26588030

  1. Peri-operative warming devices: performance and clinical application.

    John, M; Ford, J; Harper, M


    Since the adverse consequences of accidental peri-operative hypothermia have been recognised, there has been a rapid expansion in the development of new warming equipment designed to prevent it. This is a review of peri-operative warming devices and a critique of the evidence assessing their performance. Forced-air warming is a common and extensively tested warming modality that outperforms passive insulation and water mattresses, and is at least as effective as resistive heating. More recently developed devices include circulating water garments, which have shown promising results due to their ability to cover large surface areas, and negative pressure devices aimed at improving subcutaneous perfusion for warming. We also discuss the challenge of fluid warming, looking particularly at how devices' performance varies according to flow rate. Our ultimate aim is to provide a guide through the bewildering array of devices on the market so that clinicians can make informed and accurate choices for their particular hospital environment. PMID:24720346

  2. Inhaled therapy for the management of perioperative pulmonary hypertension

    C A Thunberg


    Full Text Available Patients with pulmonary hypertension (PH are at high risk for complications in the perioperative setting and often receive vasodilators to control elevated pulmonary artery pressure (PAP. Administration of vasodilators via inhalation is an effective strategy for reducing PAP while avoiding systemic side effects, chiefly hypotension. The prototypical inhaled pulmonary-specific vasodilator, nitric oxide (NO, has a proven track record but is expensive and cumbersome to implement. Alternatives to NO, including prostanoids (such as epoprostenol, iloprost, and treprostinil, NO-donating drugs (sodium nitroprusside, nitroglycerin, and nitrite, and phosphodiesterase inhibitors (milrinone, sildenafil may be given via inhalation for the purpose of treating elevated PAP. This review will focus on the perioperative therapy of PH using inhaled vasodilators.

  3. Nursing team stress in the perioperative period: an integrative review

    Dafne Eva Corrêa Brandão; Cristina Maria Galvão


    This integrative review aimed at analyzing evidences available in literature regarding stress levels in nursing teams during the perioperative period. Primary studies were searched in the following databases: PubMed, CINAHL and LILACS. Included studies were grouped into the following thematic categories: stress level in the workplace and stress factors (n=8) and stress coping strategies used by the nursing staff (n=6). Evidence suggests that stress in the workplace worsens the health of the n...

  4. Anaphylactic and anaphylactoid reactions during the perioperative period

    Lagopoulos, V; Gigi, E


    Anaphylactic reactions in the peri-operative period are often serious and potentially life-threatening conditions, involving multiple organ systems in which the clinical manifestations are the consequence of the release of preformed mediators from mast cells and basophils. Anaphylaxis is an immune mediated type I allergic reaction following the massive release of mediators from mast cells and basophils as a response to an allergen. Anaphylactoid reactions are defined as those reactions that p...

  5. Perioperative visual loss in ocular and nonocular surgery

    Lee, Michael


    Kathleen T Berg, Andrew R Harrison, Michael S LeeDepartment of Ophthalmology, University of Minnesota, Minneapolis, MN, USAAbstract: Incidence estimates for perioperative vision loss (POVL) after nonocular surgery range from 0.013% for all surgeries up to 0.2% following spine surgery. The most common neuro-ophthalmologic causes of POVL are the ischemic optic neuropathies (ION), either anterior (AION) or posterior (PION). We identified 111 case reports of AION following nonocular surgery in th...

  6. Fluvastatin and perioperative events in patients undergoing vascular surgery

    Schouten, Olaf; Boersma, Eric; Hoeks, Sanne; Benner, Robbert; Urk, Hero; Sambeek, Marc; Verhagen, Hence; Khan, Nisar Ahmed; Dunkelgrun, Martin; Bax, Jeroen; Poldermans, Don


    textabstractBACKGROUND: Adverse cardiac events are common after vascular surgery. We hypothesized that perioperative statin therapy would improve postoperative outcomes. METHODS: In this double-blind, placebo-controlled trial, we randomly assigned patients who had not previously been treated with a statin to receive, in addition to a beta-blocker, either 80 mg of extended-release fluvastatin or placebo once daily before undergoing vascular surgery. Lipid, interleukin-6, and C-reactive protein...

  7. Perioperative Outcome of Dyssomnia Patients on Chronic Methylphenidate Use

    Stoicea, Nicoleta; Ellis, Thomas; Moran, Kenneth; Ackermann, Wiebke; Wilson, Thomas; Quevedo, Eduardo; Bergese, Sergio


    Methylphenidate is frequently prescribed for attention deficit hyperactivity disorder, narcolepsy, and other sleep disorders requiring psychostimulants. Our report is based on 2 different clinical experiences of patients with chronic methylphenidate use, undergoing general anesthesia. These cases contrast different strategies of taking versus withholding the drug treatment on the day of surgery. From the standpoint of anesthetic management and patient safety, the concerns for perioperative me...

  8. A Systematic Approach to Creation of a Perioperative Data Warehouse.

    Hofer, Ira S; Gabel, Eilon; Pfeffer, Michael; Mahbouba, Mohammed; Mahajan, Aman


    Extraction of data from the electronic medical record is becoming increasingly important for quality improvement initiatives such as the American Society of Anesthesiologists Perioperative Surgical Home. To meet this need, the authors have built a robust and scalable data mart based on their implementation of EPIC containing data from across the perioperative period. The data mart is structured in such a way so as to first simplify the overall EPIC reporting structure into a series of Base Tables and then create several Reporting Schemas each around a specific concept (operating room cases, obstetrics, hospital admission, etc.), which contain all of the data required for reporting on various metrics. This structure allows centralized definitions with simplified reporting by a large number of individuals who access only the Reporting Schemas. In creating the database, the authors were able to significantly reduce the number of required table identifiers from >10 to 3, as well as to correct errors in linkages affecting up to 18.4% of cases. In addition, the data mart greatly simplified the code required to extract data, making the data accessible to individuals who lacked a strong coding background. Overall, this infrastructure represents a scalable way to successfully report on perioperative EPIC data while standardizing the definitions and improving access for end users. PMID:27195633

  9. Can Accelerators Accelerate Learning?

    The 'Young Talented' education program developed by the Brazilian State Funding Agency (FAPERJ)[1] makes it possible for high-schools students from public high schools to perform activities in scientific laboratories. In the Atomic and Molecular Physics Laboratory at Federal University of Rio de Janeiro (UFRJ), the students are confronted with modern research tools like the 1.7 MV ion accelerator. Being a user-friendly machine, the accelerator is easily manageable by the students, who can perform simple hands-on activities, stimulating interest in physics, and getting the students close to modern laboratory techniques.

  10. Perioperative smoking cessation in vascular surgery

    Kehlet, M.; Heesemann, Sabine; Tonnesen, H.;


    Background: The effect of intensive smoking cessation programs on postoperative complications has never before been assessed in soft tissue surgery when smoking cessation is initiated on the day of surgery. Methods: A single-blinded randomized clinical trial conducted at two vascular surgery...... departments in Denmark. The intervention group was offered the Gold Standard Program (GSP) for smoking cessation intervention. The control group was offered the departments' standard care. Inclusion criteria were patients with planned open peripheral vascular surgery and who were daily smokers. According to...... intervention and 21 as controls. There was no difference in 30-day complication rates or 6-week abstinence rates between the two groups. Conclusions: A trial assessing the effect of smoking cessation on postoperative complications on the day of soft tissue surgery is still needed. If another trial is to be...

  11. Incidence of and factors associated with perioperative cardiac arrest within 24 hours of anesthesia for emergency surgery

    Siriphuwanun V


    Full Text Available Visith Siriphuwanun,1 Yodying Punjasawadwong,1 Worawut Lapisatepun,1 Somrat Charuluxananan,2 Ketchada Uerpairojkit2 1Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Mueang District, Chiang Mai, Thailand; 2Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Purpose: To determine the incidence of and factors associated with perioperative cardiac arrest within 24 hours of receiving anesthesia for emergency surgery. Patients and methods: This retrospective cohort study was approved by the ethical committee of Maharaj Nakorn Chiang Mai Hospital, Thailand. We reviewed the data of 44,339 patients receiving anesthesia for emergency surgery during the period from January 1, 2003 to March 31, 2011. The data included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA physical status classification, anesthesia information, location of anesthesia performed, and outcomes. Data of patients who had received topical anesthesia or monitoring anesthesia care were excluded. Factors associated with cardiac arrest were identified by univariate analyses. Multiple regressions for the risk ratio (RR and 95% confidence intervals (CI were used to determine the strength of factors associated with cardiac arrest. A forward stepwise algorithm was chosen at a P-value <0.05. Results: The incidence (within 24 hours of perioperative cardiac arrest in patients receiving anesthesia for emergency surgery was 163 per 10,000. Factors associated with 24-hour perioperative cardiac arrest in emergency surgery were age of 2 years or younger (RR =1.46, CI =1.03–2.08, P=0.036, ASA physical status classification of 3–4 (RR =5.84, CI =4.20–8.12, P<0.001 and 5–6 (RR =33.98, CI =23.09–49.98, P<0.001, the anatomic site of surgery (upper intra-abdominal, RR =2.67, CI =2.14–3.33, P<0.001; intracranial, RR =1.74, CI =1.35–2.25, P<0.001; intrathoracic, RR =2.35, CI =1.70–3

  12. The effect of perioperative esmolol infusion on the postoperative nausea, vomiting and pain after laparoscopic appendectomy

    Lee, Sang-Jun; Lee, Jong-Nam


    Background Perioperative opioid administration results in postoperative nausea and vomiting (PONV) and acute opioid tolerance that manifests in increased postoperative pain. Esmolol is an ultra short acting cardioselective β1-adrenergic receptor antagonist, and it has been successfully used for perioperative sympatholysis and it reduces the opioid requirement during total intravenous anesthesia. We tested the hypothesis that perioperative esmolol administration results in decreased PONV and p...

  13. Perioperative morbidity and mortality of cardiothoracic surgery in patients with a do-not-resuscitate order

    Bryan G. Maxwell


    Full Text Available Background. Do-not-resuscitate (DNR orders are often active in patients with multiple comorbidities and a short natural life expectancy, but limited information exists as to how often these patients undergo high-risk operations and of the perioperative outcomes in this population. Methods. Using comprehensive inpatient administrative data from the Public Discharge Data file (years 2005 through 2010 of the California Office of Statewide Health Planning and Development, which includes a dedicated variable recording DNR status, we identified cohorts of DNR patients who underwent major cardiac or thoracic operations and compared themto age- and procedure-matched comparison cohorts. The primary study outcome was in-hospital mortality. Results. DNR status was not uncommon in cardiac (n = 2,678, 1.1% of all admissions for cardiac surgery, age 71.6 ± 15.9 years and thoracic (n = 3,129, 3.7% of all admissions for thoracic surgery, age 73.8 ± 13.6 years surgical patient populations. Relative to controls, patients who were DNR experienced significantly greater inhospital mortality after cardiac (37.5% vs. 11.2%, p < 0.0001 and thoracic (25.4% vs. 6.4% operations. DNR status remained an independent predictor of in-hospital mortality onmultivariate analysis after adjustment for baseline and comorbid conditions in both the cardiac (OR 4.78, 95% confidence interval 4.21–5.41, p < 0.0001 and thoracic (OR 6.11, 95% confidence interval 5.37–6.94, p < 0.0001 cohorts. Conclusions. DNR status is associated with worse outcomes of cardiothoracic surgery even when controlling for age, race, insurance status, and serious comorbid disease. DNR status appears to be a marker of substantial perioperative risk, and may warrant substantial consideration when framing discussions of surgical risk and benefit, resource utilization, and biomedical ethics surrounding end-of-life care.

  14. A comparison of reusable and disposable perioperative textiles: sustainability state-of-the-art 2012.

    Overcash, Michael


    Contemporary comparisons of reusable and single-use perioperative textiles (surgical gowns and drapes) reflect major changes in the technologies to produce and reuse these products. Reusable and disposable gowns and drapes meet new standards for medical workers and patient protection, use synthetic lightweight fabrics, and are competitively priced. In multiple science-based life cycle environmental studies, reusable surgical gowns and drapes demonstrate substantial sustainability benefits over the same disposable product in natural resource energy (200%-300%), water (250%-330%), carbon footprint (200%-300%), volatile organics, solid wastes (750%), and instrument recovery. Because all other factors (cost, protection, and comfort) are reasonably similar, the environmental benefits of reusable surgical gowns and drapes to health care sustainability programs are important for this industry. Thus, it is no longer valid to indicate that reusables are better in some environmental impacts and disposables are better in other environmental impacts. It is also important to recognize that large-scale studies of comfort, protection, or economics have not been actively pursued in the last 5 to 10 years, and thus the factors to improve both reusables and disposable systems are difficult to assess. In addition, the comparison related to jobs is not well studied, but may further support reusables. In summary, currently available perioperative textiles are similar in comfort, safety, and cost, but reusable textiles offer substantial opportunities for nurses, physicians, and hospitals to reduce environmental footprints when selected over disposable alternatives. Evidenced-based comparison of environmental factors supports the conclusion that reusable gowns and drapes offer important sustainability improvements. The benefit of reusable systems may be similar for other reusables in anesthesia, such as laryngeal mask airways or suction canisters, but life cycle studies are needed to

  15. Plasma accelerators

    Recently attention has focused on charged particle acceleration in a plasma by a fast, large amplitude, longitudinal electron plasma wave. The plasma beat wave and plasma wakefield accelerators are two efficient ways of producing ultra-high accelerating gradients. Starting with the plasma beat wave accelerator (PBWA) and laser wakefield accelerator (LWFA) schemes and the plasma wakefield accelerator (PWFA) steady progress has been made in theory, simulations and experiments. Computations are presented for the study of LWFA. (author)

  16. Construction of Perioperative Anesthesia Management Security System%围术期手术麻醉管理安全体系的构建

    詹莎莎; 刘炳信


    Perioperative patients require anesthesia, as medical technology continues to progress, after anesthesia, the pa-tient's safety are increasing, but the management of security perioperative anesthesia still faces many challenges. With the change of medical model to improve the quality of care, reduce health care costs become the primary purpose. Thus, in ad-dition to the initiative to change, regulate medical practices, the anesthesiologist should strengthen perioperative anesthesia safety management system in order to build a safer surgical patients throughout the medical procedure in anesthesia manage-ment.%患者在围术期需要进行手术麻醉,随着医学技术不断进步,在麻醉后,患者的安全性也不断增加,但围术期的麻醉管理安全仍然面临多项挑战。伴随着医疗模式的改变,提高医疗质量、降低医疗成本成为了首要目的。因此,除了主动改变,规范医疗行为,麻醉医师还应加强患者的围术期麻醉的安全管理,从而构建患者在整个手术医疗过程中麻醉管理的安全体系。

  17. Linear Accelerators

    Vretenar, M


    The main features of radio-frequency linear accelerators are introduced, reviewing the different types of accelerating structures and presenting the main characteristics aspects of linac beam dynamics.

  18. Advance directives in the perioperative setting: Managing ethical and legal issues when patient rights and perceived obligations of the healthcare provider conflict.

    Williams, Stephen P; Howe, Christopher L


    Perhaps individual wishes are not always acknowledged or accepted when it comes to end-of-life care. This possibility, in conjunction with the experiences of healthcare risk managers, should cause concern in the healthcare risk management community. One particularly concerning issue where a persistent failure to honor a patient's wishes exists is with Do Not Resuscitate (DNR) orders in the perioperative arena. Despite a strong focus on informed consent and advance directives, evidence suggests a number of healthcare organizations either have no policy in place regarding DNR orders during the perioperative period, or, for those organizations that do have a policy, many call for automatic suspension of the DNR order without consultation with the patient. This latter practice poses many ethical, medico-legal, and regulatory concerns, and healthcare organizations with such a policy in place should strongly consider revisiting this practice. PMID:23609975

  19. 腹腔镜前列腺癌根治术的围手术期护理%The perioperative nursing of laparoscopic radical prostatectomy

    程范华; 郑红娟; 潘翠青


    目的 探讨腹腔镜前列腺癌根治术治疗前列腺癌患者的临床疗效及围手术期的护理要点.方法 对10例前列腺癌患者采用腹腔镜前列腺癌根治术切除前列腺及行膀胱颈尿道吻合,并通过改进围手术期的护理方法,有效地促进患者恢复.结果 所有患者手术均获成功并痊愈出院.结论 腹腔镜前列腺癌根治术治疗前列腺癌,手术成功率高;加强围手术期的护理,尤其是重视术前心理疏导、术中配合及术后妥善处理好各种引流管等,有助于减少前列腺癌患者围手术期并发症的发生.%Objectives This pedicled investigates the therapeutic effects of which laparoscopic radical prostatectomy for treatment of prostate cancer patients and perioperative care elements.Methods 10 cases of prostate cancer patients,with introduction of laparoscopic radical prostatectomy for prostate,bladder neck-urethral anastomosis and through improving the perioperative nursing,promoting fistula healing and increasing the cure rate.Results ALL the operations were successfully completed fully recouered.Conclusions The laparoscopic radical prostatectomy for treatment of prostate cancer,which can improve the success rate of operation.Intensive perioperative care,with particular attention to psychological intervention,intraoperative cooperation and properly handle the various drainage tubes,etc,which are help to reduce perioperative complications.

  20. Caring for the Jehovah's Witness Parturient.

    Mason, C LaToya; Tran, Connie K


    Caring for the Jehovah's Witness parturient is a complex task that presents a number of ethical, medical, and legal concerns because many Jehovah's Witnesses refuse allogeneic blood transfusion. Childbirth and its surrounding events may be associated with significant blood loss. Given their significant role in the intraoperative administration of blood products, anesthesia providers should be familiar with factors that must be considered in the perioperative care of Jehovah's Witness parturients. Several pharmacologic therapies, anesthetic techniques, and operative interventions aimed at blood conservation may be useful in the care of such patients. Aside from their refusal of transfusion, each Witness makes a personal decision on the acceptability of derivatives of plasma or cellular blood components and autologous blood management. Therefore, the patient-physician relationship must ensure that the individual patient's desires are accurately communicated, respected, and documented in the patient's medical record. The Perioperative Surgical Home model is appropriate for use in caring for Jehovah's Witness patients because it allows for the early and continuing coordination of care and communication between the patient and a multidisciplinary team. In this article, we present a focused review of concepts important to the provision of anesthetic care of parturients who are Jehovah's Witnesses and introduce an algorithmic perioperative approach that may be applied to the care of the Jehovah's Witness parturient undergoing an operative procedure. PMID:26579658

  1. A national survey into perioperative anesthetic management of patients with a fractured neck of femur

    Soinikoski Mirka


    Full Text Available Abstract Background We made a survey among Finnish anesthesiologists concerning the current perioperative anesthetic practice of hip fracture patients for further development in patient care. Methods All members of the Finnish Society of Anesthesiologists with a known e-mail address (786 were invited to participate in an internet-based survey. Results The overall response rate was 55% (423 responses; 298 respondents participated in the care of hip fracture patients. Preoperative analgesia was mostly managed with oxycodone and paracetamol; every fifth respondent applied an epidural infusion. Most respondents (98% employed a spinal block with or without an epidural catheter for intraoperative anesthesia. Midazolam, propofol and/or fentanyl were used for additional sedation. General anesthesia was used rarely. Postoperatively, paracetamol and non-steroidal anti-inflammatory drugs and occasionally peroral oxycodone, were prescribed in addition to epidural analgesia. Conclusions The survey suggests that the impact of more individualised analgesia regimens, both preoperatively and postoperatively, should be investigated in further studies.

  2. Perioperative physiotherapy in patients undergoing lung cancer resection.

    Rodriguez-Larrad, Ana; Lascurain-Aguirrebena, Ion; Abecia-Inchaurregui, Luis Carlos; Seco, Jesús


    Physiotherapy is considered an important component of the perioperative period of lung resection surgery. A systematic review was conducted to assess evidence for the effectiveness of different physiotherapy interventions in patients undergoing lung cancer resection surgery. Online literature databases [Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, SCOPUS, PEDro and CINAHL] were searched up until June 2013. Studies were included if they were randomized controlled trials, compared 2 or more perioperative physiotherapy interventions or compared one intervention with no intervention, included only patients undergoing pulmonary resection for lung cancer and assessed at least 2 or more of the following variables: functional capacity parameters, postoperative pulmonary complications or length of hospital stay. Reviews and meta-analyses were excluded. Eight studies were selected for inclusion in this review. They included a total of 599 patients. Seven of the studies were identified as having a low risk of bias. Two studies assessed preoperative interventions, 4 postoperative interventions and the remaining 2 investigated the efficacy of interventions that were started preoperatively and then continued after surgery. The substantial heterogeneity in the interventions across the studies meant that it was not possible to conduct a meta-analysis. The most important finding of this systematic review is that presurgical interventions based on moderate-intense aerobic exercise in patients undergoing lung resection for lung cancer improve functional capacity and reduce postoperative morbidity, whereas interventions performed only during the postoperative period do not seem to reduce postoperative pulmonary complications or length of hospital stay. Nevertheless, no firm conclusions can be drawn because of the heterogeneity of the studies included. Further research into the efficacy and effectiveness of perioperative respiratory physiotherapy in

  3. Strategier til begraensning af det perioperative forbrug af allogent blod

    Jørgensen, B G; Qvist, N


    perioperative allogenic blood transfusion. The effectiveness of a number of these alternatives needs to be documented and potential adverse effects clarified. The acceptance of a lower haemoglobin level as the transfusion trigger value is perhaps the most important factor in reducing the need for peri-operative......Allogenic blood transfusion carries the risk of immunological and non-immunological adverse effects. Consequently, blood transfusion should be limited to situations where alternatives are not available. This article reviews current by available alternative strategies that reduce the need for...... allogenic blood transfusion...

  4. Severe antiphospholipid syndrome and cardiac surgery: Perioperative management.

    Mishra, Pankaj Kumar; Khazi, Fayaz Mohammed; Yiu, Patrick; Billing, John Stephen


    Antiphospholipid syndrome is an antiphospholipid antibody-mediated prothrombotic state leading to arterial and venous thrombosis. This condition alters routine in-vitro coagulation tests, making results unreliable. Antiphospholipid syndrome patients requiring cardiac surgery with cardiopulmonary bypass present a unique challenge in perioperative anticoagulation management. We describe 3 patients with antiphospholipid syndrome who had successful heart valve surgery at our institution. We have devised an institutional protocol for antiphospholipid syndrome patients, and all 3 patients were managed according to this protocol. An algorithm-based approach is recommended because it improves team work, optimizes treatment, and improves patient outcome. PMID:25829458

  5. Strategies to improve tolerance to peri-operative enteral feeding

    B. Ravinder Reddy


    Full Text Available A major surgical procedure results in injury resulting in systemic response resulting in a negative nitrogen balance. The conventional management of a patient in the peri-operative period involves pre- and post-operative fasting, which potentiates the caloric deficit. Early feeding has been shown to result in a positive clinical outcome. How-ever, the physiologic response to surgery impedes successful initiation of early enteral feeds. This article discusses the various strategies to improve tolerance to early enteral feeds in the immediate post-operative period. [J Med Allied Sci 2016; 6(1: 3-7

  6. Transfer-of-Care Communication: Nursing Best Practices.

    Chard, Robin; Makary, Martin A


    The successful and safe transfer of the patient from one phase of care to another is contingent on optimal communication by all team members. Nurses are often in a natural leadership position to improve safe practices during hand overs. A holistic understanding of the patient allows the perioperative nurse the opportunity to identify issues and choose a nursing diagnosis based on key elements of a patient's needs and goals--information that should be relayed during patient transfers. This article reviews best practices in transfer-of-care communication to enable perioperative RNs to take an active, leading role in hand-over processes. PMID:26411818

  7. Effect of perioperative blood transfusions on long term graft outcomes in renal transplant patients.

    O'Brien, Frank J


    It is established that blood transfusions will promote sensitization to human leucocyte antigen (HLA) antigens, increase time spent waiting for transplantation and may lead to higher rates of rejection. Less is known about how perioperative blood transfusion influence patient and graft outcome. This study aims to establish if there is an association between perioperative blood transfusion and graft or patient survival.

  8. Alveolar recruitment maneuver and perioperative ventilatory support in obese patients undergoing abdominal surgery

    Forgiarini Júnior, Luiz Alberto; Rezende, Juliana Castilhos; Forgiarini, Soraia Genebra Ibrahim


    The development of abdominal surgery represents an alternative therapy for the morbidly obese; however, patients undergoing this surgical procedure often experience postoperative pulmonary complications. The use of alveolar recruitment maneuvers and/or perioperative ventilatory strategies is a possible alternative to reduce these complications, focusing on the reduction of postoperative pulmonary complications. In this review, the benefits of perioperative ventilatory strategies and the imple...

  9. Realization of CARE and EuCARD Projects in ISE-WUT, Accelerator and FEL Research, Development and Applications in Europe

    Romaniuk, R.


    There are described coordinating actions of the accelerator science in Europe in 2003-2009. The actions embrace basic science, as well as development and applications. The accelerator research was not coordinated in Europe at a global scale but was rather concentrated in a few centers owning large infrastructure. These centers include: CERN, DESY, GSI, INFN, LAL, PSI etc. Such coordinating actions enable a lot of positive processes including new possibilities for research centers in this coun...

  10. Role of Esmolol in Perioperative Analgesia and Anesthesia: A Literature Review.

    Harless, Megan; Depp, Caleb; Collins, Shawn; Hewer, Ian


    Use of opioids to provide adequate perioperative analgesia often leads to respiratory depression, nausea, vomiting, urinary retention, pruritus, and opioid-induced hyperalgesia, with the potential to increase length of stay in the hospital. In an effort to reduce perioperative opioid administration yet provide appropriate pain relief, researchers began to study the use of esmolol beyond its well-known cardiovascular effects. Perioperative esmolol has been shown to reduce anesthetic requirements, decrease perioperative opioid use, decrease the incidence of postoperative nausea and vomiting, lead to an earlier discharge, and increase patient satisfaction. This article provides a review of the literature on the use of esmolol as an adjunct for perioperative analgesia and anesthesia. PMID:26137757

  11. Evaluation of the appropriate perioperative antibiotic prophylaxis in Italy.

    Francesco Napolitano

    Full Text Available BACKGROUND: The appropriate use of antibiotics prophylaxis in the prevention and reduction in the incidence of surgical site infection is widespread. This study evaluates the appropriateness of the prescription of antibiotics prophylaxis prior to surgery amongst hospitalized patients in the geographic area of Avellino, Caserta, and Naples (Italy and the factors associated with a poor adherence. METHODS: A sample of 382 patients admitted to 23 surgical wards and undergoing surgery in five hospitals were randomly selected. RESULTS: Perioperative antibiotic prophylaxis was appropriate in 18.1% of cases. The multivariate logistic regression analysis showed that patients with hypoalbuminemia, with a clinical infection, with a wound clean were more likely to receive an appropriate antibiotic prophylaxis. Compared with patients with an American Society of Anesthesiologists (ASA score ≥4, those with a score of 2 were correlated with a 64% reduction in the odds of having an appropriate prophylaxis. The appropriateness of the timing of prophylactic antibiotic administration was observed in 53.4% of the procedures. Multivariate logistic regression model showed that such appropriateness was more frequent in older patients, in those admitted in general surgery wards, in those not having been underwent an endoscopic surgery, in those with a higher length of surgery, and in patients with ASA score 1 when a score ≥4 was chosen as the reference category. The most common antibiotics used inappropriately were ceftazidime, sultamicillin, levofloxacin, and teicoplanin. CONCLUSIONS: Educational interventions are needed to improve perioperative appropriate antibiotic prophylaxis.

  12. Multimodal analgesia for perioperative pain in three cats.

    Steagall, Paulo V M; Monteiro-Steagall, Beatriz P


    Adequate pain relief is usually achieved with the simultaneous use of two or more different classes of analgesics, often called multimodal analgesia. The purpose of this article is to highlight the use of perioperative multimodal analgesia and the need to individualize the treatment plan based on the presenting condition, and to adjust it based on the response to analgesia for a given patient. This case series presents the alleviation of acute pain in three cats undergoing different major surgical procedures. These cases involved the administration of different classes of analgesic drugs, including opioids, non-steroidal anti-inflammatory drugs, tramadol, ketamine, gabapentin and local anesthetics. The rationale for the administration of analgesic drugs is discussed herein. Each case presented a particular challenge owing to the different cause, severity, duration and location of pain. Pain management is a challenging, but essential, component of feline practice: multimodal analgesia may minimize stress while controlling acute perioperative pain. Individual response to therapy is a key component of pain relief in cats. PMID:23382595

  13. Peri-operative cardiac protection for non-cardiac surgery.

    Wong, S S C; Irwin, M G


    Cardiovascular complications are an important cause of morbidity and mortality after non-cardiac surgery. Pre-operative identification of high-risk individuals and appropriate peri-operative management can reduce cardiovascular risk. It is important to continue chronic beta-blocker and statin therapy. Statins are relatively safe and peri-operative initiation may be beneficial in high-risk patients and those scheduled for vascular surgery. The pre-operative introduction of beta-blockers reduces myocardial injury but increases rates of stroke and mortality, possibly due to hypotension. They should only be considered in high-risk patients and the dose should be titrated to heart rate. Alpha-2 agonists may also contribute to hypotension. Aspirin continuation can increase the risk of major bleeding and offset the benefit of reduced myocardial risk. Contrary to the initial ENIGMA study, nitrous oxide does not seem to increase the risk of myocardial injury. Volatile anaesthetic agents and opioids have been shown to be cardioprotective in animal laboratory studies but these effects have, so far, not been conclusively reproduced clinically. PMID:26620144

  14. Perioperative Nutrition in Abdominal Surgery: Recommendations and Reality

    Yannick Cerantola


    Full Text Available Introduction. Preoperative malnutrition is a major risk factor for increased postoperative morbidity and mortality. Definition and diagnosis of malnutrition and its treatment is still subject for controversy. Furthermore, practical implementation of nutrition-related guidelines is unknown. Methods. A review of the available literature and of current guidelines on perioperative nutrition was conducted. We focused on nutritional screening and perioperative nutrition in patients undergoing digestive surgery, and we assessed translation of recent guidelines in clinical practice. Results and Conclusions. Malnutrition is a well-recognized risk factor for poor postoperative outcome. The prevalence of malnutrition depends largely on its definition; about 40% of patients undergoing major surgery fulfil current diagnostic criteria of being at nutritional risk. The Nutritional Risk Score is a pragmatic and validated tool to identify patients who should benefit from nutritional support. Adequate nutritional intervention entails reduced (infectious complications, hospital stay, and costs. Preoperative oral supplementation of a minimum of five days is preferable; depending on the patient and the type of surgery, immune-enhancing formulas are recommended. However, surgeons' compliance with evidence-based guidelines remains poor and efforts are necessary to implement routine nutritional screening and nutritional support.

  15. Future accelerators (?)

    I describe the future accelerator facilities that are currently foreseen for electroweak scale physics, neutrino physics, and nuclear structure. I will explore the physics justification for these machines, and suggest how the case for future accelerators can be made

  16. Future accelerators (?)

    John Womersley


    I describe the future accelerator facilities that are currently foreseen for electroweak scale physics, neutrino physics, and nuclear structure. I will explore the physics justification for these machines, and suggest how the case for future accelerators can be made.

  17. Accelerating Value Creation with Accelerators

    Jonsson, Eythor Ivar


    accelerator programs. Microsoft runs accelerators in seven different countries. Accelerators have grown out of the infancy stage and are now an accepted approach to develop new ventures based on cutting-edge technology like the internet of things, mobile technology, big data and virtual reality. It is also......Accelerators can help to accelerate value creation. Accelerators are short-term programs that have the objective of creating innovative and fast growing ventures. They have gained attraction as larger corporations like Microsoft, Barclays bank and Nordea bank have initiated and sponsored...

  18. 感染性心内膜炎患者瓣膜置换围术期护理配合分析%Perioperative Nursing Coordination for Patients With Infective Endocarditis Valve Replacement



    目的:探讨感染性心内膜炎患者瓣膜置换围术期护理配合效果。方法对照组患者采用常规护理模式予以护理,观察组患者实施围术期护理。结果观察组患者的护理效果与总满意度均要优于对照组。结论对于感染性心内膜炎患者瓣膜置换的围术期配合有效的护理措施,是有效改善病情,降低并发症发生率,保证手术成功的重要手段。%Objective To investigate the effect of perioperative nursing in patients with infective endocarditis valve replacement.Methods The control group were treated with routine care model, the observation group were treated with perioperative care.Results The overall satisfaction with care results was better in observation group than the control group. Conclusion For patients with infective endocarditis valve replacement, effective perioperative care measures is effective in improving the condition and reduce the incidence of complications, it is an important means to ensure the success of surgery.

  19. Vibration control in accelerators

    Montag, C.


    In the vast majority of accelerator applications, ground vibration amplitudes are well below tolerable magnet jitter amplitudes. In these cases, it is necessary and sufficient to design a rigid magnet support structure that does not amplify ground vibration. Since accelerator beam lines are typically installed at an elevation of 1-2m above ground level, special care has to be taken in order to avoid designing a support structure that acts like an inverted pendulum with a low resonance frequency, resulting in untolerable lateral vibration amplitudes of the accelerator components when excited by either ambient ground motion or vibration sources within the accelerator itself, such as cooling water pumps or helium flow in superconducting magnets. In cases where ground motion amplitudes already exceed the required jiter tolerances, for instance in future linear colliders, passive vibration damping or active stabilization may be considered.

  20. Effects of Guided Undergraduate Perioperative Education on Recruiting Novice RNs and Retaining Experienced RNs.

    Foran, Paula


    This qualitative research describes undergraduate nurses' perceptions of their perioperative placement experiences and how they may affect their future perioperative employment. It also describes experienced perioperative nurses' perceptions of the effect of student placement experiences on retention. The author asked undergraduate nurses about their experiences in the OR, if any, and whether they would consider perioperative nursing as a career; the author also asked experienced perioperative educators to comment on whether there are correlations between types of perioperative student experiences that affect stress levels for supervising staff members. The author used reporting of disconfirming data, and expert peers performed an external examination of data to guarantee the rigor of qualitative data analysis. The findings indicate that undergraduate nurses who are provided with guided practical experiences (as opposed to non-guided experiences or no OR experiences) are more likely to consider perioperative nursing as a career. In addition, the findings show that the arrival of students in the OR with no preparation for the experience is a major stressor for staff members. PMID:26323223

  1. Evaluation of a hands-free wireless communication device in the perioperative environment.

    Jacques, Paul St; France, Daniel J; Pilla, Michael; Lai, Eric; Higgins, Michael S


    The objective of this study was to evaluate the efficiency and reliability of a hands-free voice over Internet protocol (VOIP) communication system in the perioperative environment. Two surveys were administered to anesthesiologists and operating room (OR) nurses working at an academic medical center. Providers were queried by alphanumeric pages or VOIP queries during OR work shifts to measure communication response times. Providers, responding to the query, were asked to verbally complete a system performance survey to capture information regarding their workload and work environment at the time of the query. A user feedback survey was independently administered in writing to a convenience sample of OR providers to obtain information regarding provider communication preferences, concerns, and recommendations. OR providers responded to communication queries four times faster when using VOIP compared to alphanumeric pagers. Providers found VOIP to be much less reliable than conventional pager-telephone systems. Dead spots in the 802.11b network and errors in speaker recognition were frequently cited as sources of system failures. Providers also expressed concern in maintaining confidentiality of patient data or other clinical data communicated using this system. The results of this study suggest that VOIP is still a developing technology but one that is currently viable in the clinical setting. The technology can be used efficiently and securely in health care if users are given the proper training its functions and capabilities. PMID:16478412

  2. Intensification of anxiety and depression, and personal resources among women during the peri-operative period

    Magdalena Lewicka


    Full Text Available Aim. Surgical treatment of women due to gynaecological disorders is the cause of stress and may lead to psychological changes. Studies concerning human response to stress emphasize the importance of the effect of the level of the sense of coherence, anxiety, depression, dispositional optimism and skills of expressing emotions on the quality of feelings and experiences in difficult situations. Materials and methods. The study covered 232 women who had undergone gynaecological surgery due to various causes. Permission to conduct the research was obtained from the Bioethical Commission at the Medical University in Lublin. The study was carried out with the use of the State-Trait Anxiety Inventory (STAI, the Beck Depression Inventory, Courtauld Emotional Control Scale (CECS, and Life Orientation Test – Revised (LOT-R. Results and conclusions. The study showed that investigations of the sense of coherence, level of anxiety and depression, and personal resources allow determination of the characteristics of patients who should be covered with special psychoprophylactic care during the peri-operative period. In addition, the results of own studies obtained may be used for the development of adequate principles of psycho-prophylactic management in the course of the diagnostic-treatment proces with respect to women who had undergone surgical treatment due to gynaecological disorders.

  3. Novel Oral Anticoagulants: Recommendations for Patient Evaluation, Treatment Initiation, Follow-up and Perioperative Management.

    Baumann, Stefan; Huseynov, Aydin; El-Battrawy, Ibrahim; Renker, Matthias; Akin, Ibrahim


    New oral anticoagulants (NOACs) are becoming available as alternatives to vitamin K antagonists (VKAs) to prevent systemic embolism in patients with non-valvular atrial fibrillation for the prevention and treatment of venous thromboembolism and pulmonary embolism. A comprehensive understanding of the basic concepts of hemostaseology, the underlying pharmacology, drug interactions and management of potential complications is essential for the selection of suitable patients to receive NOACs, for correct prescription and for optimal patient treatment. Furthermore, the use of NOACs in a perioperative setting is crucial, as it requires knowledge of time and dose of last intake of drug, current renal function and the planned procedure in order to assess the overall risk of bleeding. Although no antidote exists to reverse the effects of these novel drugs, selective substitution of coagulation factors and dialysis may be necessary. Therefore, choosing the most beneficial alternative to VKAs on an individual basis can be challenging for physicians. In conclusion, the recent introduction of NOACs represents an opportunity for anticoagulative treatment regimes, while the benefits, risks and limitations should be reflected carefully. The purpose of this systematic review is to highlight features and to provide practical guidance of NOACs in comparison with VKAs that should be considered in a multifaceted decision making process to improve efficacy and safety. PMID:26666330

  4. Perioperative Glycemic Control in Plastic Surgery: Review and Discussion of an Institutional Protocol.

    Dortch, John D; Eck, Dustin L; Ladlie, Beth; TerKonda, Sarvam P


    Perioperative hyperglycemia is a well-known risk factor for surgical morbidity such as wound healing, infection, and prolonged hospitalization. This association has been reported for a number of surgical subspecialties, including plastic surgery. Specialty-specific guidelines have become increasingly available in the literature. Currently, glucose management guidelines for plastic surgery are lacking. Recognizing that multiple approaches exist for perioperative glucose, protocol-based models provide the necessary structure and guidance for approaching glycemic control. In this article, we review the influence of diabetes on outcomes in plastic surgery patients and propose a practical approach to perioperative blood glucose management based on current Endocrine Society and Mayo Clinic institutional guidelines. PMID:27301370

  5. [Perioperative Challenges and Strategies for Patent Foramen Ovale Patients Undergoing Non-cardiac Surgery].

    Wang, Tian; Zhu, Bin


    The close relationship between patent foramen ovale(PFO)and cryptogenic ischemic cerebrovascular disease and migraine has been concerned for years. However,in the field of non-cardiac surgery and anesthesiology, PFO and related clinical problems are less recognized. Under perioperative circumstances,PFO may generate many challenges such as paradoxical systematic embolism and severe hypoxemia. This article briefly introduces the epidemiology, paradoxical embolism, and detection methods of PFO and discribes the perioperative complications and corresponding perioperative strategies for prevention and cure. PMID:26564467

  6. [Preoperative evaluation and perioperative prevention of infectious diseases].

    Moriyama, Kiyoshi


    Preoperative evaluation of infectious diseases in patients for elective and non-elective surgery is important for the anesthesiologists not only to rule out the patient's state of illness, but also to prevent transmission of infectious diseases in healthcare settings. To prevent transmission of infectious diseases in healthcare settings, Center for Disease Control published guidelines that consist of standard precaution and transmission-based precautions. In the face of exposure to known infectious diseases, certain post exposure prophylaxis has been established, especially against exposure to human immunodeficiency virus and hepatitis B virus. There are also growing interests in perioperative prevention of surgical site infection, since World Health Organization has published surgical safety checklist with the slogan "Safe surgery saves life". Anesthesiologists need to have knowledge on the prevention of surgical site infection especially on antibiotic prophylaxis, because it starts in the operating room. PMID:20857671

  7. Perioperative glucocorticoids in hip and knee surgery - benefit vs. harm?

    Lunn, T H; Kehlet, H


    Glucocorticoids are frequently used to prevent post-operative nausea and vomiting (PONV), and may be part of multimodal analgesic regimes. The objective of this review was to evaluate the overall benefit vs. harm of perioperative glucocorticoids in patients undergoing hip or knee surgery. A wide...... glucocorticoid administration analogous to > 10 mg or ≤ 10 mg dexamethasone, and local glucocorticoid administration. Seventeen studies with data from 1081 patients were included in the final qualitative synthesis. Benefit (of any kind) with glucocorticoid vs. placebo was reported in 15 studies. PONV was reduced......-analysis was performed. In conclusion, in addition to PONV reduction with low-dose systemic glucocorticoid, this review supports high-dose systemic glucocorticoid to ameliorate post-operative pain after hip and knee surgery. However, large-scale safety and dose-finding studies are warranted before final...

  8. Nursing team stress in the perioperative period: an integrative review

    Dafne Eva Corrêa Brandão


    Full Text Available This integrative review aimed at analyzing evidences available in literature regarding stress levels in nursing teams during the perioperative period. Primary studies were searched in the following databases: PubMed, CINAHL and LILACS. Included studies were grouped into the following thematic categories: stress level in the workplace and stress factors (n=8 and stress coping strategies used by the nursing staff (n=6. Evidence suggests that stress in the workplace worsens the health of the nursing team, provoking undesirable effects both in the professional and personal lives of these professionals. The assessment of working conditions to identify the main stressing factors and the implementation of individual and organizational measures to reduce nursing teams stress may increase productivity and workers’ satisfaction, improving the assistance quality offered to surgical patients.

  9. Clinical and diagnostic features of perioperative hypersensitivity to cefuroxime

    Christiansen, I S; Krøigaard, M; Mosbech, H; Skov, P S; Poulsen, L K; Garvey, L H


    INTRODUCTION: The Danish Anaesthesia Allergy Centre (DAAC) investigated 89 adult patients with suspected perioperative cefuroxime-associated hypersensitivity reactions between 2004 and 2013. The goals were to determine if the time to index reaction after cefuroxime exposure could be used to...... implicate cefuroxime as the cause of the reactions and explore different test modalities in diagnosing cefuroxime hypersensitivity. METHOD: Skin tests, in vitro tests, and titrated provocations were used to determine cefuroxime hypersensitivity. Patients were deemed cefuroxime positive on the basis of at...... patients reacted in < 15 minutes versus only 38/58 (65.5%) of negative patients. CONCLUSION: All patients with confirmed hypersensitivity to cefuroxime reacted within 15 minutes of administration, but so did 65.5% of cefuroxime negative patients, making timing of administration an unreliable predictor of...

  10. Brugada syndrome and its relevance in the perioperative period

    Dan Sorajja


    Full Text Available Brugada syndrome is an autosomal dominant genetic disorder associated with an increased risk of sudden cardiac death, as well as ventricular tachyarrhythmias.The defective cardiac sodium channels result in usual electrocardiographic findings of a coved-type ST elevation in precordial leads V1 to V3. The majority of patients have uncomplicated courses with anesthesia, surgery, and invasive procedures. However there is risk of worsening ST elevation and ventricular arrhythmias due to perioperative medications, surgical insult, electrolyte abnormalities, fever, autonomic nervous system tone, as well as other perturbations. Given the increasing numbers of patients with inherited conduction disorders presenting for non-cardiac surgery that are at risk of sudden cardiac death, safe anesthetic management depends upon a detailed knowledge of these conditions.

  11. A Department-of-Anesthesiology-based management protocol for perioperative corneal abrasions

    Lichter JR


    the morning following their complaint. Compared to the general surgical population, CA patients were older (P<0.01 and underwent longer surgeries (P<0.01. Conclusion: Minor CAs can be safely and effectively managed using an anesthesiology-based approach. Advanced age and longer surgery are confirmed as risk factors for these injuries. Keywords: corneal injuries, clinical protocols, patient care management, perioperative complications

  12. Comunicação terapêutica no cuidado pré-operatório de mastectomia Comunicación terapéutica en la atención pre-operatoria de mastectomía Therapeutic communication in perioperative care of mastectomy

    Miria Conceição Lavinas Santos


    that the practice of therapeutic communication becomes a favorable practice, because establish the nurse-patient relationship, with patient producing his own care. Understanding the fragility of the patient at this stage, the nurse takes commitment to predefine the nursing care in partnership, in order to meet the patient needs, aiming to, mainly, the autonomy of care. In this way, the authors present a proposal for nursing managed care based on a mutal relationship, human and participatory care.

  13. Accelerating the development of an information ecosystem in health care, by stimulating the growth of safe intermediate processing of health information (IPHI

    Harshana Liyanage


    Full Text Available Health care, in common with many other industries, is generating large amounts of routine data, data that are challenging to process, analyse or curate, so-called ‘big data’. A challenge for health informatics is to make sense of these data. Part of the answer will come from the development of ontologies that support the use of heterogeneous data sources and the development of intermediate processors of health information (IPHI. IPHI will sit between the generators of health data and information, often the providers of health care, and the managers, commissioners, policy makers, researchers, and the pharmaceutical and other healthcare industries. They will create a health ecosystem by processing data in a way that stimulates improved data quality and potentially health care delivery by providers of health care, and by providing greater insights to legitimate users of data. Exemplars are provided of how a health ecosystem might be encouraged and developed to promote patient safety and more efficient health care. These are in the areas of how to integrate data around the unsafe use of alcohol and to explore vaccine safety. A challenge for IPHI is how to ensure that their processing of data is valid, safe and maintains privacy. Development of the healthcare ecosystem and IPHI should be actively encouraged internationally. Governments, regulators and providers of health care should facilitate access to health data and the use of national and international comparisons to monitor standards. However, most importantly, they should pilot new methods of improving quality and safety through the intermediate processing of health data.

  14. Ambulatory anesthetic care in pediatric tonsillectomy: challenges and risks

    Collins, Corey


    Corey Collins Massachusetts Eye and Ear Infirmary, Department of Anesthesiology, Harvard Medical School, Boston, MA, USA Abstract: Pediatric tonsillectomy is a common surgery around the world. Surgical indications are obstructive sleep apnea and recurrent tonsillitis. Despite the frequency of tonsillectomy in children, most aspects of perioperative care are supported by scant evidence. Recent guidelines provide important recommendations although clinician adherence or awareness of published ...

  15. Laser accelerator

    Vigil, Ricardo


    Approved for public release; distribution is unlimited In 1979,W. B. Colson and S. K. Ride proposed a new kind of electron accelerator using a uniform magnetic field in combination with a circularly-polarized laser field. A key concept is to couple the oscillating electric field to the electron’s motion so that acceleration is sustained. This dissertation investigates the performance of the proposed laser accelerator using modern high powered lasers and mag-netic fields that are significan...

  16. Comparative Analysis of Early Perioperative Outcomes Following Radical Cystectomy by Either the Robotic or Open Method

    Galich, Anton; Sterrett, Samuel; Nazemi, Tanya; Pohlman, Garrett; Smith, Lynette; Balaji, K. C.


    Objective: We analyzed early perioperative outcomes following radical cystectomy by the robotic method compared with the conventional open method. Methods: All relevant clinical information was entered in a Microsoft Access Database and queried. P

  17. Perioperative pregabalin improves pain and functional outcomes 3 months after lumbar discectomy.

    Burke, Siun M


    Patient outcome after lumbar discectomy for radicular low back pain is variable and the benefit is inconsistent. Many patients continue to experience pain 3 months after surgery. Pregabalin, a membrane stabilizer, may decrease perioperative central sensitization and subsequent persistent pain.

  18. Perioperative factors related to prognosis of regular hepatectomy in comparison with irregular hepatectomy

    Feng Zhiqiang; Li Hongqi; Zhang Jinqian; Xu Lining; Xiao Mei; Huang Zhiqiang; Zhang Hongyi


    Background The aim of this research was to analyze the perioperative factors of regular hepatectomy and irregular hepatectomy.The superiority of the clinical application of the two methods was compared in the perioperative period.Methods From 1986 to 2011,1798 patients underwent consecutive liver resections with regular hepatectomy and irregular hepatectomy at the Air Force General Hospital of People's Liberation Army and the General Hospital of Chinese People's Liberation Army.Their medical documentation was investigated retrospectively.Results In patients on whom regular hepatectomy and irregular hepatectomy were performed,there was no significant difference in perioperative blood loss,complications,in-hospital mortality,hospital stay,and so on.But in regular hepatectomy,operating time was an independent risk factor (P <0.001,OR=1.004).Conclusions There was no significant difference between the perioperative risk of regular hepatectomy and that of irregular hepatectomy.

  19. Development of a New Graduate Perioperative Nursing Program at an Urban Pediatric Institution.

    Gorgone, Pamela D; Arsenault, Loretta; Milliman-Richard, Yolanda J; Lajoie, Debra L


    In 2012, perioperative personnel from Boston Children's Hospital began the process of planning for perioperative staff member attrition and retirement by developing a new graduate perioperative nursing program geared toward our pediatric urban academic institution. We selected two cohorts of new graduate nurses to begin the program in 2013. To date, two cohorts of six graduate nurses have completed the program and have been hired. Our new perioperative nurse retention rate is 100%. All of these nurses are currently practicing in the main OR at our facility. In one year, we recovered the initial program costs, which included the expenses incurred by hiring 12 full-time employees to replace more highly paid tenured RNs lost to attrition or retirement and training costs for new graduates. We believe the program has reduced overall long-term staffing costs and has prevented disruption to services as a result of unexpected vacancies from retirements and resignations. PMID:27350352

  20. Impact of surgical case order on perioperative outcomes for robotic-assisted radical prostatectomy

    Anil A Thomas


    Conclusions: Surgical case order may influence perioperative outcomes for RARP with decreased operative times and increased length of hospital stay associated with later cases. These findings indicate that select perioperative factors may improve with ascending case order as the surgical team "warms up" during the day. In addition, 3 rd round cases can increase hospital costs associated with increased lengths of hospital stay. Knowledge of these differences may assist in surgical planning to improve outcomes and limit costs.

  1. Perioperative Risk Factors Related to Lumbar Spine Fusion Surgery in Korean Geriatric Patients

    Lee, Jung-Hyun; Chun, Hyoung-Joon; Yi, Hyeong-Joong; Bak, Koang Hum; Ko, Yong; Lee, Yoon Kyoung


    Objective Life expectancy for humans has increased dramatically and with this there has been a considerable increase in the number of patients suffering from lumbar spine disease. Symptomatic lumbar spinal disease should be treated, even in the elderly, and surgical procedures such as fusion surgery are needed for moderate to severe lumbar spinal disease. However, various perioperative complications are associated with fusion surgery. The aim of this study was to examine perioperative complic...

  2. Alveolar recruitment maneuver and perioperative ventilatory support in obese patients undergoing abdominal surgery.

    Forgiarini Júnior, Luiz Alberto; Rezende, Juliana Castilhos; Forgiarini, Soraia Genebra Ibrahim


    The development of abdominal surgery represents an alternative therapy for the morbidly obese; however, patients undergoing this surgical procedure often experience postoperative pulmonary complications. The use of alveolar recruitment maneuvers and/or perioperative ventilatory strategies is a possible alternative to reduce these complications, focusing on the reduction of postoperative pulmonary complications. In this review, the benefits of perioperative ventilatory strategies and the implementation of alveolar recruitment maneuvers in obese patients undergoing abdominal surgery are described. PMID:24553513

  3. The practice of cardiothoracic surgeons in the perioperative staging of non-small cell lung cancer.

    Tsang, G M; Watson, D C


    BACKGROUND: The treatment and prognosis of non-small cell lung cancer, and assessment of the results of treatment, depend on accurate perioperative staging. The extent to which this is carried out in the United Kingdom is unknown. METHODS: A postal questionnaire survey was undertaken in 1990 to determine the perioperative staging practices of cardiothoracic surgeons in the United Kingdom. RESULTS: Replies from 77 surgeons, who between them performed about 4833 pulmonary resections a year for ...

  4. Perioperative Statin Therapy Is Not Associated With Reduced Risk of Anastomotic Leakage After Colorectal Resection

    Bisgård, Anne Sofie; Noack, Morten Westergaard; Klein, Mads;


    Anastomotic leakage is a serious complication of colorectal surgery. Several studies have demonstrated the beneficial pleiotropic effects of statins, and preliminary studies have suggested that perioperative statin treatment may be associated with reduced risk of anastomotic leakage.......Anastomotic leakage is a serious complication of colorectal surgery. Several studies have demonstrated the beneficial pleiotropic effects of statins, and preliminary studies have suggested that perioperative statin treatment may be associated with reduced risk of anastomotic leakage....

  5. Perioperative management of patients for osteo-odonto-kreatoprosthesis under general anaesthesia: A retrospective study

    Rakesh Garg; Puneet Khanna; Renu Sinha


    An osteo-odonto-keratoprosthesis (OOKP) procedure is indicated in patients with failed corneal transplant but having intact retina for visual improvement. We studied perioperative concerns of patients who underwent the staged OOKP procedure. This was a retrospective analysis of patients who underwent OOKP. The information regarding symptoms, associated comorbidities, perioperative events including anaesthetic management were collected. Eight patients (five females and three males) underwent t...

  6. Normal carcinoembryonic antigen indicates benefit from perioperative chemotherapy to gastric carcinoma patients

    Shi Chen; Ying-Bo Chen; Yuan-Fang Li; Xing-Yu Feng; Zhi-Wei Zhou; Xiu-Hong Yuan; Chao-Nan Qian


    AIM:To evaluate pretreatment serum carcinoembryonic antigen (CEA) as a predictor of survival for patients with locally advanced gastric cancer receiving perioperative chemotherapy.METHODS:We retrospectively studied a cohort of 228gastric cancer patients who underwent D2 gastrectomy combined with chemotherapy at the Sun Yat-sen University Cancer Center between January 2005 and December 2009.Among them,168 patients received 6-12 cycles of oxaliplatin-based adjuvant (post-operative) chemotherapy,while 60 received perioperative chemotherapy (2 cycles of FOLFOX6 or XELOX before surgery and 4-10 cycles after surgery).Serum CEA was measured using an enzyme immunoassay.The followup lasted until December 2010.RESULTS:In the group that had elevated serum CEA,the difference in survival time between patients receiving perioperative chemotherapy and those receiving adjuvant chemotherapy had no statistical significance (P >0.05).However,in the group that had normal serum CEA,patients receiving perioperative chemotherapy had a longer survival time.In multivariate analysis,T staging and lymph node metastatic rate were independent prognostic factors for the patients.Perioperative chemotherapy improved the overall survival of patients who had a normal pretreatment CEA level (P =0.070).CONCLUSION:Normal pretreatment serum CEA is a predictor of survival for patients receiving perioperative chemotherapy.

  7. LIBO accelerates


    The prototype module of LIBO, a linear accelerator project designed for cancer therapy, has passed its first proton-beam acceleration test. In parallel a new version - LIBO-30 - is being developed, which promises to open up even more interesting avenues.

  8. Induction accelerators

    Takayama, Ken


    A broad class of accelerators rests on the induction principle whereby the accelerating electrical fields are generated by time-varying magnetic fluxes. Particularly suitable for the transport of bright and high-intensity beams of electrons, protons or heavy ions in any geometry (linear or circular) the research and development of induction accelerators is a thriving subfield of accelerator physics. This text is the first comprehensive account of both the fundamentals and the state of the art about the modern conceptual design and implementation of such devices. Accordingly, the first part of the book is devoted to the essential features of and key technologies used for induction accelerators at a level suitable for postgraduate students and newcomers to the field. Subsequent chapters deal with more specialized and advanced topics.

  9. Accelerator Experiments for Astrophysics

    Ng, Johnny S. T.


    Many recent discoveries in astrophysics involve phenomena that are highly complex. Carefully designed experiments, together with sophisticated computer simulations, are required to gain insights into the underlying physics. We show that particle accelerators are unique tools in this area of research, by providing precision calibration data and by creating extreme experimental conditions relevant for astrophysics. In this paper we discuss laboratory experiments that can be carried out at the S...

  10. Collaborating With Music Therapists to Improve Patient Care.

    Palmer, Jaclyn Bradley; Lane, Deforia; Mayo, Diane


    Collaboration between perioperative nurses and music therapists can be beneficial in providing a safe, cost-effective means of managing patients' anxiety and pain and reducing the need for pharmacologic intervention in the perioperative setting. The use of a board-certified music therapist may help to improve patient outcomes, ease nurse workload, and serve as an adjunct therapeutic modality that is enjoyable for both patients and staff members. We conducted a two-year, randomized controlled trial to determine how to best implement a music therapy program, navigate its challenges, and collaborate with nurse colleagues to bring its benefits to surgical patients. This article offers suggestions for alliances between perioperative nursing and music therapy staff members and describes the potential of music therapists to help provide optimal patient care. PMID:27568531

  11. Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery.

    Smith, Justin S; Klineberg, Eric; Lafage, Virginie; Shaffrey, Christopher I; Schwab, Frank; Lafage, Renaud; Hostin, Richard; Mundis, Gregory M; Errico, Thomas J; Kim, Han Jo; Protopsaltis, Themistocles S; Hamilton, D Kojo; Scheer, Justin K; Soroceanu, Alex; Kelly, Michael P; Line, Breton; Gupta, Munish; Deviren, Vedat; Hart, Robert; Burton, Douglas C; Bess, Shay; Ames, Christopher P


    OBJECTIVE Although multiple reports have documented significant benefit from surgical treatment of adult spinal deformity (ASD), these procedures can have high complication rates. Previously reported complications rates associated with ASD surgery are limited by retrospective design, single-surgeon or single-center cohorts, lack of rigorous data on complications, and/or limited follow-up. Accurate definition of complications associated with ASD surgery is important and may serve as a resource for patient counseling and efforts to improve the safety of patient care. The authors conducted a study to prospectively assess the rates of complications associated with ASD surgery with a minimum 2-year follow-up based on a multicenter study design that incorporated standardized data-collection forms, on-site study coordinators, and regular auditing of data to help ensure complete and accurate reporting of complications. In addition, they report age stratification of complication rates and provide a general assessment of factors that may be associated with the occurrence of complications. METHODS As part of a prospective, multicenter ASD database, standardized forms were used to collect data on surgery-related complications. On-site coordinators and central auditing helped ensure complete capture of complication data. Inclusion criteria were age older than 18 years, ASD, and plan for operative treatment. Complications were classified as perioperative (within 6 weeks of surgery) or delayed (between 6 weeks after surgery and time of last follow-up), and as minor or major. The primary focus for analyses was on patients who reached a minimum follow-up of 2 years. RESULTS Of 346 patients who met the inclusion criteria, 291 (84%) had a minimum 2-year follow-up (mean 2.1 years); their mean age was 56.2 years. The vast majority (99%) had treatment including a posterior procedure, 25% had an anterior procedure, and 19% had a 3-column osteotomy. At least 1 revision was required in 82

  12. Can Perioperative Chemotherapy for Advanced Gastric Cancer Be Recommended on the Basis of Current Research? A Critical Analysis

    Bauer, Katrin; Porzsolt, Franz; Henne-Bruns, Doris


    Purpose According to current guidelines, perioperative chemotherapy is an integral part of the treatment strategy for advanced gastric cancer. Randomized controlled studies have been conducted in order to determine whether perioperative chemotherapy leads to improved R0 resection rates, fewer recurrences, and prolonged survival. The aim of our project was to critically appraise three major studies to establish whether perioperative chemotherapy for advanced, potentially resectable gastric can...

  13. Esophageal Carcinoma Histology Affects Perioperative Morbidity Following Open Esophagogastrectomy

    Charles E. Woodall


    Full Text Available Background. Esophagectomy for esophageal cancer is being practiced routinely with favorable results at many centers. We sought to determine if tumor histology is a powerful surrogate marker for perioperative morbidity. Methods. Seventy three consecutive patients managed operatively were reviewed from our prospectively maintained database. Results. Adenocarcinoma (AC was present in 52 (71% and squamous cell (SCC in 21 (29%. The use of neoadjuvant therapy was similar for the AC (34.62% and SCC (42.86% groups. The SCC group had a higher incidence of prior pulmonary disease than the AC group (23.8% versus 5.8%, resp.; =.03. SCC patients were more likely to have a prolonged ICU stay than AC patients (=.004 despite similar complication rates, EBL, and prognostic nutritional index. The SCC group did, however, experience higher grades of complications (=.0053. Conclusions. Presence of SCC was the single best predictor of prolonged ICU stay and more severe complications as defined by this study. Only a past history of pulmonary disease was different between the two histologic subgroups.

  14. Determinants of perioperative morbidity and mortality after pneumonectomy

    A total of 197 consecutive patients undergoing pneumonectomy at the M.D. Anderson Cancer Center from 1982 to 1987 were reviewed. Sixty-five variables were analyzed for the predictive value for perioperative risk. The operative mortality rate was 7% (14/197). Patients having a right pneumonectomy (n = 95) had a higher operative mortality rate (12%) than patients having a left pneumonectomy (1%, p less than 0.05). The extent of resection correlated with the operative mortality rate (chest wall resection or extrapleural pneumonectomy, n = 39, 15%; versus simple or intrapericardial pneumonectomy, n = 158, 5%; p less than 0.05). Patients whose predicted postoperative pulmonary function, by spirometry and xenon 133 regional pulmonary function studies, was a forced expiratory volume in 1 second greater than 1.65 L, forced expiratory volume in 1 second greater than 58% of the preoperative value, forced vital capacity greater than 2.5 L, or forced vital capacity greater than 60% of the preoperative value had a lower operative mortality rate (p less than 0.05). Atrial arrhythmia was the most common postoperative complication (23%). Xenon 133 regional pulmonary function studies are useful in predicting the risks of pneumonectomy

  15. An analysis of acute complications and perioperative morbidity from high dose rate brachytherapy in the treatment of gynecological malignancies

    Purpose: To evaluate the acute morbidity and mortality for high dose-rate (HDR) brachytherapy performed in an outpatient setting in the treatment of gynecological malignancies, and to identify possible risk factors for adverse outcomes. Materials and Methods: One hundred seventy-one patients with cervical (n=129) or uterine (n=42) carcinoma with an intact uterus were evaluated and treated from August 1989 through December 1994, with at least part of their therapy delivered with intracavitary HDR 192Ir radiation. A total of 830 ICR insertions were performed with greater than 95% done on an outpatient basis under heavy intravenous sedation using fentanyl and midazolam. Perioperative morbidity and mortality were recorded for any event occurring within 30 days of the completion of therapy. Anesthesia risk was evaluated retrospectively in all patients based on the American Society of Anesthesiologists' (ASA) Physical Class System. Results: The uterine patients, many treated with radiation alone because of morbid obesity or medical inoperability, had a significantly higher perioperative morbidity and mortality rate as compared to the cervix patient cohort. Thirteen of the 42 (31%) uterine patients and 8 of the 129 (6%) cervix patients required hospitalization within 30 days of treatment completion (p2) experienced greater morbidity and mortality, while the best predictor of complications in the cervix patients was age greater than 70 years. For the entire cohort of patients, no correlation was found between the 30 day morbidity and mortality and the doses of fentanyl and midazolam used or the length of the procedure. Conclusions: The acute complication rate from HDR brachytherapy performed on an outpatient basis with heavy intravenous sedation is acceptable for the great majority of patients who present for treatment. However, the high morbidity and mortality experienced by certain patient cohorts suggests that careful assessment of the risk/benefit ratio for treatment

  16. The use of relaxation techniques in the perioperative management of proctological patients: preliminary results.

    Renzi, C; Peticca, L; Pescatori, M


    Relaxation techniques positively affect the psychosomatic pattern of patients undergoing surgical treatment. Among these techniques guided imaging (GI) has been reported to improve outcome following colorectal surgery. This study assessed the effects of GI on the postoperative course in proctological patients. We carried out a prospective randomized trial in a group of patients operated on for anorectal diseases in our coloproctology unit. Patients were randomized into group 1 (n = 43) with standard care and group 2 (n = 43) with relaxation techniques; they listened to a GI tape with music and relaxing text before, during, and after surgery. The following parameters were evaluated by a questionnaire (a) postoperative pain measured by visual analogue score, (b) the quality of sleep measured by a similar score, and (c) the nature of first micturition, evaluated as normal or difficult. Groups were similar in age and sex distribution, type of disease, and operation performed. The pain score was 3.2 +/- 1.4 in GI patients and 4.1 +/- 2.1 in controls (P = 0.07). The quality of sleep score was 4.8 +/- 2.9 in GI patients and 6.4 +/- 2.7 in controls (P = 0.01). The first micturition was painful in 10.3% of GI patients and in 27.3% of controls (P = 0.09). Perioperative relaxation techniques thus showed a trend to reducing pain following anorectal surgery and significantly improving the quality of sleep; a decrease in anxiety and a consequent muscle relaxation may be involved. Therefore GI, a low cost and noninvasive procedure, can be recommended as an helpful tool in this type of surgery. PMID:11151436

  17. Preoperative interscalene brachial plexus block aids in perioperative temperature management during arthroscopic shoulder surgery

    Lim, Se Hun; Lee, Wonjin; Park, JaeGwan; Kim, Myoung-hun; Cho, Kwangrae; Lee, Jeong Han; Cheong, Soon Ho


    Background Hypothermia is common during arthroscopic shoulder surgery under general anesthesia, and anesthetic-impaired thermoregulation is thought to be the major cause of hypothermia. This prospective, randomized, double-blind study was designed to compare perioperative temperature during arthroscopic shoulder surgery with interscalene brachial plexus block (IBPB) followed by general anesthesia vs. general anesthesia alone. Methods Patients scheduled for arthroscopic shoulder surgery were randomly allocated to receive IBPB followed by general anesthesia (group GB, n = 20) or general anesthesia alone (group GO, n = 20), and intraoperative and postoperative body temperatures were measured. Results The initial body temperatures were 36.5 ± 0.3℃ vs. 36.4 ± 0.4℃ in group GB vs. GO, respectively (P = 0.215). The body temperature at 120 minutes after induction of anesthesia was significantly higher in group GB than in group GO (35.8 ± 0.3℃ vs. 34.9 ± 0.3℃; P < 0.001). The body temperatures at 60 minutes after admission to the post-anesthesia care unit were 35.8 ± 0.3℃ vs. 35.2 ± 0.2℃ in group GB vs. GO, respectively (P < 0.001). The concentrations of desflurane at 0, 15, and 120 minutes after induction of anesthesia were 6.0 vs. 6.0% (P = 0.330), 5.0 ± 0.8% vs. 5.8 ± 0.4% (P = 0.001), and 3.4 ± 0.4% vs. 7.1 ± 0.9% (P < 0.001) in group GB vs. GO, respectively. Conclusions The present study demonstrated that preoperative IBPB could reduce both the intraoperative concentration of desflurane and the reduction in body temperature during and after arthroscopic shoulder surgery.

  18. The Emory University Perioperative Algorithm for the Management of Hyperglycemia and Diabetes in Non-cardiac Surgery Patients.

    Duggan, Elizabeth W; Klopman, Matthew A; Berry, Arnold J; Umpierrez, Guillermo


    Hyperglycemia is a frequent manifestation of critical and surgical illness, resulting from the acute metabolic and hormonal changes associated with the response to injury and stress (Umpierrez and Kitabchi, Curr Opin Endocrinol. 11:75-81, 2004; McCowen et al., Crit Care Clin. 17(1):107-24, 2001). The exact prevalence of hospital hyperglycemia is not known, but observational studies have reported a prevalence of hyperglycemia ranging from 32 to 60 % in community hospitals (Umpierrez et al., J Clin Endocrinol Metab. 87(3):978-82, 2002; Cook et al., J Hosp Med. 4(9):E7-14, 2009; Farrokhi et al., Best Pract Res Clin Endocrinol Metab. 25(5):813-24, 2011), and 80 % of patients after cardiac surgery (Schmeltz et al., Diabetes Care 30(4):823-8, 2007; van den Berghe et al., N Engl J Med. 345(19):1359-67, 2001). Retrospective and randomized controlled trials in surgical populations have reported that hyperglycemia and diabetes are associated with increased length of stay, hospital complications, resource utilization, and mortality (Frisch et al., Diabetes Care 33(8):1783-8, 2010; Kwon et al., Ann Surg. 257(1):8-14, 2013; Bower et al., Surgery 147(5):670-5, 2010; Noordzij et al., Eur J Endocrinol. 156(1):137-42, 2007; Mraovic et al., J Arthroplasty 25(1):64-70, 2010). Substantial evidence indicates that correction of hyperglycemia reduces complications in critically ill, as well as in general surgery patients (Umpierrez et al., J Clin Endocrinol Metab. 87(3):978-82, 2002; Clement et al., Diabetes Care 27(2):553-97, 2004; Pomposelli et al., JPEN J Parented Enteral Nutr. 22(2):77-81, 1998). This manuscript reviews the pathophysiology of stress hyperglycemia during anesthesia and the perioperative period. We provide a practical outline for the diagnosis and management of preoperative, intraoperative, and postoperative care of patients with diabetes and hyperglycemia. PMID:26971119

  19. 气胸围手术期的患者临床护理分析%Analysis on Clinical Nursing of Patient with Pneumothorax During Perioperative Period



    Objective Clinical treatment effects and analysis of the patients with pneumothorax during perioperative period are to be investigated. Methods Systematic plan is needed for nursing of the patients with pneumothorax during perioperative period. Results After the surgery treatment of the patients with pneumothorax,there is a significant effect of clinical nursing. Conclusion The surgery treatment should be conducted for the patient with pneumothorax with postoperative drainage and rational usage of antibiotics,which can reduce the adverse reactions of patients effectively and the incidence of complications to accelerate the patients to get wel soon.%目的:探讨气胸围手术期的患者临床护理效果及分析。方法有计划的针对气胸围手术期的患者进行护理。结果对气胸患者实施手术治疗,临床护理效果显著,结论针对气胸患者实施手术治疗,术后充分引流,合理使用抗生素。有效降低患者不良反应及并发症的发生率,促进患者早日康复。

  20. Peri-operative chemotherapy in the management of resectable colorectal cancer pulmonary metastases

    Surgery is often advocated in patients with resectable pulmonary metastases from colorectal cancer (CRC). Our study aims to evaluate peri-operative chemotherapy in patients with metastastic CRC undergoing pulmonary metastasectomy. Patients treated for CRC who underwent pulmonary metastasectomy by a single surgeon were identified. Outcome measures included survival, peri-operative complications, radiological and histological evidence of chemotherapy-induced lung toxicities. Between 1997 and 2009, 51 eligible patients were identified undergoing a total of 72 pulmonary resections. Thirty-eight patients received peri-operative chemotherapy, of whom 9 received an additional biological agent. Five-year overall survival rate was 72% in the whole cohort - 74% and 68% in those who received peri-operative chemotherapy (CS) and those who underwent surgery alone (S) respectively. Five-year relapse free survival rate was 31% in the whole cohort - 38% and ≤18% in CS and S groups respectively. Only 8% had disease progression during neoadjuvant chemotherapy. There were no post-operative deaths. Surgical complications occurred in only 4% of patients who received pre-operative chemotherapy. There was neither radiological nor histological evidence of lung toxicity in resected surgical specimens. Peri-operative chemotherapy can be safely delivered to CRC patients undergoing pulmonary metastasectomy. Survival in this selected group of patients was favourable

  1. Peri-operative chemotherapy in the management of resectable colorectal cancer pulmonary metastases

    Hawkes Eliza A


    Full Text Available Abstract Background Surgery is often advocated in patients with resectable pulmonary metastases from colorectal cancer (CRC. Our study aims to evaluate peri-operative chemotherapy in patients with metastastic CRC undergoing pulmonary metastasectomy. Methods Patients treated for CRC who underwent pulmonary metastasectomy by a single surgeon were identified. Outcome measures included survival, peri-operative complications, radiological and histological evidence of chemotherapy-induced lung toxicities. Results Between 1997 and 2009, 51 eligible patients were identified undergoing a total of 72 pulmonary resections. Thirty-eight patients received peri-operative chemotherapy, of whom 9 received an additional biological agent. Five-year overall survival rate was 72% in the whole cohort - 74% and 68% in those who received peri-operative chemotherapy (CS and those who underwent surgery alone (S respectively. Five-year relapse free survival rate was 31% in the whole cohort - 38% and ≤18% in CS and S groups respectively. Only 8% had disease progression during neoadjuvant chemotherapy. There were no post-operative deaths. Surgical complications occurred in only 4% of patients who received pre-operative chemotherapy. There was neither radiological nor histological evidence of lung toxicity in resected surgical specimens. Conclusions Peri-operative chemotherapy can be safely delivered to CRC patients undergoing pulmonary metastasectomy. Survival in this selected group of patients was favourable.

  2. Tandem accelerators

    After the installation of Ti-acceleration tubes and substantial modifications and additions to the EN tandem accelerator the performance of the machine has stabilized. The voltage behaviour of the tubes obviously improves as conditioning times necessary to run up to 6 MV decrease. A gridded lens has been added at the entrance of the first acceleration tube, and a second foil stripper is now installed in the short dead section between the high-energy tubes. The MP tandem also has been running stably during most of the year. However, beam instabilities originating from the last tube section and wear problems at the low-energy set of pelletron-chains caused some loss of beam time. During the fall, one set of pelletron charging chains has to be replaced after 49,000 hours of operation. In the course of the year, the MP and the EN tandem accelerators finished their 100,000th and 150,000th hours of operations, respectively. Preparations for the installation of the 3 MV negative heavy ion injector for the MP are progressing steadily. External beam transport, terminal ion optics, and data acquisition and control systems are to a major extent completed; the integration of the terminal power supplies has started. After the final assembly of the accelerator column structure, first voltage runs can be performed. (orig.)

  3. Bullying, mentoring, and patient care.

    Frederick, Dorothea


    The literature suggests that acts of bullying are a root cause of new nurses leaving their units or the profession entirely and have the potential to worsen the nursing shortage. As an effective way to address bullying in the perioperative setting, mentoring benefits the nursing profession. Mentoring can have a direct influence on nurses' longevity in a health care organization, thereby strengthening the nursing workforce. Magnet-designated hospitals support the importance of mentor-mentee relationships for positive employee retention and positive recruitment outcomes. One of the most important tasks that a mentor should undertake is that of a role model. Establishing a culture of mentoring requires authentic leadership, genuine caring and respect for employees, and open communication. The entire nursing profession benefits from a culture of mentoring, as do the patients and families who receive care. PMID:24766920


    V. V. Samoylenko


    Full Text Available Optimization of the pharmacotherapy in preoperative period is the cornerstone of the concept of risk modification of cardiovascular complications in the perioperative period. Therefore, special attention has recently been focused on the use of beta-blockers in the postoperative period. Nowadays convincing evidence base for the use of this class of drugs in the perioperative period that was the basis for the development of clinical guidelines is accumulated. Moreover, results of large randomized trials of beta-blockers are controversial. This has resulted in significant differences in the classes of recommendations and levels of evidence.Analysis of the results of basic researches and the provisions of recommendations of the international and national professional medical societies on the use of beta-blockers in patients with cardiovascular disease to reduce the risk of cardiac complications in the perioperative period for planned extracardiac surgical procedures is presented.

  5. Clinical guidance on the perioperative use of targeted agents in solid tumor oncology.

    Mellor, James D; Cassumbhoy, Michelle; Jefford, Michael


    The use of targeted anti-cancer agents is increasing. It is common to utilize a multi-modal treatment approach towards solid tumors, often including surgical resection, and it has become apparent that some targeted agents can impair wound healing or cause an increased risk of perioperative complications. This article reviews targeted agents used in solid tumor oncology with an emphasis on clinically relevant details. Overall, the evidence of targeted agents causing surgical complications is limited. The greatest amount of evidence exists for bevacizumab causing perioperative complications, possibly due to its extended half-life. There are limited data for cetuximab, sorafenib and sunitinib and very little for other solid tumor targeted agents. Our findings suggest that there should be heightened pharmacovigilence around targeted agents with respect to perioperative complications and increased post-surgical support for patients to aid early detection of postoperative complications until definitive data become available. PMID:21585689

  6. Risk factors for perioperative major cardiac events in Chinese elderly patients with coronary heart disease undergoing noncardiac surgery

    LIU Zi-jia; YU Chun-hua; XU Li; HAN Wei; JIANG Jing-mei; HUANG Yu-guang


    Background Few studies have investigated perioperative major adverse cardiac events (MACEs) in elderly Chinese patients with coronary heart disease (CHD) undergoing noncardiac surgery.This study examined the incidence and risk factors for perioperative MACE in elderly patients who underwent noncardiac surgery,and established a risk stratification system.Methods This retrospective observational clinical study included 482 patients aged >60 years with CHD who underwent elective major noncardiac surgery at the Peking Union Medical College Hospital.The primary outcome was MACE within 30 days after surgery.Risk factors were evaluated using multivariate Logistic regression analysis.Results Perioperative MACE occurred in 61(12.66%) of the study patients.Five independent risk factors for perioperative MACE were identified:history of heart failure,preoperative arrhythmia,preoperative diastolic blood pressure <75 mmHg,American Society of Anesthesiologists grade 3 or higher,and intraoperetive blood transfusion.The area under the receiver operating characteristic curve for the risk-index score was 0.710±0.037.Analysis of the risk stratification system showed that the incidence of perioperative MACE increased significantly with increasing levels of risk.Conclusions Elderly Chinese patients with CHD who undergo noncardiac surgery have a high risk of perioperative MACE.Five independent risk factors for perioperative MACE were identified.Our risk stratification system may be useful for assessing perioperative cardiac risk in elderly patients undergoing noncardiac surgery.

  7. Effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing gastrectomy

    Han-Cheng Liu; Yan-Bing Zhou; Dong Chen; Zhao-Jian Niu; Yang Yu


    AIM:To investigate the effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing radical distal gastrectomy.METHODS:Within 24 h of intensive care unit management,patients with gastric cancer were enrolled after written informed consent and randomized to the intensive insulin therapy (IIT) group to keep glucose levels from 4.4 to 6.1 mmol/L or the conventional insulin therapy (CIT) group to keep levels less than 10 mmol/L.Resting energy expenditure (REE),respiratory quotient (RQ),resting energy expenditure per kilogram (REE/kg),and the lipid oxidation rate were monitored by the indirect calorimeter of calcium citrate malate nutrition metabolism investigation system.The changes in body composition were analyzed by multi-frequency bioimpedance analysis.Blood fasting glucose and insulin concentration were measured for assessment of Homeostasis model assessment of insulin resistance.RESULTS:Sixty patients were enrolled.Compared with preoperative baseline,postoperative REE increased by over 22.15% and 11.07%; REE/kg rose up to 27.22 ± 1.33 kcal/kg and 24.72 ± 1.43 kcal/kg; RQ decreased to 0.759 ± 0.034 and 0.791 ± 0.037; the lipid oxidation ratio was up to 78.25% ± 17.74% and 67.13% ± 12.76% supported by parenteral nutrition solutions from 37.56% ± 11.64% at the baseline; the level of Ln-HOMA-IR went up dramatically (P < 0.05,respectively) on postoperative days 1 and 3 in the IIT group.Meanwhile the concentration of total protein,albumin and triglyceride declined significantly on postoperative days 1 and 3 compared with pre-operative levels (P < 0.05,respectively).Compared with the CIT group,IIT reduced the REE/kg level (27.22 ± 1.33 kcal/kg vs 29.97 ± 1.47 kcal/kg,P =0.008; 24.72 ± 1.43 kcal/kg vs 25.66 ± 1.63 kcal/kg,P =0.013); and decreased the Ln-HOMA-IR score (P =0.019,0.028) on postoperative days 1 and 3; IIT decreased the level of CRP on postoperative days 1 and 3 (P

  8. Particle acceleration

    Vlahos, L.; Machado, M. E.; Ramaty, R.; Murphy, R. J.; Alissandrakis, C.; Bai, T.; Batchelor, D.; Benz, A. O.; Chupp, E.; Ellison, D.


    Data is compiled from Solar Maximum Mission and Hinothori satellites, particle detectors in several satellites, ground based instruments, and balloon flights in order to answer fundamental questions relating to: (1) the requirements for the coronal magnetic field structure in the vicinity of the energization source; (2) the height (above the photosphere) of the energization source; (3) the time of energization; (4) transistion between coronal heating and flares; (5) evidence for purely thermal, purely nonthermal and hybrid type flares; (6) the time characteristics of the energization source; (7) whether every flare accelerates protons; (8) the location of the interaction site of the ions and relativistic electrons; (9) the energy spectra for ions and relativistic electrons; (10) the relationship between particles at the Sun and interplanetary space; (11) evidence for more than one acceleration mechanism; (12) whether there is single mechanism that will accelerate particles to all energies and also heat the plasma; and (13) how fast the existing mechanisms accelerate electrons up to several MeV and ions to 1 GeV.

  9. Accelerator design

    The feasibility of constructing a TeV region electron-positron linear collider in Japan is discussed. The design target of the collider is given as follows: Energy, 1 TeV + 1 TeV; luminosity, 1032-1033/cm2/s; total length, 25km; electric power, 250MW; energy dispersion, 1%-10%; the start of the first experiment, early 1990s. For realizing the above target, the following research and developmental works are necessary. (a) Development of an acceleration tube with short filling time and high shunt resistance. (b) Short pulse microwave source with high peak power. (c) High current, single bunch linac. (d) Beam dynamics. As for the acceleration tube, some possibility is considered: For example, the use of DAW (Disk and Washer) which is being developed for TRISTAN as a traveling-wave tube; and the Jungle Gym-type acceleration tube. As a promising candidate for the microwave source, the Lasertron has been studied. The total cost of the collider construction is estimated to be about 310 billion yen, of which 120 billion yen is for the tunnel and buildings, and 190 billion yen for the accelerator facilities. The operation cost is estimated to be about 3 billion yen per month. (Aoki, K.)

  10. Accelerator operations

    This section is concerned with the operation of both the tandem-linac system and the Dynamitron, two accelerators that are used for entirely different research. Developmental activities associated with the tandem and the Dynamitron are also treated here, but developmental activities associated with the superconducting linac are covered separately because this work is a program of technology development in its own right

  11. Perioperative Colonic Evaluation in Patients with Rectal Cancer; MR Colonography Versus Standard Care

    Achiam, Michael Patrick; Løgager, Vibeke; Lund Rasmussen, Vera;


    postoperatively. RESULTS: Twenty-eight patients were randomized to group A and 28 to group B. Complete preoperative colonic evaluation with CC was achieved in 39% patients in group A and 93% for group B (Fisher's exact test, P < .001). PCE with CC was achieved in 64% and 93% in groups A and B, respectively...

  12. Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies).

    Ichai, Carole; Vinsonneau, Christophe; Souweine, Bertrand; Armando, Fabien; Canet, Emmanuel; Clec'h, Christophe; Constantin, Jean-Michel; Darmon, Michaël; Duranteau, Jacques; Gaillot, Théophille; Garnier, Arnaud; Jacob, Laurent; Joannes-Boyau, Olivier; Juillard, Laurent; Journois, Didier; Lautrette, Alexandre; Muller, Laurent; Legrand, Matthieu; Lerolle, Nicolas; Rimmelé, Thomas; Rondeau, Eric; Tamion, Fabienne; Walrave, Yannick; Velly, Lionel


    Acute kidney injury (AKI) is a syndrome that has progressed a great deal over the last 20 years. The decrease in urine output and the increase in classical renal biomarkers, such as blood urea nitrogen and serum creatinine, have largely been used as surrogate markers for decreased glomerular filtration rate (GFR), which defines AKI. However, using such markers of GFR as criteria for diagnosing AKI has several limits including the difficult diagnosis of non-organic AKI, also called "functional renal insufficiency" or "pre-renal insufficiency". This situation is characterized by an oliguria and an increase in creatininemia as a consequence of a reduction in renal blood flow related to systemic haemodynamic abnormalities. In this situation, "renal insufficiency" seems rather inappropriate as kidney function is not impaired. On the contrary, the kidney delivers an appropriate response aiming to recover optimal systemic physiological haemodynamic conditions. Considering the kidney as insufficient is erroneous because this suggests that it does not work correctly, whereas the opposite is occurring, because the kidney is healthy even in a threatening situation. With current definitions of AKI, normalization of volaemia is needed before defining AKI in order to avoid this pitfall. PMID:27230984

  13. [Risk assessment and management of exodontia perioperative patients with cardiovascular diseases].

    Wang, W Y


    The number of tooth extraction patients with cardiovascular disease in our country is increasing year by year. Safety is essential for those patients and there is no uniform standard of risk assessment and management for tooth extraction patients with cardiovascular disease during perioperative period. By referring to literatures and with the clinical experience, the author summarized the risk assessment methods for tooth extraction patients with cardiovascular disease during perioperative period. Blood pressure control, cardiac function determination, arrhythmia recognition, blood glucose management, oral antiplatelet or anticoagulant medicine use, etc, were proposed in this article. PMID:27480428

  14. Adverse effects of perioperative paracetamol, NSAIDs, glucocorticoids, gabapentinoids and their combinations

    Mathiesen, O; Wetterslev, Jørn; Kontinen, V K;


    most common perioperative non-opioid analgesics: paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids (GCCs), gabapentinoids and their combinations. The review is based on data from systematic reviews with meta-analyses of analgesic efficacy and/or adverse effects of...... perioperative non-opioid analgesics, and randomised trials and cohort/retrospective studies. Generally, data on AE are sparse and related to the immediate post-operative period. For paracetamol, the incidence of AEs appears trivial. Data are inconclusive regarding an association of NSAIDs with mortality...

  15. AORN Ergonomic Tool 6: lifting and carrying supplies and equipment in the perioperative setting.

    Waters, Thomas; Baptiste, Andrea; Short, Manon; Plante-Mallon, Lori; Nelson, Audrey


    Perioperative team members often are required to lift and carry heavy supplies and equipment into and around the OR; this includes lifting equipment such as hand tables, fluoroscopy boards, stirrups, Wilson frames, irrigation containers for lithotripsy, and heavy instrument pans. Lifting heavy objects creates considerable risk for musculoskeletal injuries to the back and shoulders. AORN Ergonomic Tool 6: Lifting and Carrying Supplies and Equipment in the Perioperative Setting can help caregivers evaluate lifting and carrying tasks and take measures to protect themselves from injury. Caregivers can use the revised National Institute for Occupational Safety and Health lifting equation to assess whether a specific lifting task can be performed safely. PMID:21802544

  16. Hemodynamic Assessment and Monitoring in the Intensive Care Unit: an Overview

    Adler, Adam C.; Ramakant Sharma; Thomas Higgins; McGee, William T


    The goal of hemodynamic monitoring in intensive care is to assess the adequacy of perfusion, specifically with regard to maintaining sufficient perfusion pressures and oxygen delivery. Precise volume management of peri-operative and critical care patients is crucial as under or over resuscitation is associated with adverse outcomes. Hemodynamic monitoring allows care to be individualized based on specific patient response to therapy and can provide early warning of impending perfusion deficit...

  17. Advanced accelerators

    This report discusses the suitability of four novel particle acceleration technologies for multi-TeV particle physics machines: laser driven linear accelerators (linac), plasma beat-wave devices, plasma wakefield devices, and switched power and cavity wakefield linacs. The report begins with the derivation of beam parameters practical for multi-TeV devices. Electromagnetic field breakdown of materials is reviewed. The two-beam accelerator scheme for using a free electron laser as the driver is discussed. The options recommended and the conclusions reached reflect the importance of cost. We recommend that more effort be invested in achieving a self-consistent range of TeV accelerator design parameters. Beat-wave devices have promise for 1-100 GeV applications and, while not directly scalable to TeV designs, the current generation of ideas are encouraging for the TeV regime. In particular, surfatrons, finite-angle optical mixing devices, plasma grating accelerator, and the Raman forward cascade schemes all deserve more complete analysis. The exploitation of standard linac geometry operated in an unconventional mode is in a phase of rapid evolution. While conceptual projects abound, there are no complete designs. We recommend that a fraction of sponsored research be devoted to this approach. Wakefield devices offer a great deal of potential; trades among their benefits and constraints are derived and discussed herein. The study of field limitation processes has received inadequate attention; this limits experiment designers. The costs of future experiments are such that investment in understanding these processes is prudent. 34 refs., 12 figs., 3 tabs

  18. Perioperative nursing of augmentation mammoplasty with silicone implant through armpit incision%经腋下切口硅胶置入隆乳术的围手术期护理

    谭文娟; 熊燕; 田诗政


    Objective To investigate the hospital via the armpit incision implantation of silicone augmentation mammoplasty surgery perioperative nursing. Methods December 2008 to October 2011,24 patients were taken before surgery, intraoperative and postoperative care to observe the perioperative care of patients undergoing augmentation, mammoplasty role of clinical care. Results 24 regular silicone implants augmentation mammmoplasty through armpit incision surgery after surgery, were successful plant income, type of milk after implantation full symmetry, no degeneration, inflammation and other adverse reactions, surgical success rate was 100%. Conclusion Complete perioperative care can help patients resume this morning to help the rehabilitation of patients.%目的:探讨我院行经腋下切口硅胶置入隆乳术的围手术期护理.方法:选择我院2008年12月~2011年10月在我院行硅胶置入隆乳术的患者24例,分别采取术前、术中以及术后护理,观察围手术期护理对隆乳术患者的临床护理作用;结果:24例行经腋下切口硅胶置入隆乳术的女性经手术后,均成功置入,置入后乳型丰满对称,无变性、炎症等不良反应,手术成功率100%;结论:完善的围手术期护理可以帮助患者今早的恢复,有助于患者的康复.


    WEI, J.


    In the framework of the CARE HHH European Network, we have developed a web-based dynamic accelerator-physics code repository. We describe the design, structure and contents of this repository, illustrate its usage, and discuss our future plans, with emphasis on code benchmarking.

  20. Perioperative Nursing for patients with the combination therapy of liposuction and abdominoplasty%脂肪抽吸联合腹壁整形术的围术期护理



    Objective To explore the perioperative nursing measures for the patients with the combination therapy of liposuction and abdominoplasty in order to reduce the incidence rate of postoperative complications. Methods 12 patients were treated with the combination therapy of liposuction and abdominoplasty, and all of them were conducted with careful perioperative nursing. Results Abdominal morphology of patients was improved significantly, the scars of surgical incisions were tiny and rarely observed. No patient had severe complications such as hematoma, fat liquefaction and fat embolism. Conclusion Perioperative nursing is the important factor for the success of combination operation of liposuction and abdominoplasty.%目的 探讨脂肪抽吸联合腹壁整形术的围术期护理措施,降低术后并发症的发生率.方法 将肿胀吸脂术和腹壁整形术联合应用于12例患者,并在围术期进行精心护理.结果 患者腹部形态明显改善,手术切口疤痕细小、隐蔽,无血肿发生,无脂肪液化、脂肪栓塞等严重并发症发生.结论 围术期的护理过程是影响脂肪抽吸联合腹壁整形术手术成败的重要因素.




    One of the major motivations driving recent interest in FFAGs is their use for the cost-effective acceleration of muons. This paper summarizes the progress in this area that was achieved leading up to and at the FFAG workshop at KEK from July 7-12, 2003. Much of the relevant background and references are also given here, to give a context to the progress we have made.

  2. KEKB accelerator

    KEKB, the B-Factory at High Energy Accelerator Research Organization (KEK) recently achieved the luminosity of 1 x 1034 cm-2s-1. This luminosity is two orders higher than the world's level at 1990 when the design of KEKB started. This unprecedented result was made possible by KEKB's innovative design and technology in three aspects - beam focusing optics, high current storage, and beam - beam interaction. Now KEKB is leading the luminosity frontier of the colliders in the world. (author)

  3. Psychological nursing research of breast cancer patients in the perioperative period%乳腺癌患者围术期进行心理护理的调查研究

    王宏; 张丽


    目的 调查乳腺癌患者围术期期间存在的心理问题及相关因素,实施正确护理,减轻心理困扰程度.方法 对65例乳腺癌患者在围手术期进行问卷调查,并进行心理护理.结果 进行心理护理后遭受心理困扰的患者人数明显减少(P<0.05).结论 所有乳腺癌患者都有不同程度的心理问题,实施心理护理后心理困扰程度明显降低.%Objective To investigate the psychological problems and related factors, the implementation of proper care of patients with breast cancer in perioperative period, to alleviate the psychological distress degree. Methods Sixty-five cases of breast cancer in the perioperative period to conduct a questionnaire survey, and accepted psychological care. Results After being accepted psychological care, the number of patients subjected to psychological distress significantly reduced(P<0.05).Conclusions All patients with breast cancer have different degrees of psychological problems, the implementation of psychological care significantly reduced the degree of psychological distress.

  4. 子宫癌患者围手术期进行心理护理的调查研究%Uterine cancer patients in the perioperative period of psychological nursing research

    王丰松; 牟宗梅; 郑玉秀; 孙衍伟


    Objective To investigate the perioperative period in patients with uterine cancer, psychological problems and related factors, the implementation of proper care, to alleviate the psychological distress degree. Methods 65 cases of uterine cancer patients in the perioperative period to conduct a questionnaire survey, and psychological care. Results After being accepted psychological care, the number of patients subjected to psychological distress significantly reduced ( P < 0. 05 ). Conclusion All patients with uterine cancer have different degrees of psychological problems, the implementation of psychological care significantly reduced the degree of psychological distress.%目的 调查子宫癌患者围手术期间存在的心理问题及相关因素,实施正确护理,以减轻心理困扰程度.方法 对65例子宫癌患者在围手术期进行问卷调查,并进行心理护理.结果 进行心理护理后,遭受心理困扰的患者人数明显减少(P<0.05).结论 所有子宫癌患者都有不同程度的心理问题,实施心理护理后心理困扰程度明显降低.

  5. Prospective, multidisciplinary recording of perioperative errors in cerebrovascular surgery: is error in the eye of the beholder?

    Michalak, Suzanne M; Rolston, John D; Lawton, Michael T


    OBJECT Surgery requires careful coordination of multiple team members, each playing a vital role in mitigating errors. Previous studies have focused on eliciting errors from only the attending surgeon, likely missing events observed by other team members. METHODS Surveys were administered to the attending surgeon, resident surgeon, anesthesiologist, and nursing staff immediately following each of 31 cerebrovascular surgeries; participants were instructed to record any deviation from optimal course (DOC). DOCs were categorized and sorted by reporter and perioperative timing, then correlated with delays and outcome measures. RESULTS Errors were recorded in 93.5% of the 31 cases surveyed. The number of errors recorded per case ranged from 0 to 8, with an average of 3.1 ± 2.1 errors (± SD). Overall, technical errors were most common (24.5%), followed by communication (22.4%), management/judgment (16.0%), and equipment (11.7%). The resident surgeon reported the most errors (52.1%), followed by the circulating nurse (31.9%), the attending surgeon (26.6%), and the anesthesiologist (14.9%). The attending and resident surgeons were most likely to report technical errors (52% and 30.6%, respectively), while anesthesiologists and circulating nurses mostly reported anesthesia errors (36%) and communication errors (50%), respectively. The overlap in reported errors was 20.3%. If this study had used only the surveys completed by the attending surgeon, as in prior studies, 72% of equipment errors, 90% of anesthesia and communication errors, and 100% of nursing errors would have been missed. In addition, it would have been concluded that errors occurred in only 45.2% of cases (rather than 93.5%) and that errors resulting in a delay occurred in 3.2% of cases instead of the 74.2% calculated using data from 4 team members. Compiled results from all team members yielded significant correlations between technical DOCs and prolonged hospital stays and reported and actual delays (p = 0

  6. Accelerating networks

    Evolving out-of-equilibrium networks have been under intense scrutiny recently. In many real-world settings the number of links added per new node is not constant but depends on the time at which the node is introduced in the system. This simple idea gives rise to the concept of accelerating networks, for which we review an existing definition and-after finding it somewhat constrictive-offer a new definition. The new definition provided here views network acceleration as a time dependent property of a given system as opposed to being a property of the specific algorithm applied to grow the network. The definition also covers both unweighted and weighted networks. As time-stamped network data becomes increasingly available, the proposed measures may be easily applied to such empirical datasets. As a simple case study we apply the concepts to study the evolution of three different instances of Wikipedia, namely, those in English, German, and Japanese, and find that the networks undergo different acceleration regimes in their evolution

  7. Perioperative management of a patient of Rubinstein-Taybi syndrome with ovarian cyst for laparotomy.

    Darlong, Vanlal; Pandey, Ravinder; Garg, Rakesh; Pahwa, Deepak


    Rubinstein-Taybi syndrome (RTS) is a multisystem involvement disease. These children may present for various surgeries of different systems. Due to multisystem involvement, perioperative management of such patients poses peculiar challenges for the anesthesiologists. We report the successful anesthetic management of a patient with RTS with tonsillar hypertrophy grade III scheduled for ovarian cystectomy. PMID:25190959

  8. Perioperative management of a patient of Rubinstein-Taybi syndrome with ovarian cyst for laparotomy

    Darlong, Vanlal; Pandey, Ravinder; Garg, Rakesh; Pahwa, Deepak


    Rubinstein-Taybi syndrome (RTS) is a multisystem involvement disease. These children may present for various surgeries of different systems. Due to multisystem involvement, perioperative management of such patients poses peculiar challenges for the anesthesiologists. We report the successful anesthetic management of a patient with RTS with tonsillar hypertrophy grade III scheduled for ovarian cystectomy.

  9. Overview of the Perioperative Management of Lung Volume Reduction Surgery Patients

    Sharafkhaneh, Amir; Falk, Jeremy A; Minai, Omar A.; Lipson, David A.


    This article reviews management strategies that may improve the outcome of thoracic surgery and particularly lung volume reduction surgery (LVRS) in patients with severe emphysema. Maximal preoperative pharmacologic therapy includes bronchodilators and inhaled corticosteroids to attain peak lung function at the time of surgery. Nonpharmacologic measures include smoking cessation and pulmonary rehabilitation. Mechanical ventilation during the perioperative period should ensure adequate oxygena...

  10. [Current status and prospect of perioperative thrombus management in gastrointestinal cancer].

    Qin, X Y


    Thanks to the progress of surgical theory and skills, as well as the application of modern medical devices in general surgery, both the occurrence of perioperative complications and mortality of gastrointestinal surgery have significantly reduced recently. However, it is still far from optimal in terms of the perioperative venous thromboembolism (VTE) management in gastrointestinal cancer, and what is responsible for that? This paper aims at finding out the reasons contributing to the current status, giving suggestions for how to make improvement at both disease level and hospital management level. At the same time, while paying attention for the prophylaxis of VTE, there have been more and more patients receiving antithrombotic treatment require elective or emergent surgery in clinical practice, due to aging and increased incidence of cardiovascular disease year by year. How to balance the bleeding and thrombosis risk for these patients during perioperative periods is also a question we are going to discuss. In conclusion, as to the issue of the management of perioperative thrombosis, there will be a long way for Chinese doctors to go. Our peers should pay more attention to this problem and take more efforts, so that the thrombotic complications in surgical patients can be reduced. PMID:26932880

  11. Influence of Perioperative Blood Transfusion on Prognosis in Patients with Colon Cancer

    LIANG Han; WANG Xiaona; WANG Baogui; PAN Yuan; LIU Ning; WANG Dianchang; HAO Xishan


    Objective: To explore the influence of perioperative blood transfusion on the postoperative survival of patients with colon cancer. Methods: Univariate and multivariate retrospective analyses were performed on the survival in a total of 723 colon cancer patients which were treated surgically during a period of 10 years. Results: Kaplan-Meicr estimates showed that more than 800 mL perioperative blood transfusion was the survival predictor. Blood transfusion influenced significantly the prognosis of patients 40 years old and younger, those undergoing helicoloectomy left side, those with papillary adenocarcinoma,those with big tumors (diameter ≥8 em), those with stage I tumors, those with lymphatic node metastases and those without liver metastases. In multivariate analysis only the tumor location, radicality of operation, lymphatic invasion, liver metastasis, depth of tumor invasion and TNM stage retained their significance. Conclusion: Perioperative blood transfusion is the prognostic factor for patients with colon cancer to some extent. The indication of blood transfusion must be restricted strictly, specially in patients younger than 40 years old, with right side lesion, papillary adenocarcinoma, big tumors (diameter ≥8 em), stage I tumors and lymphatic node metastases or without liver metastases. But perioperative blood transfusion may not be deleterious for patients with staging Ⅳ disease and with distant metastases.

  12. Perioperative outcomes in minimally invasive lumbar spine surgery: A systematic review

    Skovrlj, Branko; Belton, Patrick; Zarzour, Hekmat; Qureshi, Sheeraz A.


    AIM: To compare minimally invasive (MIS) and open techniques for MIS lumbar laminectomy, direct lateral and transforaminal lumbar interbody fusion (TLIF) surgeries with respect to length of surgery, estimated blood loss (EBL), neurologic complications, perioperative transfusion, postoperative pain, postoperative narcotic use, and length of stay (LOS).

  13. Perioperative blood transfusion does not decrease survival after surgical treatment of spinal metastases

    Clausen, Caroline; Lönn, Lars; Morgen, Søren Schmidt;


    at surgery, gender, preoperative hemoglobin, revised Tokuhashi score and no. of instrumented levels. RESULTS: Perioperative allogenic blood transfusion of 1-2 units was associated with increased 12-month survival [p = 0.049, odds ratio 2.619 (confidence interval 1.004-6.831)], but not with 3-month...

  14. Systematic Review of Peri-Operative Nutritional Supplementation in Patients Undergoing Pancreaticoduodenectomy

    Kolitha Sanjaya Goonetilleke; Ajith Kumar Siriwardena


    Background: Although nutritional supplementation is established in surgicalpractice, studies on feeding patients undergoing pancreaticoduodenectomy utilize widely disparate protocols, include small numbers of patients and have disparate endpoints. The aim of this study is to carry out a systematic review of peri-operative nutritional supplementation in patients undergoing pancreaticoduodenectomy in order to identify consistent themes. Methods :Searches of the MEDLINE and EMBASE databases yie...

  15. Is There a Role for Perioperative Nutritional Support in Liver Resection?

    Albert Bothe; Glenn Steele


    Background: Resection of hepatocellular carcinoma is associated with high rates of morbidity and mortality. Since intensive nutritional support can reduce the catabolic response and improve protein synthesis and liver regeneration, we performed a prospective study to investigate whether perioperative nutritional support could improve outcome in patients undergoing hepatectomy for hepatocellular carcinoma. Methods: We studied 124 patients undergoing resection of hepatocellular carcinoma. Sixty...

  16. Pharmacogenetics and anaesthetic drugs: Implications for perioperative practice

    Arash Behrooz


    Pharmacogenetics seeks to elucidate the variations in individual's genetic sequences in order to better understand the differences seen in pharmacokinetics, drug metabolism, and efficacy between patients. This area of research is rapidly accelerating, aided by the use of novel and more economical molecular technologies. A substantial evidence base is being generated with the hopes that in the future it may be used to generate personalised treatment regimens in order to improve patient comfort...

  17. Up in flames: a flammability assessment of alcohol-based hand sanitizers on common perioperative materials

    Samuel Almengor


    Full Text Available Introduction: The objective of this study was to perform a flammability assessment of alcohol-based hand sanitizers on common perioperative materials. There is an estimated 550–650 surgical fires that occur nationally each year, an instance comparable to that of wrong-site surgery, yet only about 100 operating room fires are reported each year.  The median cost of an OR fire settlement claim is $120,166.  Generation of fire requires the presence of three components, known as the “fire triad”: (1 an oxidizer, (2 an ignition source, and (3 fuel. Methods: The flammability of five common perioperative materials was assessed (conform stretch gauze, surgical drape, foam headrest, OR towels, and lap sponges.  The flammability of these materials was assessed alone and with six test liquids (Purell Advanced, Germ-X, generic hand sanitizer, spray hand sanitizer, ChloraPrep, and sterile water.  The assessments with the test liquids were conducted immediately after application and after five minutes.  The ignition sources used were a lighter and two spark generators (piezo-electric and battery-powered spark generator. Results: Two of the five perioperative materials were easily ignitable (OR towels and lap sponges, while the others exhibited flame retardant properties, which manifested itself as “melting” when an ignition source was applied (conform stretch gauze, surgical drape, and foam headrest.  ChloraPrep served as the positive control and sterile water served as the negative control.  When alcohol-based hand sanitizers and ChloraPrep were added to these materials, the flammability increased.  The addition of sterile water to the perioperative materials rendered the material nonflammable. The piezo-electric spark generator did not elicit any combustion of perioperative materials with or without test liquids, but the battery-powered spark generator did. Conclusion: Commonly used alcohol-based hand sanitizers are flammable.  When

  18. Accelerators and the Accelerator Community

    Malamud, Ernest; Sessler, Andrew


    In this paper, standing back--looking from afar--and adopting a historical perspective, the field of accelerator science is examined. How it grew, what are the forces that made it what it is, where it is now, and what it is likely to be in the future are the subjects explored. Clearly, a great deal of personal opinion is invoked in this process.

  19. Perioperative management of endovascular abdominal aortic aneurysm repair

    Objective: To summarize the clinical experience of perioperative management in performing endovascular abdominal aortic aneurysm repair (EVAR). Methods: EVAR was performed in 22 patients with abdominal aortic aneurysm. The clinical data were retrospectively analyzed. Before treatment the functions of main organs were evaluated and certain measures were adopted in order to protect them. Useful parameters, including the length, diameter, angle and configuration of the proximal and distal aneurysmal neck, the relationship of the aneurysm to aortic branches, the distance from the lowest renal artery to the bifurcation of abdominal aorta, and the quality of access vessels (such as diameter, tortuosity and calcification degree) were determined and assessed with CTA. According to the parameters thus obtained, the suitable stent-graft with ideal diameter and length was selected, and the optimal surgery pattern was employed. Local anesthesia was employed in 20 patients, among them the local anesthesia had to be changed to general anesthesia in one. Epidural anesthesia was carried out in one patient through the surgically-reconstructed iliac artery access,and general anesthesia was employed in one patient who had Stanford type A aortic dissection. The lowest renal artery must be accurately localized before deployment of stent-graft was started. At least one patent internal iliac artery should be reserved when bilateral internal iliac arteries needed to be covered, to be covered by stages or to be reconstructed. After stent-graft placement, angiography must be performed to find out if there was any endoleak and, if any, to determine the type of endoleak and to deal with it properly. Two cases had proximal type I endoleak, so balloon dilation was employed in one and cuff implantation in another one. Distal type I endoleak occurred in one case, but, unfortunately, the iliac artery ruptured when balloon dilation was employed, therefore the patient had to receive vascular repair

  20. Duration of deep hypothermia during aortic surgery and the risk of perioperative blood transfusion

    Michael Mazzeffi


    Full Text Available Deep hypothermia, which is used during thoracic aortic surgery for neuroprotection, is associated with coagulation abnormalities in animal and in vitro models. However, there is a paucity of data regarding the impact of deep hypothermia duration on perioperative bleeding. The objective of the current study was to examine the relationship between the duration of deep hypothermia and perioperative bleeding. A retrospective review of 507 consecutive thoracic aortic surgery patients who had surgery with deep hypothermic circulatory arrest was performed. The degree of bleeding and coagulopathy was estimated using perioperative transfusion. Log linear modeling with Poisson regression was used to analyze the relationship between deep hypothermia duration and perioperative bleeding, while controlling for other preselected variables. There was a significant association between deep hypothermia duration and RBC transfusion (P = 0.001. There was no significant association between deep hypothermia duration and FFP and platelet transfusion (P = 0.18 and P = 0.06. The association between deep hypothermia duration and the amount of bleeding (RBC transfusion was dependent on total CPB time. In general, for shorter CPB times (approximately 120 to 180 minutes there was an upward sloping line or positive relationship between deep hypothermia duration and bleeding. However, for cases with longer CPB times (300 to 360 minutes, there was no such relationship. The relationship between deep hypothermia duration and perioperative bleeding is dependent on CPB time. For surgeries with short CPB times (120 to 180 minutes, prolonged deep hypothermia is associated with increased post-operative bleeding, as estimated by RBC transfusion. For cases with longer CPB times (300 to 360 minutes, there appears to be no relationship.

  1. Application of electron accelerator worldwide

    Electron accelerator is an important radiation source for radiation technology, which covers broad fields such as industry, health care, food and environmental protection. There are about 1,000 electron accelerators for radiation processing worldwide. Electron accelerator has advantage over Co-60 irradiator in term of high dose rate and power, assurance of safety, and higher economic performance at larger volume of irradiation. Accelerator generating higher energy in the range of 10 MeV and high power electron beam is now commercially available. There is a trend to use high-energy electron accelerator replacing Co-60 in case of large through-put of medical products. Irradiated foods, in particular species, are on the commercial market in 35 countries. Electron accelerator is used efficiently and economically for production of new or modified polymeric materials through radiation-induced cross-linking, grafting and polymerization reaction. Another important application of electron beam is the curing of surface coatings in the manufacture of products. Electron accelerators of large capacity are used for cleaning exhaust gases in industrial scale. Economic feasibility studies of this electron beam process have shown that this technology is more cost effective than the conventional process. It should be noted that the conventional limestone process produce gypsum as a by-product, which cannot be used in some countries. By contrast, the by-product of the electron beam process is a valuable fertilizer. (Y. Tanaka)

  2. accelerating cavity

    On the inside of the cavitytThere is a layer of niobium. Operating at 4.2 degrees above absolute zero, the niobium is superconducting and carries an accelerating field of 6 million volts per metre with negligible losses. Each cavity has a surface of 6 m2. The niobium layer is only 1.2 microns thick, ten times thinner than a hair. Such a large area had never been coated to such a high accuracy. A speck of dust could ruin the performance of the whole cavity so the work had to be done in an extremely clean environment.

  3. Linac transport and acceleration

    The acceleration of intense bunches maintaining high brightness is limited both by single-particle effects, e.g., misalignments, injection errors, and rf-steering, and collective phenomena, where the effects of the longitudinal and transverse wakefield on particles within a single bunch are the most severe. The working group has considered both problems and potentials of linac acceleration from ∼50 MeV to 1 GeV for free electron laser (FEL) applications, as well as from a few Gev to 1 TeV for linear colliders. The outlook for free electron lasers is bright: no fundamental problems seem to arise in the acceleration of peak currents in excess of 100 A with small emittance and low momentum spread. The situation of linear colliders is more complex and more difficult. Two examples, one operating at 11.4 GHz, the other at 30 GHz, are used to illustrate some of the difficulties and the exceedingly tight tolerances required. Both examples are based on round beams, and thus neither benefit from the advantages of flat beams nor address the increased care required in transporting beams of very small emittance in one plane. The working group acknowledges, but did not explore, promising concepts for colliders based on RF superconductivity

  4. [A case report: perioperative management of adenotonsillectomy in a morbidly obese patient with severe obstructive sleep apnea syndrome].

    Mine, Tomoko; Wada, Minori; Hashimoto, Ai; Minami, Kotaro; Nikai, Tetsuro; Imamachi, Noritaka; Saito, Yoji


    A male patient in his thirties was scheduled to undergo adenotonsillectomy due to dyspnea from bilateral tonsillar hypertrophy. He was morbidly obese (body mass index 56 kg x m(-2)) with severe obstructive sleep apnea syndrome (OSAS), and thus was evaluated with extreme risk for difficult ventilation and intubation. We planned awake intubation via video-assisted laryngoscopy and fiberoptic bronchoscopy under dexmedetomidine sedation, and the intubation was successfully performed. After adenotonsillectomy, upper airway obstruction due to hemorrhage and oropharyngeal swelling can be life-threatening requiring emergent airway management. Thus for postoperative airway management, due to the possibility of "cannot intubate, cannot ventilate" (CICV) and presumed difficult tracheotomy, we scheduled to perform tracheotomy during adenotonsillectomy, right after anesthetic induction and awake intubation. On postoperative day 1, he started walking with no need of sedative drugs. On day 4, after confirmation of minimal oropharyngeal swelling, tracheal cannulae was removed, and no further complications were observed in his postoperative course. We conclude that careful preoperative evaluation of the airway, retention of spontaneous breathing via awake intubation, and preventive tracheotomy for postoperative airway management are important points in perioperative management of a morbidly obese patient with severe obstructive sleep apnea syndrome. PMID:25731066

  5. Does surgical resection of hepatocellular carcinoma accelerate cancer dissemination?

    I-Shyan Sheen; Yi-Chun Tsai; Tsu-Yen Wu; Kuo-Shyang Jeng; Shou-Chuan Shih; Po-Chuan Wang; Wen-Hsiung Chang; Horng-Yuan Wang; Li-Rung Shyung; Shee-Chan Lin; Chin-Roa Kao


    recurrence (58% vs.39%, P=0.093). The correlation between perioperative hAFP mRNA positivity and recurrence related mortality had no statistical significance (P=0.836).CONCLUSION: From our study, perioperative detection of hAFP mRNA in peripheral blood of patients has no clinical relevance and significant role in the prediction of HCC recurrence. Surgical resection itself may not accelerate cancer dissemination and does not increase postoperative recurrence significantly either.

  6. Perioperative sleep apnea: a real problem or did we invent a new disease? [version 1; referees: 2 approved

    Sebastian Zaremba


    Full Text Available Depending on the subpopulation, obstructive sleep apnea (OSA can affect more than 75% of surgical patients. An increasing body of evidence supports the association between OSA  and perioperative complications, but some data indicate important perioperative outcomes do not differ between patients with and without OSA. In this review we will provide an overview of the pathophysiology of sleep apnea and the risk factors for perioperative complications related to sleep apnea. We also discuss a clinical algorithm for the identification and management of OSA patients facing surgery.

  7. Acquired Factor XIII Inhibitor in Hospitalized and Perioperative Patients: A Systematic Review of Case Reports and Case Series.

    Tone, Kira J; James, Tyler E; Fergusson, Dean A; Tinmouth, Alan; Tay, Jason; Avey, Marc T; Kilty, Shaun; Lalu, Manoj M


    Factor XIII (FXIII) cross-links fibrin monomers to support clot stabilization and wound healing. Acquired FXIII deficiency is caused by autoantibodies that inhibit FXIII and can result in bleeding despite normal routine coagulation test results. Given the rarity of this disease, large clinical studies are not feasible. We therefore conducted a systematic review of case reports and case series of acquired FXIII inhibitor to evaluate potential management and treatment strategies for acquired FXIII inhibitor in hospitalized and/or perioperative patients. A systematic search of MEDLINE, Embase, and Web of Science identified reports of hospitalized and perioperative patients with acquired FXIII deficiency. No restrictions were placed on language or publication type. Article screening and data extraction were performed independently by 2 abstractors. Completeness of reporting was evaluated according to modified elements from the CAse REport (CARE) guidelines. A total of 1028 citations were reviewed, with 36 case reports and 3 case series meeting eligibility criteria (63 patients total). The mean age was 60 (range, 9-87) years with balanced sex representation. At presentation, 48 patients (76%) had intramuscular or subcutaneous bleeding, and 34 patients (54%) had external or surgical bleeding. All cases were diagnosed by initially detecting a FXIII deficiency and then identifying the inhibitor. Clinical improvement in bleeding was seen in patients receiving FXIII concentrate (13/17 patients), cryoprecipitate (5/8), and plasma (10/18). Inhibitor reduction was seen in patients who received rituximab (6/6 patients), plasma exchange (2/2), intravenous immunoglobulin (4/5), steroid (15/20), and cyclophosphamide (10/15). Concurrent initiation of multiple therapies and obvious lack of control comparisons made direct association to outcomes difficult to establish. Outcomes were reported for 55 patients, with 25 patients (45%) having complete inhibitor eradication and 15 patients

  8. Electron Accelerator Facilities

    Lecture presents main aspects of progress in development of industrial accelerators: adaptation of accelerators primary built for scientific experiments, electron energy and beam power increase in certain accelerator constructions, computer control system managing accelerator start-up, routine operation and technological process, maintenance (diagnostics), accelerator technology perfection (electrical efficiency, operation cost), compact and more efficient accelerator constructions, reliability improvement according to industrial standards, accelerators for MW power levels and accelerators tailored for specific use

  9. Prognostic impact of clinical course-specific mRNA expression profiles in the serum of perioperative patients with esophageal cancer in the ICU: a case control study

    Oshima Yoshiaki


    Full Text Available Abstract Background We previously reported that measuring circulating serum mRNAs using quantitative one-step real-time RT-PCR was clinically useful for detecting malignancies and determining prognosis. The aim of our study was to find crucial serum mRNA biomarkers in esophageal cancer that would provide prognostic information for post-esophagectomy patients in the critical care setting. Methods We measured serum mRNA levels of 11 inflammatory-related genes in 27 post-esophagectomy patients admitted to the intensive care unit (ICU. We tracked these levels chronologically, perioperatively and postoperatively, until the two-week mark, investigating their clinical and prognostic significance as compared with clinical parameters. Furthermore, we investigated whether gene expression can accurately predict clinical outcome and prognosis. Results Circulating mRNAs in postoperative esophagectomy patients had gene-specific expression profiles that varied with the clinical phase of their treatment. Multivariate regression analysis showed that upregulation of IL-6, VWF and TGF-β1 mRNA in the intraoperative phase (p = 0.016, 0.0021 and 0.009 and NAMPT and MUC1 mRNA on postoperative day 3 (p ®, Ono Pharmaceutical Co., Ltd. significantly correlated with MUC1 and NAMPT mRNA expression (p = 0.048 and 0.045. IL-6 mRNA correlated with hypercytokinemia and recovery from hypercytokinemia (sensitivity 80.9% and was a significant biomarker in predicting the onset of severe inflammatory diseases. Conclusion Chronological tracking of postoperative mRNA levels of inflammatory-related genes in esophageal cancer patients may facilitate early institution of pharamacologic therapy, prediction of treatment response, and prognostication during ICU management in the perioperative period.

  10. An evaluation of POSSUM and P-POSSUM scoring in predicting post-operative mortality in a level 1 critical care setting

    Scott, Sarah; Lund, Jonathan N; Gold, Stuart; Elliott, Richard; Vater, Mair; Chakrabarty, Mallicka P; Heinink, Thomas P; Williams, John P


    Background POSSUM and P-POSSUM are used in the assessment of outcomes in surgical patients. Neither scoring systems’ accuracy has been established where a level 1 critical care facility (level 1 care ward) is available for perioperative care. We compared POSSUM and P-POSSUM predicted with observed mortality on a level 1 care ward. Methods A prospective, observational study was performed between May 2000 and June 2008. POSSUM and P-POSSUM scores were calculated for all postoperative patients w...

  11. Effect of intermediate care on mortality following emergency abdominal surgery. The InCare trial

    Vester-Andersen, Morten; Waldau, Tina; Wetterslev, Jørn;


    . The aim of the present trial is to evaluate the effect of postoperative intermediate care following emergency major abdominal surgery in high-risk patients.Methods and design: The InCare trial is a randomised, parallel-group, non-blinded clinical trial with 1:1 allocation. Patients undergoing...... emergency laparotomy or laparoscopic surgery with a perioperative Acute Physiology and Chronic Health Evaluation II score of 10 or above, who are ready to be transferred to the surgical ward within 24 h of surgery are allocated to either intermediate care for 48 h, or surgical ward care. The primary outcome...... measure is all-cause 30-day mortality. We aim to enrol 400 patients in seven Danish hospitals. The sample size allows us to detect or refute a 34% relative risk reduction of mortality with 80% power. DISCUSSION: This trial evaluates the benefits and possible harm of intermediate care. The results may...

  12. Accelerator system and method of accelerating particles

    Wirz, Richard E. (Inventor)


    An accelerator system and method that utilize dust as the primary mass flux for generating thrust are provided. The accelerator system can include an accelerator capable of operating in a self-neutralizing mode and having a discharge chamber and at least one ionizer capable of charging dust particles. The system can also include a dust particle feeder that is capable of introducing the dust particles into the accelerator. By applying a pulsed positive and negative charge voltage to the accelerator, the charged dust particles can be accelerated thereby generating thrust and neutralizing the accelerator system.

  13. Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life.

    Ali, M


    Perioperative epidural analgesia provides continuous pain control and may have advantages over parenteral opiate administration. This study assessed the impact of epidural analgesia on quality of life (QOL) of patients undergoing major surgery.

  14. Nursing care of patients receiving interventional therapy for hepatic artery stenosis after liver transplantation

    Objective: To discuss the perioperative nursing care of patients who is going to receive interventional therapy for hepatic artery stenosis after liver transplantation and to provide useful reference for reducing surgery-related complication and for improving the prognosis of patients. Methods: Based on the patient's condition and operative requirement,we provided effective nursing care for 20 patients who were admitted to receive the interventional therapy for hepatic artery stenosis after liver transplantation. The nursing care included preoperative preparation,postoperative nursing and medical guidance at the time of discharge. Results: Interventional therapy was successfully performed in all 20 cases, and no hemorrhagic tendency or acute thrombosis occurred. Marked symptomatic improvement was obtained in all patients. Conclusion: The interventional therapy is an effective treatment for hepatic artery stenosis after liver transplantation. Intensive perioperative nursing care can well prevent the occurrence of surgery-related complications and can surely improve the therapeutic results. (authors)

  15. Perioperative Psychological and Music Interventions in Elderly Patients Undergoing Spinal Anesthesia: Effect on Anxiety, Heart Rate Variability, and Postoperative Pain

    Wang, Yisha; Dong, Youjing; Li, Yang


    Purpose The aim of this study was to evaluate the effects of perioperative psychological and music interventions in elderly patients undergoing elective surgery on anxiety, post-operative pain, and changes in heart rate variability (HRV) to ascertain if perioperative psychological and music interventions can affect overall anxiety levels. Materials and Methods Fourty elderly patients undergoing elective surgery were randomized to two groups; one group received psychological and music interven...

  16. Perioperative changes of ventricular function and three indicators of myocardial injury during orthotopic liver transplantation

    HEI Zi-qing; LIU De-zhao; LUO Chen-fang; LI Shang-rong; MA Wu-hua; LUO Gang-jian


    @@ Patients undergoing orthotopic liver transplantation may develop significant haemodynamic instability, especially during anhepatic phase and immediately after reperfusion of the graft. The haemodynamic instability may be caused directly by myocardial depression due to pathogenic substances released from the liver, or by acute blood loss.1 Creatine kinase(CK) and its MB fraction (CK-MB) are sensitive and specific indicators to reflect myocardial damage.2 Cardiac troponin I (cTnl) is a specific and sensitive marker of myocardial necrosis.3 This study assessed perioperative cardiac function using three indicators (CK,CK-MB,and CTnl) to evaluate perioperative myocardial damage.$4This study was supported by grants from the National Natural Science Foundation of China (No. 30271254) and Guangdong Medical Development Foundation (No. 2004B35001005).

  17. Standardized testing with chlorhexidine in perioperative allergy – a large single-centre evaluation

    Schjørring Opstrup, Morten; Malling, Hans-Jørgen; Krøigaard, Mogens;


    BACKGROUND: Perioperative allergic reactions to chlorhexidine are often severe and easily overlooked. Although rare, the prevalence remains unknown. Correct diagnosis is crucial, but no validated provocation model exists, and other diagnostic tests have never been evaluated. The aims were...... to estimate 1) the prevalence of chlorhexidine allergy and 2) the specificity and sensitivity for diagnostic tests for chlorhexidine allergy. METHODS: We included all patients investigated for suspected perioperative allergic reactions in the Danish Anaesthesia Allergy Centre during 2004-2012. The following...... tests were performed: specific IgE (Immunocap(®) , Phadia AB, Sweden), histamine release test (HR) (RefLab ApS, Denmark), skin prick test (SPT) and intradermal test (IDT). Positivity criteria: specific IgE > 0.35 kUA/l; HR class 1-12; SPT mean wheal diameter ≥ 3 mm; IDT mean wheal diameter ≥ twice...

  18. Use of transoesophageal echocardiography during the peri-operative period for trauma patients.

    Smyth, K; Hebballi, R; Peterson, M K


    The medical facility at Camp Bastion continues to evolve as a consequence of the increased throughput of battlefield trauma patients. There is a requirement for rapid and accurate diagnosis of haemodynamic instability and continued haemodynamic monitoring throughout the peri-operative period. Transoesophageal echocardiography (TOE) has been used for this purpose in the arena of cardiac anaesthesia since the mid 1980s. It is being introduced to other peri-operative settings where severe haemodynamic instability is expected. The old proverb: 'There are none so blind as those who cannot see' (Jeremiah 5:21) is applicable to this topic, in that TOE is proven to be a rapid, portable, safe and effective tool in the assessment of the haemodynamically unstable patient. This paper explores the application of TOE for the assessment of the major causes of haemodynamic instability in the trauma population. PMID:21302659

  19. Perioperative use of methotrexate--a survey of clinical practice in the UK.

    Steuer, A; Keat, A C


    We have surveyed the use of methotrexate in the perioperative period in patients with rheumatoid arthritis (RA) undergoing surgery. A total of 200 consultant rheumatologists and 200 consultant orthopaedic surgeons in the UK were sent a postal questionnaire. Thirty-five per cent of rheumatologists and 46% of orthopaedic surgeons were concerned that the drug may increase the risk of post-operative complications, although significantly less 'always' stopped the drug around the time of surgery. There was great variation in the timing of stopping the drug with most stopping treatment within 2 weeks before surgery and restarting within 2 weeks after surgery. The majority of clinicians surveyed (70%) felt that national guidelines for the perioperative use of methotrexate would be helpful. PMID:9376976

  20. A practical approach to perioperative management of cardiac implantable electronic devices.

    Chia, Pow-Li; Foo, David


    With the increased use of cardiac implantable electronic devices (CIEDs), it is increasingly important to recognise the unique challenges involved in the management of patients with CIEDs who are undergoing surgery. Practice advisories and consensus statements have been issued by the American Society of Anesthesiologists and the Heart Rhythm Society, advocating a multidisciplinary approach. This review discusses and presents a practical approach to perioperative CIED management in the Singapore context. PMID:26512144

  1. Perioperative management of patients with severe pulmonary hypertension in major orthopedic surgery: experience-based recommendations

    Seyfarth, Hans-Jürgen; Gille, Jochen; Sablotzki, Armin; Gerlach, Stefan; Malcharek, Michael; Gosse, Andreas; Gahr, Ralf H.; Czeslick, Elke


    Introduction: It is known that pulmonary hypertension is associated with worse outcome in both cardiac and non-cardiac surgery. The aims of our retrospective analysis were to evaluate the outcomes of our patients with pulmonary hypertension undergoing major orthopedic surgery and to give experience-based recommendations for the perioperative management. Material and methods: From 92 patients with pulmonary hypertension undergoing different kinds of surgical procedures from 2011–2014 in a tert...

  2. Utilization and perioperative complications of laparoscopic cryoablation vs. robotic partial nephrectomy for localized renal tumors

    Weinberg, Aaron C; Solomon L. Woldu; Wen, Timothy; Deibert, Christopher M.; Korets, Ruslan; Badani, Ketan K


    ABSTRACT Objective: To compare the utilization, perioperative complications and predictors of LCA versus RPN in the treatment of localized renal tumors. Methods: From the Nationwide Inpatient Sample we identified patients undergoing RPN or LCA for the treatment of localized renal tumors from October 2008 through 2010. Patient and hospital-specific factors which predict postoperative complications and use of LCA were investigated. Results: 14,275 patients with localized renal tumors were ident...

  3. Perioperative stress in dogs : Different aspects of manifestation and characteristics with medetomidine and acepromazine preanaesthetic medication

    VÀisÀnen, Misse


    The series of investigations presented in this thesis examined different aspects of the manifestation of perioperative stress in client-owned dogs and compared the influences of two preanaesthetic medications. Data were obtained from 43 overtly healthy dogs that underwent ovariohysterectomy following preanaesthetic administration of medetomidine and butorphanol (MED) or acepromazine and butorphanol (ACE) (Study 1) and from 96 dogs that were recovering from day-case soft-tissue operations at h...

  4. Role of noninvasive ventilation in perioperative patients with neuromuscular disease: a clinical case

    Ana Marinho


    Full Text Available The inclusion body myositis is an inflammatory myopathy that leads to chronic muscle inflammation associated with muscle weakness. It is characterized by a restrictive ventilatory syndrome requiring ventilatory support under non-invasive ventilation. The authors describe a clinical case and the anaesthetic management of a patient with inclusion body myopathy candidate for vertebroplasty, which highlights the importance of locoregional anaesthesia and of noninvasive ventilation and includes assisted cough techniques, maintained throughout the perioperative period.

  5. Perioperative Tumor Cell Dissemination In Patients With Primary Or Metastatic Colorectal Cancer

    Tralhão, J. G.; Hoti, E.; Serôdio, M.; Laranjeiro, P.; Paiva, A.; Abrantes, A.M.; Pais, M.L.; Botelho, M. F.; Sousa, F. Castro


    Abstract Introduction Although there is general correlation between TNM stage of colorectal cancer (CRC) and its prognosis, there is often significant variability of tumor behaviour and individual patient outcome, which is unaccounted for by pathologic factors alone. Our aim was to estimate the perioperative tumor cell dissemination in patients with primary or CRC liver metastases as a possible factor influencing the outcome. Methods Forty patients ...

  6. Perioperative steroid administration inhibits angiogenic host tissue response to porous polyethylene (medpor®) implants

    S Ehrmantraut; MW Laschke; Merkel, D.; Scheuer, C; Willnecker, V.; Meyer-Lindenberg, A; MD Menger; Naumann, A.


    Porous polyethylene (Medpor®) is an alloplastic biomaterial, which is commonly used in plastic and reconstructive surgery. In the present study, we analyzed the effect of perioperative steroid administration on the inflammatory and angiogenic host tissue response to implanted Medpor®. For this purpose, Medpor® was implanted into the dorsal skinfold chamber of prednisolone-treated and vehicle-treated (control) balb/c mice and analyzed by means of intravital fluorescence microscopy over a 14-da...

  7. Perioperative Outcomes of Robotic Assisted Laparoscopic Surgery Versus Conventional Laparoscopy Surgery for Advanced-Stage Endometriosis

    Nezhat, Farr R.; Sirota, Ido


    Background and Objectives: To determine perioperative outcome differences in patients undergoing robotic-assisted laparoscopic surgery (RALS) versus conventional laparoscopic surgery (CLS) for advanced-stage endometriosis. Methods: This retrospective cohort study at a minimally invasive gynecologic surgery center at 2 academically affiliated, urban, nonprofit hospitals included all patients treated by either robotic-assisted or conventional laparoscopic surgery for stage III or IV endometrios...

  8. Surgical risks and perioperative complications of instrumented lumbar surgery in patients with liver cirrhosis

    Tung-Yi Lin


    Full Text Available Background: Patients with liver cirrhosis have high surgical risks due to malnutrition, impaired immunity, coagulopathy, and encephalopathy. However, there is no information in English literature about the results of liver cirrhotic patients who underwent instrumented lumbar surgery. The purpose of this study is to report the perioperative complications, clinical outcomes and determine the surgical risk factors in cirrhotic patients. Methods: We retrospectively reviewed 29 patients with liver cirrhosis who underwent instrumented lumbar surgery between 1997 and 2009. The hepatic functional reserves of the patients were recorded according to the Child-Turcotte-Pugh scoring system. Besides, fourteen other variables and perioperative complications were also collected. To determine the risks, we divided the patients into two groups according to whether or not perioperative complications developed. Results: Of the 29 patients, 22 (76% belonged to Child class A and 7 (24% belonged to Child class B. Twelve patients developed one or more complications. Patients with Child class B carried a significantly higher incidence of complications than those with Child class A (p = 0.011. In the Child class A group, patients with 6 points had a significantly higher incidence of complications than those with 5 points (p = 0.025. A low level of albumin was significantly associated with higher risk, and a similar trend was also noted for the presence of ascites although statistical difference was not reached. Conclusion: The study concludes that patients with liver cirrhosis who have undergone instrumented lumbar surgery carry a high risk of developing perioperative complications, especially in those with a Child-Turcotte-Pugh score of 6 or more.

  9. Scintigraphic, electrocardiographic, and enzymatic diagnosis of perioperative myocardial infarction in patients undergoing myocardial revascularization

    To assess the incidence of perioperative myocardial infarction, 214 consecutive patients were evaluated 1 to 5 days after coronary bypass surgery, using Tc-99m pyrophosphate (TcPPi) myocardial imaging, serial electrocardiograms (ECG), and enzyme levels (SGOT, LDH, CPK). On the basis of the clinical course and scintigraphic, enzymatic, and ECG changes, the diagnosis of perioperative infarction was definite in 17 of 214 cases (7.9%) and probable in six of 214 (2.8%). In all of these 23 patients, TcPPi scans were abnormal; one additional patient had a false-positive scintigram. Only 13 of the 23 had ECG evidence of infarction, but there were no false positives. We set the threshold for abnormality of enzyme changes quite high, owing to experience in more than 900 postoperative patients (SGOT > 200, LDH > 500, CPK > 500 on the same day). Using these criteria, 22 of the 23 infarct patients had abnormal enzymes, and six others were falsely positive. These results indicate a relatively low sensitivity for the ECG in diagnosing perioperative infarction, but the lack of false positives suggests high specificity. The sensitivity and specificity of the enzymes and the TcPPi image were both excellent and quite similar; the main difference was a reduction of certainty of infarction with the enzyme criteria, caused by the six patients whose enzyme values were falsely positive. Considering its sensitivity,specificity, and ability to locate and to a certain extent quantitate necrosis, TcPPi imaging is probably the most valuable means of diagnosing perioperative myocardial infarction

  10. Process Analysis and Monitoring in Complex Perioperative Environments: Health Operations Management

    Seim, Andreas Røsland


     This thesis presents studies in perioperative environments at two large university hospitals, St. Olavs Hospital in Trondheim, Norway and Massachusetts General Hospital in Boston, USA. It is submitted in partial fulfillment of the requirements for the degree of PhD at the Norwegian University of Science and Technology.The thesis consists of two parts. First is an overarching, unifying discussion. Second is a collection of five papers, three published in international peer-reviewed journals a...

  11. IV Acetaminophen: Assessment of Medication Utilization Evaluation Data in Peri-operative Pain Management

    Mark A. Malesker; Anne L Bruckner; Hilleman, Daniel E; Brian Loggie


    IV acetaminophen has become an accepted component of a multimodal analgesic strategy in perioperative patients. It is currently a branded drug (Ofirmev®) in the United States. The purchase price of the drug is greater than oral and rectal acetaminophen, intravenous ketorolac, and parenteral opioids. As a result, a large number of medication utilization evaluations (MUEs) have been conducted to evaluate the appropriateness of IV acetaminophen use. Many of these MUEs have failed to demonstrate ...

  12. Perioperative optic neuropathy in patients undergoing off-pump coronary artery bypass graft surgery

    Rajani Battu; Apoorva Prasad; Muralidhar Kanchi


    Aims and Objectives: Perioperative optic neuropathy (PON) is a rare, but devastating complication following coronary artery bypass graft surgery (CABG). We performed a retrospective study of PON associated with off-pump CABG (OPCABG) to identify possible risk factors. Materials and Methods: 1442 patients underwent OPCABG over a 10-month period from October 2008 to August 2009; PON was identified in four (0.28%) patients. A retrospective review of the charts was done to identify the patient ch...

  13. Comparative analysis of perioperative period in children with different corrections of vesicoureteral reflux

    P.V. Glybochko


    Full Text Available The article presents the analysis of perioperative period of 52 children with different variants of correction of vesicoureteral reflux. It was based on acute-phase proteins amount, cytokines level and adhesion molecules content in blood and urine. the study revealed that if the correction is performed during the latent phase of chronic obstructive pyelonephritis the preference should be given to the endoscopic operations as they do not lead to acute inflammatory process in the urinary tract

  14. Perioperative safety of two-team simultaneous bilateral total knee arthroplasty in the obese patient

    Gaines Steven T


    Full Text Available Abstract Background Although the rates of perioperative morbidity and mortality with simultaneous bilateral total knee arthroplasty remain a concern, multiple studies have shown the procedure to be safe in selected patient populations. Evidence also remains mixed regarding the outcomes of total knee arthroplasty in obese patients. The purpose of this paper is to compare the rates of perioperative morbidity and mortality in consecutive obese patients undergoing two-team simultaneous bilateral total knee arthroplasty and unilateral total knee arthroplasty. Methods The records on all two-team simultaneous total knee arthroplasties and unilateral total knee arthroplasties from October 1997 to December 2007 were reviewed. A total of 151 patients with a body mass index (BMI >30 undergoing two-team simultaneous total knee arthroplasty and 148 patients with a BMI >30 undergoing unilateral total knee arthroplasty were retrospectively reviewed and analyzed to determine perioperative morbidity and mortality as well as one-year mortality rates. Results Preoperative patient characteristics did not show any significant differences between groups. The simultaneous bilateral group had significantly longer operative times (127.4 versus 112.7 minutes, p Conclusions Two-team simultaneous total knee arthroplasty appears to be safe in obese patients, with similar complication rates as compared to unilateral procedures. Two-team simultaneous total knee arthroplasty also appears to have potential benefits over a staged procedure in the obese patient, although more study is required regarding this topic.

  15. The role of perioperative sodium bicarbonate infusion affecting renal function after Cardiothoracic Surgery

    Katja Regina Turner


    Full Text Available Cardiac surgery associated acute kidney injury (CSA-AKI is associated with poor outcomes including increased mortality, length of hospital stay and cost. The incidence of acute kidney injury (AKI is reported to be between 3-30% depending on the definition of AKI. We designed a multicenter randomized controlled trial to test our hypothesis that a perioperative infusion of sodium bicarbonate during cardiac surgery will attenuate the postoperative rise in creatinine indicating renal injury when compared to a perioperative infusion with normal saline. An interim analysis was performed after data was available on the first 120 participants. A similar number of patients in the two treatment groups developed acute kidney injury (AKI, defined as an increase in serum creatinine the first 48 hours after surgery of 0.3 mg/dl or more. Specifically 14 patients (24% who received sodium chloride (SC and 17 patients (27% who received sodium bicarbonate (SB were observed to develop AKI post surgery, resulting in a relative risk of AKI of 1.1 (95% CI: 0.6-2.1, chi-square p-value=0.68 for patients receiving SB compared to those who received SC . The data safety monitoring board for the trial recommended closing the study early as there was only a 12% probability that the null hypothesis would be rejected. We therefore concluded that a perioperative infusion of sodium bicarbonate failed to attenuate the risk of CSA-AKI.

  16. Prospective study of use of perioperative antimicrobial therapy in general surgery.

    Fennessy, Brendan G


    BACKGROUND: Perioperative antimicrobial therapy has demonstrated efficacy in reducing the rate of surgical site infections in clinical trials. With the emergence of antibiotic resistance, the risk of reaction, and the inevitable financial repercussions, use of prophylactic antibiotics is not a panacea, and their misuse may have considerable implications. The aim of this study was to assess the use of antibiotics in the perioperative period in both general and vascular surgery procedures. METHODS: A prospective study was undertaken of 131 patients with a mean age of 43 years (range one month-88 years), of whom 68 (51%) were male, who underwent twenty-seven different general or vascular surgery procedures over a four-week period. Each patient was evaluated from the time of antibiotic commencement through their operative procedure until the treatment was discontinued. RESULTS: A total of 73 patients (54%) received ten antibiotics, with 71 (97%) of these uses being prophylactic. Of the 15 appendectomies performed for uncomplicated appendicitis, the mean number of prophylactic antibiotic doses was 5.3 (range 1-12). Where they were documented, written postoperative directives were not adhered to in 18\\/27 prescriptions (66%). CONCLUSION: This study has demonstrated a lack of adherence to guidelines in the perioperative administration of antimicrobial agents. In addition, it calls attention to the economic implications of unnecessary prophylaxis.

  17. The association of perioperative dexamethasone, smoking and alcohol abuse with wound complications after laparotomy

    Dahl, Rikke M; Wetterslev, Jørn; Jorgensen, Lars N;


    BACKGROUND: A number of perioperative risk factors may suppress the immune system and contribute to the development of post-operative complications. The association between surgical site infection (SSI) and other wound-related complications resulting from immunosuppression through either perioper......BACKGROUND: A number of perioperative risk factors may suppress the immune system and contribute to the development of post-operative complications. The association between surgical site infection (SSI) and other wound-related complications resulting from immunosuppression through either......, smoking status and alcohol abuse with the primary outcome, being a composite of SSI, anastomotic leak, wound dehiscence, burst abdomen and 30-day mortality. RESULTS: The primary outcome occurred in 21% of patients receiving dexamethasone versus 28% of patients not receiving dexamethasone......, and this was not statistically significant when adjusting for stratification variables originally used in the PROXI trial [OR 0.90, 95% CI (0.65-1.24)]. In smokers, the primary outcome occurred in 32%, compared with 23% of non-smokers (P = 0.0001). Smokers also had a higher frequency of SSI (25% vs 17%, P 

  18. Perioperative music and its effects on anxiety, hemodynamics, and pain in women undergoing mastectomy.

    Binns-Turner, Pamela G; Wilson, Lynda Law; Pryor, Erica R; Boyd, Gwendolyn L; Prickett, Carol A


    There is increasing interest in evaluating the use of nonpharmacologic interventions such as music to minimize potential adverse effects of anxiety-reducing medications. This study used a quasi-experimental design to evaluate the effects of a perioperative music intervention (provided continuously throughout the preoperative, intraoperative, and postoperative periods) on changes in mean arterial pressure (MAP), heart rate, anxiety, and pain in women with a diagnosis of breast cancer undergoing mastectomy. A total of 30 women were assigned randomly to a control group or to the music intervention group. Findings indicated that women in the intervention group had a greater decrease in MAP and anxiety with less pain from the preoperative period to the time of discharge from the recovery room compared with women in the control group. Music is a noninvasive and low-cost intervention that can be easily implemented in the perioperative setting, and these findings suggest that perioperative music can reduce MAP, anxiety, and pain among women undergoing mastectomy for breast cancer. PMID:22403963

  19. Anesthesia Strategies and Perioperative Optimization for Patients with Ankylosing Spondylitis Undergoing Total Hip Replacement Surgery.


    Objective To identify the characteristics of anesthesia and perioperative management for ankylosing spondylitis (AS) patients undergoing total hip arthroplasty (THA). Methods Totally 63 patients scheduled for single THA in PUMC Hospital from January 1st 2013 to June 1st 2015 were included in this retrospective analysis,among whom 21 patients were diagnosed of AS. The perioperative clinical data included:demographic data,American Society of Anesthesiologists (ASA) classification,medical history,airway assessment,preoperative laboratory examinations,electrocardiogram,pulmonary function tests,intubation information,operation time,intraoperative intake and output volume,postoperative hospital stay,and postoperative complications. Results Significantly fewer AS patients undergoing THA were evaluated as ASA classification I than non-AS patients (9.5% vs. 33.3%,P=0.041). AS patients had significantly higher level of preoperative high-sensitivity C-reactive protein [(17.0±14.8)mg/L vs.(4.3±7.1)mg/L,P0.05). Conclusions AS patients undergoing THA have elevated preoperative inflammatory markers,with high incidence of pulmonary function abnormality and difficult airway. In consideration of high risk of surgery and anesthesia,adequate airway evaluation and optimization of perioperative management are needed to ensure the patients' safety. PMID:27469916

  20. Current perioperative management of radical cystectomy with intestinal urinary reconstruction for muscle-invasive bladder cancer and reduction of the incidence of postoperative ileus.

    Maffezzini, Massimo; Campodonico, Fabio; Canepa, Giorgio; Gerbi, Guido; Parodi, Donatella


    Major abdominal surgery, and also radical cystectomy, is followed by a delayed return of bowel function attributable to postoperative ileus (POI), which, in addition, stands out as one of the most frequent complications that causes increased length of stay (LOS). Some variability exists in the definition of POI since time to return of peristalsis and time to first passage of flatus, which are commonly referred to as indicators of bowel activity, have their own weaknesses, observer dependent and time dependent, among other variables. A number of causes have been recognized to induce or maintain the condition of ileus. Some among them are part of the perioperative period. The practices of mechanical bowel preparation (MBP) and of fasting before surgery have been challenged and can be safely abandoned. The perception of pain is an acknowledged promoter of POI; therefore, providing complete pain control constitutes the rationale in favor of administering anesthesia and analgesia combined, both in the form of concurrent general and epidural anesthesia (i.e., at the thoracic level, T9, T11), and represents the mainstay of intraoperative measures. Hypovolemia is also associated with an increased risk of POI. The use of nasogastric tubing (NGT) has been associated with increased pulmonary complications; moreover, bowel resection can be performed safely without postoperative NGT. Early postoperative provision of artificial nutrients has shown beneficial effects, both in the form of total parenteral and enteral nutrition (PEN, EN). We devised a perioperative care regimen, adopting a multimodality approach aimed at minimizing the effects of the above listed factors to ascertain if they could contribute to preventing or reducing POI and the complications associated with radical cystectomy and intestinal urinary diversion. In addition, we investigated the impact of early artificial nutrition, combining PEN and EN via a jejunal nutrition cannula. Time to return of bowel

  1. 肝癌介入治疗病人围术期合并上消化道出血的护理%The nursing methods for liver cancer interventional treatment patients with upper gastrointestinal bleeding in the perioperative

    龚美霞; 洪侠; 徐艳莉; 陈川


    Objective:To study the nursing methods for liver cancer interventions! Treatment patients with upper gastrointestinal bleeding in the periopera-tive. Methods:To analyzing the nursing experience of 42 liver cancer interventional treatment patients with upper gastrointestinal bleeding in January 2005 -December 2010 and summarizing the care nursing experience points. Results:Thirty - nine of forty - two patients survived after clinical rescue and nursing, while there were 3 cases of death. Conclusions: liver interventional perioperative with upper gastrointestinal bleeding is in critical need of professional and careful nursing, and has a bit inadvertent, serious consequences.%目的:探讨介入治疗肝癌病人围术期合并上消化道出血的护理方法.方法:分析2005年1月~2010年12月42例肝癌介入治疗病人围术期合并上消化道出血的护理经验,总结其护理要点.结果:42例病人经临床抢救及护理,存活39例,死亡3例.结论:肝癌介入治疗围术期合并上消化道出血病情危重,需要专业和细心的护理,稍有不慎,后果严重.

  2. Ultrasound-guided rectus sheath and transversus abdominis plane blocks for perioperative analgesia in upper abdominal surgery: A randomized controlled study

    Khaled Abdelsalam


    Full Text Available Background: Regional anesthetic techniques can be used to alleviate postoperative pain in patients undergoing major upper abdominal surgery. Our aim was to evaluate the efficacy of bilateral ultrasound (US-guided rectus sheath (RS and transversus abdominis plane (TAP blocks for better perioperative analgesia. Patients and Methods: It is a prospective, observer-blinded, randomized clinical study. 40 eligible patients undergoing elective liver resection or Whipple procedure were included. All patients received a standardized anesthetic technique. Group 1 (n = 20 received preincisional US-guided bilateral RS and TAP blocks using 20 ml volume of bupivacaine 0.25% for each, and group 2 (n = 20 received local wound infiltration at end of surgery with 40 ml of bupivacaine 0.25%. A standardized postoperative analgesic regimen composed of intravenous paracetamol and a morphine patient-controlled analgesia (PCA. The use of intraoperative fentanyl and recovery room morphine boluses, PCA-administered morphine, pain scores as well as number of patients′ experienced postoperative nausea and vomiting in the ward at 6 and 24 h were recorded. Results: Group 1 patients received a significantly lower cumulative intraoperative fentanyl, significantly lesser boluses of morphine in postanesthesia care unit, as well, significantly lower cumulative 24 h postoperative morphine dosage than the group 2 patients. Pain visual analog scale scores were significantly lower at both 6 and 24 h postoperatively in TAP group when compared with the no-TAP group. There were no complications related to the TAP block procedures. No signs or symptoms of local anesthetic systemic toxicity were detected. Conclusion: The combination of bilateral US-guided RS and TAP blocks provides excellent perioperative analgesia for major upper abdominal surgery.

  3. The nursing care for patients of hepatocellular carcinoma treated with transcatheter hepatic arterial chemoembolization and high intensive focus ultrasound

    Objective: To discuss the nursing measures for patients of hepatocellular carcinoma treated with transcatheter hepatic arterial chemoembolization (TACE) and high intensive focus ultrasound(HIFU). Methods: During the period of Aug.2008-Aug. 2009, TACE together with HIFU were performed in 40 patients with hepatocellular carcinoma. The perioperative nursing measures were summarized. Results: During hospitalization no severe complications, such as dangerous infection, intestinal bleeding, etc. occurred in all patients. Conclusion: Correct and proper perioperative nursing care is of significant importance for the prevention of complications and for the therapeutic effectiveness. (authors)

  4. Pulsed DC accelerator for laser wakefield accelerator

    For the acceleration of ultra-short, high-brightness electron bunches, a pulsed DC accelerator was constructed. The pulser produced megavolt pulses of 1 ns duration in a vacuum diode. Results are presented from field emission of electrons in the diode. The results indicate that the accelerating gradient in the diode is approximately 1.5 GV/m

  5. Linear Accelerator (LINAC)

    ... News Physician Resources Professions Site Index A-Z Linear Accelerator A linear accelerator (LINAC) customizes high energy x-rays to ... ensured? What is this equipment used for? A linear accelerator (LINAC) is the device most commonly used ...

  6. High-risk bladder cancer: improving outcomes with perioperative chemotherapy

    Daniel Y.C. Heng


    Full Text Available Despite treatment with radical cystectomy and pelvic lymph node dissection, muscle invasive bladder cancer has a relapse rate of 50%. Patients can develop regionally advanced or metastatic disease that ultimately leads to death. The addition of neoadjuvant or adjuvant chemotherapy to reduce the risk of relapse and death has been extensively studied over the past two decades. Two contemporary trials coupled with a recent meta-analysis evaluating neoadjuvant chemotherapy demonstrated a modest but real improvement in overall survival. This has made neoadjuvant chemotherapy a standard of care. Clinical trials evaluating adjuvant chemotherapy in patients with high-risk disease have been plagued with statistical flaws and have, therefore, been unable to define the survival impact of this approach. It is hoped that ongoing adjuvant trials that are powered to detect small but meaningful clinical differences will clarify the benefit of chemotherapy after cystectomy. Since there are theoretical advantages and disadvantages to each of these approaches, both are widely used in North America. The evidence behind each approach and potential future developments in this field will be described.

  7. Perioperative management of tracheobronchial injury following blunt trauma

    Nilesh M Juvekar


    Full Text Available We describe tracheobronchial injury (TBI in a 17-year-old teenager following blunt trauma resulting from a road traffic accident. The patient presented to a peripheral hospital with swelling over the neck and face associated with bilateral pneumothorax for which bilateral intercostal drains were inserted and the patient was transferred to our institute. Fiber-optic videobronchoscopy (FOB was performed, the trachea and bronchi were visualized, and the site and extent of injury was assessed. Spontaneous respiration was maintained till assessment of the airway. Then the patient was anesthetized with propofol and paralyzed using succinylcholine and a double-lumen endobronchial tube was inserted; thereafter, the adequacy of controlled manual ventilation and air-leak through intercostal drains was assessed and the patient was transferred to operating room (OR for repair of the airway injury. The OR was kept ready during FOB to manage any catastrophe. This case describes the need for proper preparation and communication between health care team members to manage all possible scenarios of traumatic TBI.

  8. 老年糖尿病患者行冠状动脉搭桥术围术期护理研究%Perioperative Nursing of Elderly Patients with Diabetes Mellitus Undergoing Coronary Artery Bypass Grafting



    Objective To study the perioperative nursing care of elderly patients with diabetes mellitus, and to study the ef-fect of perioperative nursing. Methods from June 2012 to March 2015, the clinical data of elderly patients with diabetes mellitus were studied, and the patients were treated with careful perioperative nursing. Results in this study, 110 cases of elderly patients with diabetes, 2 cases of hypoglycemia symptoms, 3 cases of elderly patients with diabetes after surgery, the symptoms of superficial infection, and the rest of the elderly patients with diabetes were not complications, after active treatment and care, all the elderly patients with diabetes were discharged. Conclusion elderly patients with diabetes melli-tus underwent coronary artery bypass grafting surgery has a greater risk, provide a careful perioperative care, and close monitoring of patients with blood glucose changes is a smooth operation of coronary artery bypass surgery, elderly patients with diabetes safely through perioperative period of important guarantee.%目的:研究老年糖尿病患者行冠状动脉搭桥术围术期护理方法,以及围术期的护理效果。方法选取2012年6月—2015年3月该院收治的实施行冠状动脉搭桥术的老年糖尿病患者临床资料为研究对象,并对这些患者进行精心围术期护理,并且严密监控患者血糖变化。结果在此次研究的110例老年糖尿病患者中有2例出现低血糖症状,3例老年糖尿病患者术后切口出现表浅感染症状,其余老年糖尿病患者均未出现并发症,经过该院积极治疗和护理,所有老年糖尿病患者均康复出院。结论老年糖尿病患者行冠状动脉搭桥术有着较大的风险,提供精心围术期护理,以及密切监控患者血糖变化是行冠状动脉搭桥手术顺利进行、老年糖尿病患者安全渡过围术期的重要保证。

  9. Nursing care for patients receiving percutaneous lumbar discectomy and intradiscal electrothermal treatment for lumbar disc herniation

    Objective: To summarize the nursing experience in caring patients with lumbar intervertebral disc herniation who received percutaneous lumbar discectomy (PLD) together with intradiscal electrothermal treatment (IDET) under DSA guidance. Methods: The perioperative nursing care measures carried out in 126 patients with lumbar intervertebral disc herniation who underwent PLD and IDET were retrospectively analyzed. Results: Successful treatment of PLD and IDET was accomplished in 112 cases. Under comprehensive and scientific nursing care and observation, no serious complications occurred. Conclusion: Scientific and proper nursing care is a strong guarantee for a successful surgery and a better recovery in treating lumbar intervertebral disc herniation with PLD and IDET under DSA guidance. (authors)

  10. Perioperative steroid administration inhibits angiogenic host tissue response to porous polyethylene (medpor® implants

    S Ehrmantraut


    Full Text Available Porous polyethylene (Medpor® is an alloplastic biomaterial, which is commonly used in plastic and reconstructive surgery. In the present study, we analyzed the effect of perioperative steroid administration on the inflammatory and angiogenic host tissue response to implanted Medpor®. For this purpose, Medpor® was implanted into the dorsal skinfold chamber of prednisolone-treated and vehicle-treated (control balb/c mice and analyzed by means of intravital fluorescence microscopy over a 14-day period. Incorporation of the implants was evaluated by histology. An aortic ring assay and Western blot analyses were performed to determine in vitro the effect of prednisolone on angiogenesis. Implantation of Medpor® did not induce a leukocytic inflammatory host tissue response. However, in prednisolone-treated and control animals giant cells could be detected at the interface between the implants and the surrounding granulation tissue as a typical indicator for a chronic foreign body reaction. Interestingly, perioperative prednisolone administration inhibited vascularisation of the implants, as indicated by a significantly decreased functional density of newly developing capillary blood vessels. Accordingly, prednisolone suppressed in vitro endothelial sprouting and tube formation in the aortic ring assay and reduced proliferating cell nuclear antigen (PCNA, Tie2, vascular endothelial growth factor (VEGF and matrix metalloproteinase (MMP-9 expression of murine endothelioma cells. In conclusion, prednisolone treatment inhibits the early vascularisation of Medpor® implants due to direct inhibition of distinct angiogenic mechanisms. Therefore, perioperative steroid therapy should be avoided in case of Medpor® implantation to achieve a rapid incorporation of the biomaterial at the implantation site.

  11. Acceleration without Horizons

    Doria, Alaric; Munoz, Gerardo


    We derive the metric of an accelerating observer moving with non-constant proper acceleration in flat spacetime. With the exception of a limiting case representing a Rindler observer, there are no horizons. In our solution, observers can accelerate to any desired terminal speed $v_{\\infty} < c$. The motion of the accelerating observer is completely determined by the distance of closest approach and terminal velocity or, equivalently, by an acceleration parameter and terminal velocity.

  12. Administration of perioperative penicillin reduces postoperative serum amyloid A response in horses being castrated standing

    Busk, Peter; Jacobsen, Stine; Martinussen, Torben


    Objectives: To compare postoperative inflammatory responses in horses administered perioperative procaine penicillin and those not administered penicillin using acute phase protein serum amyloid A (SAA) as a marker of inflammation. Study Design: Randomized clinical trial. Animals: Stallions (n = 50...... administered NSAID and 25,000 U/kg procaine penicillin on day 0, 1, and 2. Results: SAA concentrations increased significantly from preoperative levels in both groups, and on day 8 concentrations were significantly (P o .02) higher in horses administered only NSAID than in those administered procaine penicillin...

  13. Kidney Dysfunction and Left Ventricular Assist Device Support: A Comprehensive Perioperative Review

    Coffin, Samuel T.; Waguespack, Dia R.; Haglund, Nicholas A.; Maltais, Simon; Dwyer, Jamie P.; Keebler, Mary E.


    Left ventricular assist devices (LVADs) are used increasingly as a bridge to transplantation or as destination therapy in end-stage heart failure patients who do not respond to optimal medical therapy. Many of these patients have end-organ dysfunction, including advanced kidney dysfunction, before and after LVAD implantation. Kidney dysfunction is a marker of adverse outcomes, such as increased morbidity and mortality. This review discusses kidney dysfunction and associated management strategies during the dynamic perioperative time period of LVAD implantation. Furthermore, we suggest potential future research directions to better understand the complex relationship between renal pathophysiology and mechanical circulatory support. PMID:25759700

  14. A look at a successful perioperative nurse extern-intern program.

    Courney, Thomas J


    IN 2000, St Mary-Corwin Medical Center, Pueblo, Colo, launched a perioperative nurse extern-intern program to address the critical nursing shortage the facility's OR was experiencing. THE PROGRAM HAS THREE LEVELS, all of which focus on applying lessons learned in the classroom to the clinical setting. The final level of the program is designed to help participants' transition from being students to being clinical practitioners. ALL STUDENTS who participated in the program passed the National Council Licensure Examination on the first attempt. In addition, the program has improved employee recruitment and retention rates, reduced orientation and training costs, and resulted in positive feedback from participants. PMID:15799507

  15. Perioperative visual loss with non-ocular surgery: Case report and review of literature

    Nidhi Pandey


    Full Text Available Perioperative visual loss (POVL, a rare but devastating complication, has been reported after spine, cardiac, and head-neck surgeries.The various causes include ischemic optic neuropathy, central or branch retinal artery occlusion, and cortical blindness. The contributory factors described are microvascular diseases and intraoperative hemodynamic compromise. However, the exact association of these factors with post-operative blindness has not yet been confirmed. A case of POVL with caesarian section surgery is being presented. The visual loss occurred due to a combined occlusion of central retinal artery and vein.The causes, presentation, and risk factors of POVL after non-ocular surgery are being discussed.

  16. Perioperative Management of a Jehovah's Witness Presenting for Skull Base Surgery.

    Chaney, M A; Jellish, W S; Leonetti, J P


    A 22-year-old, otherwise healthy, female Jehovah's Witness underwent resection of a midline skull base chondrosarcoma which had been detected after a work-up for headache and diplopia. After bilateral maxillectomies, ethmoidectomies, and a sphenoidectomy, the patient's chondrosarcoma was resected. Despite proper anesthetic management and meticulous hemostasis, significant intraoperative blood loss occurred. The initial postoperative hemoglobin level was 2.3 gm/dL. The clinical concerns pertaining to the perioperative management of the Jehovah's Witness are discussed along with the patient's course and management. PMID:17170989

  17. A randomized double-blind trial on perioperative administration of probiotics in colorectal cancer patients

    Luca; Gianotti; Lorenzo; Morelli; Francesca; Galbiati; Simona; Rocchetti; Sara; Coppola; Aldo; Beneduce; Cristina; Gilardini; Daniela; Zonenschain; Angelo; Nespoli; Marco; Braga


    AIM:To investigate whether probiotic bacteria,given perioperatively,might adhere to the colonic mucosa, reduce concentration of pathogens in stools,and modulate the local immune function. METHODS:A randomized,double-blind clinical trial was carried out in 31 subjects undergoing elective colorectal resection for cancer.Patients were allocated to receive either a placebo(group A,n=10),or a dose of 10 7 of a mixture of Bifidobacterium longum(BB536) and Lactobacillus johnsonii(La1)(group B,n=11),or the same mix...

  18. Role of perioperative transesophageal echocardiography in the management of adolescent truncus arteriosus: Rare case report

    P S Nagaraja


    Full Text Available Truncus arteriosus (TA is a rare congenital heart disease defined as a single arterial vessel arising from the heart that gives origin to the systemic, pulmonary and coronary circulations. The truncal valve in majority of the cases is tricuspid though quadricuspid and bicuspid valves have been reported. Patients with TA typically have a large nonrestrictive sub truncal ventricular septal defect. Survival of these infants beyond 1-year is uncommon. Here, we report a unique case of 12-year-old female patient with persistent TA who underwent surgical repair by using transesophageal echocardiography as a monitoring device during the perioperative management.

  19. Perioperative external pneumatic calf compression as thromboembolism prophylaxis in gynecologic oncology: report of a randomized controlled trial

    Postoperative venous thromboembolic complications are a major problem for the gynecologic oncologist. External pneumatic calf compression (EPC), when applied intraoperatively and left on the patient's legs for 5 days postoperatively, has been previously demonstrated to significantly reduce the incidence of venous thromboembolic complications in patients undergoing surgery for pelvic malignancies. The purpose of this study is to evaluate whether a short perioperative course of EPC is also effective in preventing venous thromboembolic complications. One hundred ninety-four patients participated in a randomized controlled trial of perioperative external pneumatic calf compression. 125I-labeled fibrinogen scanning and impedance plethysmography were used as prospective surveillance methods in both groups. Venous thromboembolic complications were diagnosed in 12.4% of control group patients and in 18.6% of EPC group patients. External pneumatic calf compression when used only in the perioperative period appears to be of no benefit in reducing the incidence of postoperative venous thromboembolic complications

  20. Utilization and perioperative complications of laparoscopic cryoablation vs. robotic partial nephrectomy for localized renal tumors

    Aaron C. Weinberg


    Full Text Available ABSTRACTObjective:To compare the utilization, perioperative complications and predictors of LCA versus RPN in the treatment of localized renal tumors.Methods:From the Nationwide Inpatient Sample we identified patients undergoing RPN or LCA for the treatment of localized renal tumors from October 2008 through 2010. Patient and hospital-specific factors which predict postoperative complications and use of LCA were investigated.Results:14,275 patients with localized renal tumors were identified: 70.3% had RPN and 29.7% had LCA. LCA was more common in older patient and at hospitals without robotic consoles. No difference was identified in perioperative complications (0.2% vs. 0.2%, transfusion (5.1% vs. 6.2%, length of stay (2.9 vs. 3.0 days or median cost ($41,753 vs. $44,618 between the groups, LCA vs. RPN. On multivariate analysis sicker patients were more likely to have LCA (OR 1.34, p=0.048 and sicker patients had greater postoperative complications (OR 3.30, pConclusions:More patients had RPN vs. LCA; surgical technique was not predictive of postoperative complications. As technology develops to treat localized renal tumors, it will be important to continue to track outcomes and costs for procedures including RPN and LCA.

  1. Selective use of peri-operative steroids in pituitary tumor surgery: escape from dogma

    Jacqueline Marie Regan


    Full Text Available Objective: Traditional neurosurgical practice calls for administration of peri-operative stress-dose steroids for sellar-suprasellar masses undergoing operative treatment. This practice is considered critical to prevent peri-operative complications associated with hypoadrenalism, such as hypotension and circulatory collapse. However, stress-dose steroids complicate the management of these patients. It has been our routine practice to use stress steroids during surgery only if the patient has clinical or biochemical evidence of hypocortisolism pre-operatively. We wanted to be certain that this practice was safe.Methods: We present our retrospective analysis from a consecutive series of 114 operations in 109 patients with sellar and/or suprasellar tumors, the majority of whom were managed without empirical stress-dose steroid coverage. Only patients who were hypoadrenal pre-operatively or who had suffered apoplexy were given stress dose coverage during surgery. We screened for biochemical evidence of hypoadrenalism as a result of surgery by measuring immediate post-operative AM serum cortisol levels.Results: There were no adverse events related to the selective use of cortisol replacement in this patient population. Conclusions: Our experience demonstrates that selective use of corticosteroid replacement is safe; it simplifies the management of the patients, and has advantages over empiric dogmatic steroid coverage.

  2. Revisiting perioperative chemotherapy: the critical importance of targeting residual cancer prior to wound healing

    Scientists and physicians have long noted similarities between the general behavior of a cancerous tumor and the physiological process of wound healing. But it may be during metastasis that the parallels between cancer and wound healing are most pronounced. And more particularly and for the reasons detailed in this paper, any cancer remaining after the removal of a solid tumor, whether found in micrometastatic deposits in the stroma or within the circulation, may be heavily dependent on wound healing pathways for its further survival and proliferation. If cancer cells can hijack the wound healing process to facilitate their metastatic spread and survival, then the period immediately after surgery may be a particularly vulnerable period of time for the host, as wound healing pathways are activated and amplified after the primary tumor is removed. Given that we often wait 30 days or more after surgical removal of the primary tumor before initiating adjuvant chemotherapy to allow time for the wound to heal, this paper challenges the wisdom of that clinical paradigm, providing a theoretical rationale for administering therapy during the perioperative period. Waiting for wound healing to occur before initiating adjuvant therapies may be seriously compromising their effectiveness, and patients subsequently rendered incurable as a result of this wait. Clinical trials to establish the safety and effectiveness of administering adjuvant therapies perioperatively are needed. These therapies should target not only the residual cancer cells, but also the wound healing pathway utilized by these cells to proliferate and metastasize

  3. Comparison of robotic and laparoscopic colorectal resections with respect to 30-day perioperative morbidity

    Feinberg, Adina E.; Elnahas, Ahmad; Bashir, Shaheena; Cleghorn, Michelle C.; Quereshy, Fayez A.


    Background Robotic surgery has emerged as a minimally invasive alternative to traditional laparoscopy. Robotic surgery addresses many of the technical and ergonomic limitations of laparoscopic surgery, but the literature regarding clinical outcomes in colorectal surgery is limited. We sought to compare robotic and laparoscopic colorectal resections with respect to 30-day perioperative outcomes. Methods The American College of Surgeons National Surgical Quality Improvement Program database was used to identify all patients who underwent robotic or laparoscopic colorectal surgery in 2013. We performed a logistic regression analysis to compare intraoperative variables and 30-day outcomes. Results There were 8392 patients who underwent laparoscopic colorectal surgery and 472 patients who underwent robotic colorectal surgery. The robotic cohort had a lower incidence of unplanned intraoperative conversion (9.5% v. 13.7%, p = 0.008). There were no significant differences between robotic and laparoscopic surgery with respect to other intraoperative and postoperative outcomes, such as operative duration, length of stay, postoperative ileus, anastomotic leak, venous thromboembolism, wound infection, cardiac complications and pulmonary complications. On multivariable analysis, robotic surgery was protective for unplanned conversion, while male sex, malignancy, Crohn disease and diverticular disease were all associated with open conversion. Conclusion Robotic colorectal surgery has comparable 30-day perioperative morbidity to laparoscopic surgery and may decrease the rate of intraoperative conversion in select patients. PMID:27240135

  4. Perioperative plasma concentrations of stable nitric oxide products are predictive of cognitive dysfunction after laparoscopic cholecystectomy.

    Iohom, G


    In this study our objectives were to determine the incidence of postoperative cognitive dysfunction (POCD) after laparoscopic cholecystectomy under sevoflurane anesthesia in patients aged >40 and <85 yr and to examine the associations between plasma concentrations of i) S-100beta protein and ii) stable nitric oxide (NO) products and POCD in this clinical setting. Neuropsychological tests were performed on 42 ASA physical status I-II patients the day before, and 4 days and 6 wk after surgery. Patient spouses (n = 13) were studied as controls. Cognitive dysfunction was defined as deficit in one or more cognitive domain(s). Serial measurements of serum concentrations of S-100beta protein and plasma concentrations of stable NO products (nitrate\\/nitrite, NOx) were performed perioperatively. Four days after surgery, new cognitive deficit was present in 16 (40%) patients and in 1 (7%) control subject (P = 0.01). Six weeks postoperatively, new cognitive deficit was present in 21 (53%) patients and 3 (23%) control subjects (P = 0.03). Compared with the "no deficit" group, patients who demonstrated a new cognitive deficit 4 days postoperatively had larger plasma NOx at each perioperative time point (P < 0.05 for each time point). Serum S-100beta protein concentrations were similar in the 2 groups. In conclusion, preoperative (and postoperative) plasma concentrations of stable NO products (but not S-100beta) are associated with early POCD. The former represents a potential biochemical predictor of POCD.

  5. Predicting perioperative mortality after oesophagectomy: a systematic review of performance and methods of multivariate models.

    Warnell, I; Chincholkar, M; Eccles, M


    Predicting risk of perioperative mortality after oesophagectomy for cancer may assist patients to make treatment choices and allow balanced comparison of providers. The aim of this systematic review of multivariate prediction models is to report their performance in new patients, and compare study methods against current recommendations. We used PRISMA guidelines and searched Medline, Embase, and standard texts from 1990 to 2012. Inclusion criteria were English language articles reporting development and validation of prediction models of perioperative mortality after open oesophagectomy. Two reviewers screened articles and extracted data for methods, results, and potential biases. We identified 11 development, 10 external validation, and two clinical impact studies. Overestimation of predicted mortality was common (5-200% error), discrimination was poor to moderate (area under receiver operator curves ranged from 0.58 to 0.78), and reporting of potential bias was poor. There were potentially important case mix differences between modelling and validation samples, and sample sizes were considerably smaller than is currently recommended. Steyerberg and colleagues' model used the most 'transportable' predictors and was validated in the largest sample. Most models have not been adequately validated and reported performance has been unsatisfactory. There is a need to clarify definition, effect size, and selection of currently available candidate predictors for inclusion in prediction models, and to identify new ones strongly associated with outcome. Adoption of prediction models into practice requires further development and validation in well-designed large sample prospective studies. PMID:25231768

  6. Perioperative ischaemia-induced liver injury and protection strategies: An expanding horizon for anaesthesiologists

    Chandra Kant Pandey


    Full Text Available Liver resection is an effective modality of treatment in patients with primary liver tumour, metastases from colorectal cancers and selected benign hepatic diseases. Its aim is to resect the grossly visible tumour with clear margins and to ensure that the remnant liver mass has sufficient function which is adequate for survival. With the advent of better preoperative imaging, surgical techniques and perioperative management, there is an improvement in the outcome with decreased mortality. This decline in postoperative mortality after hepatic resection has encouraged surgeons for more radical liver resections, leaving behind smaller liver remnants in a bid to achieve curative surgeries. But despite advances in diagnostic, imaging and surgical techniques, postoperative liver dysfunction of varied severity including death due to liver failure is still a serious problem in such patients. Different surgical and non-surgical techniques like reducing perioperative blood loss and consequent decreased transfusions, vascular occlusion techniques (intermittent portal triad clamping and ischaemic preconditioning, administration of pharmacological agents (dextrose, intraoperative use of methylprednisolone, trimetazidine, ulinastatin and lignocaine and inhaled anaesthetic agents (sevoflurane and opioids (remifentanil have demonstrated the potential benefit and minimised the adverse effects of surgery. In this article, the authors reviewed the surgical and non-surgical measures that could be adopted to minimise the risk of postoperative liver failure following liver surgeries with special emphasis on ischaemic and pharmacological preconditioning which can be easily adapted clinically.



    Objective To explore the relationship between perioperative serum thyroid hormone changes and heart dysfunction in patients undergone cardiac valve replacement. Methods The serum concentrations of free tri- iodothyronine (),free thyroxine (),total total reverse and thyroid-stimulating hor- mone (TSH) in 20 patients undergone routine rheumatic mitral valve replacement were determined by radioim- munoassay at preoperation, the end of myocardial ischemia, and 2,6,12,24 and 48h postoperation, respectively. The alteration hormones above mentioned were comparatively analysed of the normal heart function group (group I,n = 14) and heart dysfunction group (group I ,n=6) after surgery. Results In comparing group I with group I , the more severe the chronic congestive heart failure, the lower the thyroid hormone level before operation;and subse- quently both progressively lowered T3 level and acute heart dysfunction emerged after operation. The decreased extent of serum thyroid hormone was closely parallel to the severity of heart dysfunction. Gonclusion Perioperatively, de- creased serum FT3 and TT3 concentrations are at least an important humoral factor aggravating heart dysfunction, and the patients with preoperative low T3 should be considered as high-risk valvular surgical cases.

  8. The use of antivascular endothelial growth factor agents in the perioperative period in diabetic vitrectomy

    Nakhleh E Abu-Yaghi


    Full Text Available Pars plana vitrectomy is an established surgical method for the treatment of proliferative diabetic retinopathy and its complications. Anti-vascular endothelial growth factor agents suppress vascular proliferation and may be used as pharmacological adjuvants to reduce the incidence of postoperative hemorrhage in the vitreous cavity and to facilitate the surgical approach. We conducted an electronic search to identify prospective randomized controlled trials looking at the use of -perioperative vascular endothelial growth factor suppression in diabetic patients undergoing vitrectomy. We found six prospective randomized trials with only one being double-masked. We present a summary of the findings. Four studies suggest that the use of perioperative, anti-vascular endothelial growth factor agents facilitate vitrectomy surgery, but only one study supports their use to reduce the chances of early postoperative vitreous bleeding. Two studies did not find a significant benefit for their use before surgery to reduce the recurrence of vitreous hemorrhage in proliferative diabetic retinopathy. More randomized double blinded studies with a larger number of patients are needed to establish a clear recommendation regarding the use of these agents. Those studies should factor in the use of endo-tamponade with gas or silicone oil following vitrectomy.

  9. [Perioperative Pain Management of Minimally Invasive Esophagectomy with Bilateral Continuous Thoracic Paravertebral Block].

    Hida, Kumiko; Murata, Hiroaki; Sakai, Akiko; Ogami, Keiko; Maekawa, Takuji; Hara, Tetsuya


    Minimally invasive esophagectomy has become popular as a surgical procedure for esophageal cancer. We describe bilateral continuous thoracic paravertebral blocks for perioperative pain management in 3 patients who underwent minimally invasive esophagectomy. After anesthesia induction, bilateral thoracic paravertebral catheters were placed under ultrasound guidance with the patients in left lateral decubitus position at the sixth or seventh right intercostal space and eighth or ninth left intercostal space, respectively. Multiple ports for thoracoscopic procedures were located between the right third and ninth intercostal spaces. Laparoscopy-assisted gastric tube reconstruction was performed with skin incisions at bilateral T7-10 dermatomes. Intraoperative intermittent bolus injections of ropivacaine through the thoracic paravertebral catheters were used in combination with sevoflurane-remifentanil anesthesia, followed by continuous thoracic paravertebral infusion of ropivacaine for postoperative analgesia with continuous intravenous fentanyl infusion and periodical intravenous acetaminophen administration. Numerical rating scales of postoperative pain at rest and when coughing were 4 or less for 48 hr after surgery. No complications related to thoracic paravertebral catheterization were observed. Bilateral continuous thoracic paravertebral blocks at different intercostal levels can provide good perioperative analgesia for minimally invasive esophagectomy. PMID:27017762

  10. Perioperative optic neuropathy in patients undergoing off-pump coronary artery bypass graft surgery

    Rajani Battu


    Full Text Available Aims and Objectives: Perioperative optic neuropathy (PON is a rare, but devastating complication following coronary artery bypass graft surgery (CABG. We performed a retrospective study of PON associated with off-pump CABG (OPCABG to identify possible risk factors. Materials and Methods: 1442 patients underwent OPCABG over a 10-month period from October 2008 to August 2009; PON was identified in four (0.28% patients. A retrospective review of the charts was done to identify the patient characteristics, pre-operative status, intra-operative details, and ophthalmic examination details. Friedman test was used to compare the hematocrit (Hct and the mean arterial pressure (MAP values across the three time periods: Pre-, intra- and post-operative periods. Results: All four patients were male, diabetic, and in the age range 51-69 years. All patients noted unilateral or bilateral severe visual loss in the immediate post-operative period, which was permanent. All the four patients had statistically significant decrease in the Hct (P < 0.039 and mean arterial blood pressure (P < 0.018 in the intraoperative and post-operative period when compared to pre-operative value. Conclusions : PON is a rare but definite possibility in patients undergoing OPCABG. Diabetes mellitus may be a risk factor. Perioperative hemodynamic abnormalities like decrease in MAP and anemia may play a role in the development of PON in OPCABG.

  11. Perioperative insulin therapy using a closed-loop artificial endocrine pancreas after hepatic resection

    Takehiro Okabayashi; Hiromichi Maeda; Zhao-Li Sun; Robert A Montgomery; Isao Nishimori; Kazuhiro Hanazaki


    Postoperative hyperglycemia is common in critically ill patients, even in those without a prior history of diabetes mellitus. It is well known that hyperglycemia induced by surgical stress often results in dysregulation of liver metabolism and immune function, impairing postoperative recovery. Current evidence suggests that maintaining normoglycemia postoperatively improves surgical outcome and reduces the mortality and morbidity of critically ill patients. On the basis of these observations, several large randomized controlledstudies were designed to evaluate the benefit of postoperative tight glycemic control with intensive insulin therapy. However, intensive insulin therapy carries the risk of hypoglycemia, which is linked to serious neurological events. Recently, we demonstrated that perioperative tight glycemic control in surgical patients could be achieved safely using a closed-loop glycemic control system and that this decreased both the incidence of infection at the site of the surgical incision, without the appearance of hypoglycemia, and actual hospital costs. Here, we review the benefits and requirements of perioperative intensive insulin therapy using a closed-loop artificial endocrine pancreas system in hepatectomized patients. This novel intensive insulin therapy is safe and effectively improves surgical outcome after hepatic resection.

  12. High intensity hadron accelerators

    In this paper we give an introductory discussion of high intensity hadron accelerators with special emphasis on the high intensity feature. The topics selected for this discussion are: Types of acclerator - The principal actions of an accelerator are to confine and to accelerate a particle beam. Focusing - This is a discussion of the confinement of single particles. Intensity limitations - These are related to confinement of intense beams of particles. Power economics - Considerations related to acceleration of intense beams of particles. Heavy ion kinematics - The adaptation of accelerators to accelerate all types of heavy ions

  13. The direction of acceleration

    Wilhelm, Thomas; Burde, Jan-Philipp; Lück, Stephan


    Acceleration is a physical quantity that is difficult to understand and hence its complexity is often erroneously simplified. Many students think of acceleration as equivalent to velocity, a ˜ v. For others, acceleration is a scalar quantity, which describes the change in speed Δ|v| or Δ|v|/Δt (as opposed to the change in velocity). The main difficulty with the concept of acceleration therefore lies in developing a correct understanding of its direction. The free iOS app AccelVisu supports students in acquiring a correct conception of acceleration by showing acceleration arrows directly at moving objects.

  14. 2014 CERN Accelerator Schools: Plasma Wake Acceleration


    A specialised school on Plasma Wake Acceleration will be held at CERN, Switzerland from 23-29 November, 2014.   This course will be of interest to staff and students in accelerator laboratories, university departments and companies working in or having an interest in the field of new acceleration techniques. Following introductory lectures on plasma and laser physics, the course will cover the different components of a plasma wake accelerator and plasma beam systems. An overview of the experimental studies, diagnostic tools and state of the art wake acceleration facilities, both present and planned, will complement the theoretical part. Topical seminars and a visit of CERN will complete the programme. Further information can be found at:

  15. Nursing care for patients receiving perccutaneous biopsy of the pancreas under CT-guidance

    Objective: To discuss the application of nursing care in CT-guided percutaneous biopsy of the pancreas. Methods: The perioperative nursing measures were carried out in 21 patients receiving percutaneous biopsy of the pancreas under CT-guidance. Active, effective and comprehensive nursing procedures were adopted to closely cooperate with the whole process of percutaneous biopsy as far as possible. Results: All the patients could actively cooperate with the physician during the whole process of percutaneous biopsy and the surgery was successfully completed in all patients. The technical success rate with only single puncture was 100%. No obvious complications occurred after the procedure. Conclusion: In order to ensure that the patient will be able to cooperate with the CT-guided percutaneous biopsy of the pancreas, that the operation time can be shortened and that the postoperative complications can be avoided, perioperative nursing care is indispensable. (authors)

  16. Accelerated partial breast irradiation with multi-catheter brachytherapy: Local control, side effects and cosmetic outcome for 274 patients. Results of the German-Austrian multi-centre trial

    Background and purpose: To evaluate the safety and effectiveness of accelerated partial breast irradiation (APBI) with multi-catheter brachytherapy. Patients and methods: Between 11/2000 and 04/2005, 274 patients participated. Patients were eligible for APBI if they had histologically confirmed breast cancer, a tumour diameter ≤3 cm, complete resection with clear margins ≥2 mm, negative axillary lymph nodes or singular nodal micro-metastasis, no distant metastases, hormone receptor-positive tumours, and were ≥35 years. Patients were excluded if mammographically they showed a multicentric invasive growth pattern, poorly differentiated tumours, residual diffuse micro-calcifications, extensive intraductal component, or vessel invasion. Median follow-up was 32 months (range; 8-68). Results: The local control rate was 99.3% (272/274), the 3 year-local-recurrence-free survival probability, 99.6%. Peri-operative complications occurred in 5.5% (15/274): 9 (3.3%) experienced implant infection and 6 (2.2%) hematoma. Acute toxicity (Grade 1/2 radio-dermatitis) was seen in 6.6% (18/274). Late side effects ≥ Grade 3 (fibrosis, telangiectasia) occurred in 1.8% (4/274). Cosmetic results were excellent/good in 94% (253/274). Conclusions: This analysis underlined the safety and effectiveness of APBI in a carefully selected subgroup with favourable disease characteristics. Of course, longer follow-up and randomised trials are necessary to conclusively assess the potential of APBI

  17. San Francisco Accelerator Conference

    'Where are today's challenges in accelerator physics?' was the theme of the open session at the San Francisco meeting, the largest ever gathering of accelerator physicists and engineers

  18. Dielectric Laser Acceleration

    England, R. Joel; Noble, Robert J.; Wu, Ziran; Qi, Minghao


    We describe recent advances in the study of particle acceleration using dielectric near-field structures driven by infrared lasers, which we refer to as Dielectric Laser Accelerators. Implications for high energy physics and other applications are discussed.

  19. Standing wave linear accelerator

    Consideration is being given to standing wave linear accelerator containing generator, phase shifter, two accelerating resonator sections, charged particle injector and waveguide bridge. Its first arm is oined up with generator via the phase shifter, the second and the third ones-with accelerating sections and the fourth one - with HF-power absorber. HF-power absorber represents a section of circular diaphragmatic wavequide with transformer with input wave and intrawaveguide output load located between injector and the first accelerating section. The section possesses holes in side walls lying on accelerator axis. The distances between centers of the last cell of the fast accelerating section and the first cell of the second accelerating sectiOn equal (2n+3)lambda/4, where n=1, 2, 3..., lambda - wave length of generator. The suggested system enables to improve by one order spectral characteristics of accelerators as compared to the prototype in which magnetrons are used as generator

  20. Improved plasma accelerator

    Cheng, D. Y.


    Converging, coaxial accelerator electrode configuration operates in vacuum as plasma gun. Plasma forms by periodic injections of high pressure gas that is ionized by electrical discharges. Deflagration mode of discharge provides acceleration, and converging contours of plasma gun provide focusing.

  1. High Energy Particle Accelerators

    Audio Productions, Inc, New York


    Film about the different particle accelerators in the US. Nuclear research in the US has developed into a broad and well-balanced program.Tour of accelerator installations, accelerator development work now in progress and a number of typical experiments with high energy particles. Brookhaven, Cosmotron. Univ. Calif. Berkeley, Bevatron. Anti-proton experiment. Negative k meson experiment. Bubble chambers. A section on an electron accelerator. Projection of new accelerators. Princeton/Penn. build proton synchrotron. Argonne National Lab. Brookhaven, PS construction. Cambridge Electron Accelerator; Harvard/MIT. SLAC studying a linear accelerator. Other research at Madison, Wisconsin, Fixed Field Alternate Gradient Focusing. (FFAG) Oakridge, Tenn., cyclotron. Two-beam machine. Comments : Interesting overview of high energy particle accelerators installations in the US in these early years. .

  2. Maximal Acceleration Is Nonrotating

    Page, Don N.


    In a stationary axisymmetric spacetime, the angular velocity of a stationary observer that Fermi-Walker transports its acceleration vector is also the angular velocity that locally extremizes the magnitude of the acceleration of such an observer, and conversely if the spacetime is also symmetric under reversing both t and phi together. Thus a congruence of Nonrotating Acceleration Worldlines (NAW) is equivalent to a Stationary Congruence Accelerating Locally Extremely (SCALE). These congruenc...

  3. Accelerators at school

    Latest subject covered by the CERN Accelerator School was 'Applied Geodesy of Particle Accelerators', which attracted an impressive number of outside participants to CERN for a week in April. Since the forerunners of today's particle accelerators were demonstrated over 50 years ago, the positioning of accelerator components has progressed from the laboratory bench-top to tunnels tens of kilometres long. Despite this phenomenal growth in size, sub-millimetre accuracy is still required

  4. A Solid state accelerator

    We present a solid state accelerator concept utilizing particle acceleration along crystal channels by longitudinal electron plasma waves in a metal. Acceleration gradients of order 100 GV/cm are theoretically possible, but channeling radiation limits the maximum attainable energy to 105 TeV for protons. Beam dechanneling due to multiple scattering is substantially reduced by the high acceleration gradient. Plasma wave dissipation and generation in metals are also discussed

  5. Superconducting accelerator technology

    Modern and future accelerators for high energy and nuclear physics rely increasingly on superconducting components to achieve the required magnetic fields and accelerating fields. This paper presents a practical overview of the phenomenon of superconductivity, and describes the design issues and solutions associated with superconducting magnets and superconducting rf acceleration structures. Further development and application of superconducting components promises increased accelerator performance at reduced electric power cost

  6. Applications of particle accelerators

    Particle accelerators are now widely used in a variety of applications for scientific research, applied physics, medicine, industrial processing, while possible utilisation in power engineering is envisaged. Earlier presentations of this subject, given at previous CERN Accelerator School sessions have been updated with papers contributed to the first European Conference on Accelerators in Applied Research and Technology (ECAART) held in September 1989 in Frankfurt and to the Second European Particle Accelerator Conference in Nice in June 1990. (orig.)

  7. Perioperative anaphylaxis.

    Mertes, P M


    The incidence of immune-mediated anaphylaxis during anesthesia ranges from 1 in 10,000 to 1 in 20,000. Neuromuscular blocking agents are most frequently incriminated, followed by latex and antibiotics, although any drug or substance used may be a culprit. Diagnosis relies on tryptase measurements at the time of the reaction and skin tests, specific immunoglobulin E, or basophil activation assays. Treatment consists of rapid volume expansion and epinephrine administration titrated to symptom severity.

  8. Accelerator development in BARC

    Charged particle accelerators have played crucial role in the field of both basic and applied sciences. This has been possible because the accelerators have been extensively utilized from unraveling the secrets of nature to diverse applications such as implantation, material modification, medical diagnostics and therapy, nuclear energy and clean air and water. The development of accelerators in BARC can be categorized in two broad categories namely proton and heavy ion based accelerators and electron based accelerators. The heavy ion accelerators with sufficiently high energies are currently being used for conducting frontline nuclear and allied research whereas the electron accelerators are being routinely used for various industrial applications. Recently, there is a strong interest for developing the high energy and high intensity accelerators due to their possibility of effective utilization towards concept of energy amplification (Accelerator Driven System), incineration nuclear waste and transmutation. This talk will discuss details of the accelerator development program in BARC with particular emphasis on the recent development at Low Energy High Intensity Proton Accelerator (LEHIPA) Facility in Ion Accelerator Development Division, BARC. (author)

  9. Far field acceleration

    Far fields are propagating electromagnetic waves far from their source, boundary surfaces, and free charges. The general principles governing the acceleration of charged particles by far fields are reviewed. A survey of proposed field configurations is given. The two most important schemes, Inverse Cerenkov acceleration and Inverse free electron laser acceleration, are discussed in detail

  10. The CERN Accelerator School


    Introduction to accelerator physics The CERN Accelerator School: Introduction to Accelerator Physics, which should have taken place in Istanbul, Turkey, later this year has now been relocated to Budapest, Hungary.  Further details regarding the new hotel and dates will be made available as soon as possible on a new Indico site at the end of May.

  11. Accelerators and Dinosaurs

    Turner, Michael Stanley


    Using naturally occuring particles on which to research might have made accelerators become extinct. But in fact, results from astrophysics have made accelerator physics even more important. Not only are accelerators used in hospitals but they are also being used to understand nature's inner workings by searching for Higgs bosons, CP violation, neutrino mass and dark matter (2 pages)

  12. Acceleration: It's Elementary

    Willis, Mariam


    Acceleration is one tool for providing high-ability students the opportunity to learn something new every day. Some people talk about acceleration as taking a student out of step. In actuality, what one is doing is putting a student in step with the right curriculum. Whole-grade acceleration, also called grade-skipping, usually happens between…

  13. Peripheral Cytokines as a Chemical Mediator for Postconcussion Like Sickness Behaviour in Trauma and Perioperative Patients: Literature Review

    Yasir Rehman; Nadia Rehman; Riaz Rehman


    Besides brain injury and systemic infection, cognitive and concussion like sickness behaviour is associated with muscular trauma and perioperative patients, which represents a major obstacle to daily activities and rehabilitation. The neuroinflammatory response triggers glial activation and consequently the release of proinflammatory cytokines within the hippocampus. We review clinical studies that have investigated neurocognitive and psychosomatic symptoms related to muscular trauma and in p...

  14. Exploration of Syndrome Differentiation Patterns in Coronary Heart Disease Patients during Peri-Operative Stage of Coronary Artery Bypass Graft


    Objective: To explore the patterns of Syndrome Differentiation (SD) of coronary heart disease (CHD) patients in peri-operative stage of coronary artery bypass graft (CABG). Methods: One week after operation, thirty-seven CHD patients, who received CABG of internal mammary artery or great saphena vein under conventional general anesthesia with low or middle temperature extracorporeal circulation were differentiated as various syndromes, with the pre- or post-operational EKG, color Doppler echocardiography were done during and after operation. The hemodynamic parameters were monitored. Results: In the CHD patients, 64.9% were differentiated as Qi-Yin deficiency, 67.6% were complicated with phlegm syndrome and 62.2% with blood stasis, suggesting that Qi-deficiency, phlegm and stasis are the basic pathogenetic factors in patients with CABG. Moreover, the peri-operative syndrome was correlated with the condition of coronary artery lesion, heart and lung functions before operation, and the extracorporeal circulation time during the operation. Conclusion: TCM SD conducting in peri-operative stage might be useful in exploring the patterns of syndrome alteration which provided a basis for preventing peri-operative complications and elevating success rate of operation.

  15. Risk factors for insufficient perioperative oral nutrition after hip fracture surgery within a multi-modal rehabilitation programme

    Foss, Nicolai B; Jensen, Pia S; Kehlet, Henrik


    To examine oral nutritional intake in the perioperative phase in elderly hip fracture patients treated according to a well-defined multi-modal rehabilitation program, including unselected oral nutritional supplementation, and to identify independent risk factors for insufficient nutritional intake....

  16. 破裂颅内动脉瘤围手术期护理%The perioperative nursing of 22 patients with rupture of intracranial aneurysms

    张兰; 庄爱琴


    探讨破裂颅内动脉瘤患者围手术期护理经验.对破裂颅内动脉瘤患者术前做到常规护理快速全面、专科护理用药准确、观察细致、通气良好.术后做到重视病情观察,做好用药、管道及各器官功能的预防性护理.22例患者均得到及时手术,术后恢复良好15例,中度残废5例,重度残废1例,死亡1例.认真细致的病情观察和全面周到的护理是破裂颅内动脉瘤患者顺利康复的保障.%Objective To summarize perioperative nursing experience for the patients with rupture of intracranial aneurysms. Methods 22 patients with rupture of intracranial aneurysm were given quick and all - round routine nursing. And they were accessed medication accurately, observed carefully and good ventilation in special care before operation. They were laid stress on observation, drugs, pipes nursing and preventive nursing of various organs in poetopeative. Results All of 22 patients had been operated in time. After operation, 15 case, were good recovery, 5 cases were moderate disability, 1 case was severe disability and 1 case was died. Conclusions The observation of illness carefully and all- round nursing are the security of smooth rehabilitation with the patients of rapture intracranial aneurysms.

  17. Radiation load of workers on linear accelerators

    Burden of health care personnel working on linear accelerators. New examination and treatment methods enable to reduce the number of health care personnel even in the case of increased numbers of examined patients. However, still open is the question of determining the effective dose delivered to health care personnel. The employment of several methods of evaluation of received dose at one workplace makes it possible to compare the accuracy and reliability of the respective types of measuring devices, as well as to point out the pitfalls of their use.At the St. Elizabeth Cancer Institute we compared the results of measurements of TL dosimeters, and OSL dosimeters at workplaces with linear accelerators. (authors)

  18. Machine Protection: Availability for Particle Accelerators

    Apollonio, Andrea; Schmidt, Ruediger


    Machine availability is a key indicator for the performance of the next generation of particle accelerators. Availability requirements need to be carefully considered during the design phase to achieve challenging objectives in different fields, as e.g. particle physics and material science. For existing and future High-Power facilities, such as ESS (European Spallation Source) and HL-LHC (High-Luminosity LHC), operation with unprecedented beam power requires highly dependable Machine Protection Systems (MPS) to avoid any damage-induced downtime. Due to the high complexity of accelerator systems, finding the optimal balance between equipment safety and accelerator availability is challenging. The MPS architecture, as well as the choice of electronic components, have a large influence on the achievable level of availability. In this thesis novel methods to address the availability of accelerators and their protection systems are presented. Examples of studies related to dependable MPS architectures are given i...

  19. Perioperative fractionated high dose rate brachytherapy in bone and soft-tissue tumors

    Purpose/Objective: Perioperative fractionated HDR brachytherapy was applied for treatment of bone and soft-tissue tumors. We investigate the local control and side effect, and consider possibility to reduce surgical margin. Materials and Methods: The 13 lesions of 11 patients with bone and soft-tissue tumors (four primary and nine recurrent lesions) were treated at Osaka University Hospital between Aug. 1992 and Feb. 1995. Follow-up terms are between a year and 30 months (median; 15 months). They consisted of 8 males and 3 females. The age ranged from 14 to 75 (median; 38). The histology contained 3 MFH's, 2 liposarcomas, 1 chordoma, osteosarcoma, malignant schwanoma, synovial sarcoma, and epithelioid sarcoma. The sites of lesion are 4 pelvis, 4 neck or supraclavicle, 3 upper limbs, and 2 lower limbs. The surgical margins including intraoperative catheterizing are 3 wide, 6 marginal, and 4 intralesional resection. Postoperative fractionated high dose rate (HDR) brachytherapy started on 4-7th day after surgery. A total dose was 40-50 Gy/7-10 fr/6-7 d (bid) at 5 mm from the sources. Results: One case was dead of tumor, 4 cases were dead of metastasis, 1 case is alive with tumor, 2 cases are alive with distant metastasis, and 4 cases are no evidence of disease. Local control was achieved in eight of 13 lesions (62%). Four of the five uncontrolled lesions had macroscopic residual tumor after the surgery. In five of the six marginal resection, lesions were controlled. Local control rates with Kaplan-Mayer methods were 69% in 1 year and 58% in 2 years. Survival rates were 82% in 1 year and 66% in 2 years. There was one peripheral nerve palsy as a side effect. There was no infection or delayed heal of surgical scar, affected by tubing and interstitial radiation. Conclusion: This study indicates that the use of perioperative fractionated HDR brachytherapy is easy, safe, and well tolerated. Some cases with frequent recurrence previously, can also be controlled. A safe

  20. Risk factors for perioperative venous thromboembolism: A retrospective study in Japanese women with gynecologic diseases

    Yoshimatsu Misako


    Full Text Available Abstract Background Patients with gynecologic cancer have a high risk of venous thromboembolism (VTE like patients with other cancers. However, there is little information on risk factors for VTE during gynecologic surgery and no uniform preventive strategy. Our objectives were to identify risk factors for perioperative VTE in gynecologic patients and establish methods for prevention. Methods We analyzed 1,232 patients who underwent surgery at the Department of Obstetrics and Gynecology of St. Marianna University School of Medicine between January 2005 and June 2008. We investigated (1 risk factors for preoperative VTE, (2 use of an inferior vena cava (IVC filter, and (3 risk factors for postoperative VTE. Results There were 39 confirmed cases of perioperative VTE (3.17%, including 25 patients with preoperative VTE and 14 with postoperative VTE. Thirty-two patients had cancer and seven patients had benign diseases. Twenty-two of the 32 cancer patients (68.7% had preoperative VTE, while postoperative VTE occurred in 10 cancer patients. Multivariate analysis indicated that ovarian cancer, tumor diameter ≥10 cm, and previous of VTE were independent risk factors for preoperative VTE. Among ovarian cancer patients, multivariate analysis showed that an age ≥50 years, the presence of heart disease, clear cell adenocarcinoma, and tumor diameter ≥20 cm were independent risk factors for preoperative VTE. The factors significantly related to preoperative VTE in patients with benign disease included previous VTE, age ≥55 years, tumor diameter ≥20 cm, and a history of allergic-immunologic disease. Thirteen of the 25 patients (52% with preoperative VTE had an IVC filter inserted preoperatively. Postoperative screening (interview and D-dimer measurement revealed VTE in 14/1,232 patients (1.14%. Multivariate analysis indicated that cancer surgery, a history of allergic-immunologic disease, and blood transfusion ≥2,000 ml were independent risk

  1. Does concomitant tricuspid annuloplasty increase perioperative mortality and morbidity when correcting left-sided valve disease?

    Zhu, Tie-Yuan; Wang, Jian-Gang; Meng, Xu


    A best evidence topic in adult valvular surgery was written according to a structured protocol. The question addressed was 'Does concomitant tricuspid annuloplasty increase the perioperative mortality and morbidity when correcting left-sided valve disease?' A total of 561 papers were found using the reported search, of which 12 presented the best evidence to answer the clinical question. The authors, country, journal, date of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Among these 12 papers, there were nine retrospective studies, two cohort studies and one randomized controlled trial (RCT). Overall, additional tricuspid valve (TV) repair takes more time during operations, particularly with a ring annuloplasty method. The mean aortic cross-clamping times were 57-83 min without associated tricuspid repair and 62-100 min with, and cardiopulmonary bypass times without and with repair were 82-124 and 90-174 min, respectively. A study of 624 patients who had undergone isolated mitral valve (MV) surgery and MV surgery plus TV repair showed more female and atrial fibrillation patients in the tricuspid valve plasty (TVP) group, but no increase in the 30-day mortality was found. One RCT, presenting similar patient baseline characteristics, also found no difference in the hospital mortality rates between the TVP group and the non-TVP group. Another 10 studies also demonstrated no statistically significant differences in perioperative mortality. In a cohort study of 311 patients undergoing MV repair with or without tricuspid annuloplasty, postoperative complications, such as bleeding, stroke, pacemaker, haemofiltration and myocardial infarction, all showed no statistically significant differences in the two groups. One study retrospectively analysed a large number of patients undergoing either isolated left-sided valve surgery or a concomitant TV repair, and there were no statistically significant differences

  2. The Accelerator Reliability Forum

    Lüdeke, Andreas; Giachino, R


    A high reliability is a very important goal for most particle accelerators. The biennial Accelerator Reliability Workshop covers topics related to the design and operation of particle accelerators with a high reliability. In order to optimize the over-all reliability of an accelerator one needs to gather information on the reliability of many different subsystems. While a biennial workshop can serve as a platform for the exchange of such information, the authors aimed to provide a further channel to allow for a more timely communication: the Particle Accelerator Reliability Forum [1]. This contribution will describe the forum and advertise it’s usage in the community.

  3. Direct Laser Acceleration in Laser Wakefield Accelerators

    Shaw, Jessica


    In this dissertation, the direct laser acceleration (DLA) of ionization-injected electrons in a laser wakefield accelerator (LWFA) operating in the quasi-blowout regime has been investigated through experiment and simulation. In the blowout regime of LWFA, the radiation pressure of an intense laser pulse can push a majority of the plasma electrons out and around the main body of the pulse. The expelled plasma electrons feel the electrostatic field of the relatively-stationary ions and are t...

  4. Prenatal Care

    ... am thinking about getting pregnant. How can I take care of myself? You should start taking care of ... What should I do — or not do — to take care of myself and my unborn baby? Follow these ...

  5. Self Care

    ... Care Connections Experiences Research Learning Evaluation Print Email Self Care If you are living with a chronic ... help you cope can make a real difference. Self-care techniques are things you can do for ...

  6. Are we causing the recurrence-impact of perioperative period on long-term cancer prognosis: Review of current evidence and practice

    Jyotirmoy Das


    Full Text Available Newer developments in the field of chemotherapeutic drug regimes, radiotherapy, and surgical techniques have improved the prognosis of cancer patients tremendously. Today increasing numbers of patients with aggressive disease are posted for surgical resection. The advances in reconstructive flap surgery offer the patient a near normal dignified postresection life. Hence, the expectations from the patients are also on the rise. Anesthetic challenges known in oncosurgery are that of difficult airway, maintenance of hemodynamics and temperature during long surgical hours, pain management, and postoperative intensive care management. But, recently acquired data raised the possibility of the anesthetic technique and conduct of perioperative period as a possible contributory factor in the growth and possible recurrence of the primary tumor. The foundation of the concept is somewhat fragile and not supported by conclusive evidence. In fact, like any other controversial topic in medicine, contradictory reports of the favorable effects of anesthetic technique and medications are plenty in the literature. This is the basis of our article where we have analyzed the current evidence available in the literature and how these and the forthcoming large scale studies may revolutionize the practice of oncoanesthesia.

  7. Perioperative transfusion of leukocyte depleted blood products in gastric cancer patients negatively influences oncologic outcome: A retrospective propensity score weighted analysis on 610 curatively resected gastric cancer patients.

    Reim, Daniel; Strobl, Andreas N; Buchner, Christian; Schirren, Rebekka; Mueller, Werner; Luppa, Peter; Ankerst, Donna Pauler; Friess, Helmut; Novotny, Alexander


    The influence of perioperative transfusion (PT) on outcome following surgery for gastric cancer (GC) remains controversial, with randomized trials lacking and observational series confounded by patient risk factors. This analysis determines the association between reception of leukocyte-depleted blood products and post-operative survival for GC.Data from 610 patients who underwent curative surgery for GC in a German tertiary care clinic from 2001 to 2013 were included. Kaplan-Meier survival curves and Cox proportional hazards regression were applied to determine the association of PT and clinical and patient risk factors for overall and relapse-free survival. Propensity score analysis was performed to adjust for observational biases in reception of PT.Higher Union International Contre le Cancer/American Joint Committee on Cancer (UICC/AJCC)-stages (P female gender (P = 0.03). In the adjusted propensity score weighted analysis, PT remained associated with an increased risk of death (hazard ratio (HR): 1.31, 95% CI: 1.01-1.69, P = 0.04).Because of the association of PT with negative influence on patient survival following resection for GC, risks from application of blood products should be weighed against the potential benefits. PMID:27442682

  8. Use of recombinant activated factor VII for reduction of perioperative blood loss during elective surgical correction of spine deformity in a Jehovah's Witness. Case report.

    Kącka, Katarzyna; Kącki, Wojciech; Merak, Joanna; Błęka, Adam


    Planned surgical procedures at patients who refuse allogenic blood transfusion because of religious convictions are important problem, not only medical but also ethical and juristical. At the study authors report the successful use of activated recombinant factor VII (rFVIIa) for the reduction of perioperative blood loss in four years old child - Jehovah's Witness, who had planned Torode kyphectomy. Applied perioperative management together with preparing to surgery with erythropoietin allowed for reduction of blood loss and avoiding of blood transfusion. Authors state, that appropriate perioperative proceeding makes a possibility of safe surgical procedures also at patients who refuse the transfusion. PMID:21057153

  9. Factors influencing the presence of circulating differentiated thyroid cancer cells in the thyroidectomy perioperative period*

    Wentao Wei; Qinjiang Liu; Wei Yao


    Objective The aim of the study was to detect circulating differentiated thyroid cancer (DTC) micrometas-tasis and to investigate the factors influencing their presence in the perioperative thyroidectomy period. Methods DTC micrometastases in the peripheral blood were detected with flow cytometry, and patient clinical and pathological factors were analyzed in 327 DTC patients.Results Circulating blood micrometastases were present in the peripheral circulation at a higher rate 1 week postoperatively than preoperatively and at 4 weeks postoperatively (P 0.05). At 4 weeks postoperatively, the presence of circulating micrometastasis was not associated with tumor size or lymph node stage (P > 0.05), but was associated with poorly differentiated tumors (P < 0.05). Conclusion The presence of circulating DTC micrometastases correlates to tumor size, lymph node stage, and operative manipulation. The differentiation degree of the tumors were associated with the persistent presence of micrometastasis in the circulating blood.

  10. A Literature Review of Total Hip Arthroplasty in Patients with Ankylosing Spondylitis: Perioperative Considerations and Outcome.

    Putnis, S E; Wartemberg, G K; Khan, W S; Agarwal, S


    Ankylosing spondylitis is a spondyloarthropathy affecting the sacro-iliac joints with subsequent progression to the spine and the hip joints. The hip joints are affected by synovitis, enthesial inflammation, involvement of medullary bone, progressive degeneration and secondary osteoarthritis. Clinical presentation is usually in the form of pain and stiffness progressing to disabling fixed flexion contractures and in some instances, complete ankylosis. Hip arthroplasty should be considered for hip pain, postural and functional disability, or pain in adjacent joints due to hip stiffness. We conducted a literature review to determine peri-operative considerations and outcome in ankylosing spondylitis patients undergoing hip arthroplasty. In this review, we have discussed pre-operative surgical planning, thromboprophylaxis, anaesthetic considerations and heterotopic ossification. Outcomes of arthroplasty include range of movement, pain relief, survivorship and complications. PMID:26587066

  11. Analgesic effect of perioperative escitalopram in high pain catastrophizing patients after total knee arthroplasty

    Lunn, Troels H; Frokjaer, Vibe G; Hansen, Torben Bæk;


    has not previously been investigated. The authors hypothesized that perioperative escitalopram would reduce pain after TKA in high pain catastrophizing patients. METHODS: A total of 120 pain catastrophizing patients (selected using the pain catastrophizing scale as preoperative screening tool......) scheduled for TKA were randomized in a double-blind manner to either 10 mg escitalopram or placebo daily from preanesthesia to postoperative day 6 in addition to a standardized analgesic regime. The primary outcome was pain upon ambulation 24 h after surgery. Secondary outcomes were overall pain during well......-defined mobilizations and at rest from 2 to 48 h and from days 2 to 6, morphine equivalents, anxiety, depression, and side effects. RESULTS: Pain upon ambulation (mean [95% CI]) 24 h after surgery in the escitalopram versus placebo group was 58 (53 to 64) versus 64 (58 to 69), the mean difference being -5 (-13 to 3), P...

  12. Effect of Melatonin on Sleep in the Perioperative Period after Breast Cancer Surgery

    Madsen, Michael Tvilling; Hansen, Melissa Voigt; Andersen, Lærke Toftegård;


    STUDY OBJECTIVES: To investigate whether administration of an oral dose of 6 mg melatonin before bedtime perioperatively in breast cancer surgery could change sleep outcomes measured by actigraphy. METHODS: This paper reports secondary outcomes from a double-blind, placebo-controlled, randomized...... clinical trial where patients received 6 mg melatonin (n = 27) or placebo (n = 21) approximately 60 minutes before bedtime 3 nights preoperatively until at least one week postoperatively. Participants were monitored in the entire period with actigraphy, and were instructed to complete visual analogue scale...... (VAS) for sleep, and the Karolinska Sleepiness Scale (KSS) each morning. RESULTS: Administration of 6 mg oral melatonin approximately 1 hour before bedtime resulted in significantly increased sleep efficiency and reduced wake after sleep onset for the entire 2-week postoperative period. No other...

  13. Monitoring of peri-operative fluid administration by individualized goal-directed therapy

    Bundgaard-Nielsen, M; Holte, Kathrine; Secher, N H; Kehlet, Henrik


    the use of strategies, parameters and monitors for goal-directed therapy. METHODS: A MEDLINE search (1966 to 2 October 2006) was performed to identify studies in which a goal-directed therapeutic strategy was used to maximize flow-related haemodynamic parameters in surgical patients, as well as......BACKGROUND: In order to avoid peri-operative hypovolaemia or fluid overload, goal-directed therapy with individual maximization of flow-related haemodynamic parameters has been introduced. The objectives of this review are to update research in the area, evaluate the effects on outcome and assess...... studies referenced from these papers. Furthermore, methods applied in these studies and other monitors with a potential for goal-directed therapy are described. RESULTS: Nine studies were identified pertaining to fluid optimization during the intra- and post-operative period with goal-directed therapy...

  14. Anesthesia management in laparoscopic bariatric surgery: Perioperative complications and outcomes in the third year of practice

    Serkan Karaman


    Full Text Available Objective: In this study, we aimed to assess the perioperative and postoperative results of the patients who underwent bariatric surgery. Methods: After obtaining approval, a retrospectively designed observational study was conducted. All adult patients who underwent laparoscopic gastric plication, sleeve gastrectomy, or roux-en-Y anastomosis between January 2011 and May 2013 were included. Results: A total of 104 patients were included in the study period: 49 (47.1% underwent laparoscopic roux-en-Y anastomosis, 44 (42.3% underwent laparoscopic sleeve gastrectomy, and 11 (10.6% underwent laparoscopic gastric plication. The present study showed a mortality rate of 1.9% (n = 2, one after Roux-en-Y anastomosis operation, and the other one after gastric plication. Conclusion: The anesthesia methods and approaches have no association with morbidity and mortality in such procedures of bariatric surgery indicated in the present study. J Clin Exp Invest 2014; 5 (2: 200-205

  15. Perioperative growth hormone treatment and functional outcome after major abdominal surgery

    Kissmeyer-Nielsen, Peter; Jensen, Martin Bach; Laurberg, Søren


    OBJECTIVE: To evaluate short- and long-term effects of perioperative human growth hormone (hGH) treatment on physical performance and fatigue in younger patients undergoing a major abdominal operation in a normal postoperative regimen with oral nutrition. SUMMARY BACKGROUND DATA: Muscle wasting and...... after surgery. RESULTS: The total muscle strength of four limb muscle groups was reduced by 7.6% in the hGH group and by 17.1% in the placebo group at postoperative day 10 compared with baseline values. There was also a significant difference between treatment groups in total muscle strength at day 30......, and at the 90-day follow-up total muscle strength was equal to baseline values in the hGH group, but still significantly 5.9% below in the placebo group. The work capacity decreased by approximately 20% at day 10 after surgery, with no significant difference between treatment groups. Both groups were...

  16. The peri-operative cytokine response in infants and young children following major surgery

    Hansen, Tom Giedsing; Tønnesen, Else Kirstine; Andersen, J B; Toft, P; Bendtzen, Klaus


    The peri-operative cytokine response was studied in 13 infants and young children undergoing major surgery. All children were anaesthetized with a combined general and epidural anaesthetic technique, followed by post-operative epidural analgesia with bupivacaine and fentanyl. Blood samples were...... taken before and after surgery, 24 h post-operatively, and finally, when the children were mobilized and had regained gastrointestinal function. Plasma samples were analysed for tumour necrosis factor-alpha, interleukin-1 alpha, interleukin-1 beta, interleukin-6, interferon-gamma, interleukin-10 and the...... interleukin-1 receptor antagonist. The cytokine responses were highly variable. Overall, no significant changes between pre- and post-operative plasma concentrations were found. Tumour necrosis factor-alpha and the interleukin-1 receptor antagonist were detectable in all children, and a trend towards an early...

  17. Coagulation competence for predicting perioperative hemorrhage in patients treated with lactated Ringer's vs. Dextran

    Rasmussen, Kirsten C; Højskov, Michael; Johansson, Per Ingemar;


    BACKGROUND: Perioperative hemorrhage may depend on coagulation competence and this study evaluated the influence of coagulation competence on blood loss during cystectomy due to bladder cancer. METHODS: Forty patients undergoing radical cystectomy were included in a randomized controlled trial to...... receive either lactated Ringer's solution or Dextran 70 (Macrodex ®) that affects coagulation competence. RESULTS: By thrombelastography evaluated coagulation competence, Dextran 70 reduced "maximal amplitude" (MA) by 25 % versus a 1 % reduction with the administration of lactated Ringer's solution (P <0.......001). Blinded evaluation of the blood loss was similar in the two groups of patients - 2339 ml with the use of Dextran 70 and 1822 ml in the lactated Ringer's group (P = 0.27). Yet, the blood loss was related to the reduction in MA (r = -0.427, P = 0.008) and by multiple regression analysis independently...

  18. Bioactive substance accumulation and septic complications in a burn trauma patient: effect of perioperative blood transfusion?

    Nielsen, H J; Reimert, C M; Dybkjaer, E;


    have been shown. The potential adverse effects of these bioactive substances were analysed in a burn trauma patient. A patient with 40 per cent second and third degree burn trauma without other injuries underwent a two-step transplantation operation. Samples for analyses of histamine, eosinophil......Evidence has emerged that suggests adverse effects to perioperative homologous blood transfusion are related to the age of the blood products. Recently, time-dependent accumulation of bioactive substances in red cell suspensions, standard platelet concentrates and fresh frozen plasma during storage...... cationic protein (ECP), eosinophil protein X (EPX), neutrophil myeloperoxidase (MPO) and interleukin 6 (IL-6) were drawn frequently from the patient before, during and after the operations, and from all transfused red cell, platelet and fresh frozen plasma units. Urine was sampled every hour during the...

  19. [Victims of traffic occurrence submitted to surgery procedures: characteristics and perioperative complications].

    Reiniger, Lívia Ortiz; de Sousa, Regina Marcia Cardoso; Nogueira, Lilia de Souza; Costa, Ana Lucia Siqueira


    This study aimed to characterize the victims of traffic occurrence submitted to anesthetic-surgical procedures according to demographics and clinical data and identify the predictors of complications during the perioperative period (hemorrhagic shock and death). A cross-longitudinal analysis developed from the consultations of patients´ records submitted to surgery at a hospital in São Paulo city. There was predominance of young, male, and motorcycle/cyclist accident victims who received prehospital support in 69 analyzed patients. The abdomen as the most severely injured region, Injury Severity Score, general and orthopedic surgeries variables showed statistically significant association with shock and death. Age was only associated with shock. In the final model, the Injury Severity Score was predictor for shock and death, and general surgery only for shock. Orthopedic surgery was a protection factor for death. These findings subsidize the surgical team in strategic planning that aims to decrease undesirable outcomes. PMID:23250259

  20. Application of radionuclide infarct scintigraphy to diagnose perioperative myocardial infarction following revascularization

    To evaluate the application of radionuclide infarct scintigraphy to diagnose myocardial infarction after revascularization, we obtained postoperative technetium 99m pyrophosphate myocardial scintigrams, serial electrocardiograms and CPK-MB isoenzymes in ten control and 51 revascularized patients. All control patients had negative electrocardiograms and scintigrams, but eight had positive isoenzymes. Eight revascularized patients had positive electrocardiograms, images and enzymes and two had positive scintigrams and enzymes with negative electrocardiograms. Thirty-four patients with negative electrocardiograms and scintigrams had positive isoenzymes; in only seven patients were all tests negative. Our data suggest radionuclide infarct scintigraphy is a useful adjunct to the electrocardiogram in diagnosing perioperative infarction. The frequent presence of CPK-MB in postoperative patients without other evidence of infarction suggests that further studies are required to identify all factors responsible for its release

  1. Changes in fibrosis and oxygen metabolism index during perioperative period of patients with laparoscopic liver resection

    Ya-Qi Jiang


    Objective:To observe the changes in fibrosis and oxygen metabolism index during perioperative period of patients with laparoscopic liver resection, and to explore the advantages of laparoscopic liver resection in the treatment of liver cancer.Methods:According to the inclusion criteria, 53 patients who processed with liver resection from February 2013 to March 2015 in our hospital were randomly divided into control group (open operation group, n=25) and study group (laparoscopic liver resection group,n=28). Then the operation and postoperative recovery of two groups were compared, and the fibrosis and oxygen metabolism indexes of two groups were compared too.Results:There was no significant difference in operation time, bleeding volume, tumor resection margin and liver resection volume between the two groups. The postoperative activity time, the first time for dieting post operation and time of postoperative hospital stay in study group were significantly shorter than the control group. After operation in 3, 7, 14 d, the serum levels of AST, ALT and CRP in study group were significantly lower than the control group. During perioperative period, there was no obvious change in the oxygen metabolism index in the study group, while which showed significantly change in the control group. After operation in the 3rd, 7th, 14th days, the levels of fibrosis related indexes HA, PCⅢ and Ⅳ C in study group were significantly lower than the control group.Conclusion:The efficacy of laparoscopic liver resection for the treatment of liver cancer is consistent with the open surgery, while the laparoscopic surgery has the advantages of less trauma, less liver damage and rapid recovery.

  2. Perioperative intensity-modulated brachytherapy for refractory orbital rhabdomyosarcomas in children

    Strege, Rainer Joachim; Mehdorn, Maximilian H. [Dept. of Neurosurgery, Univ. Clinic Schleswig-Holstein, Campus Kiel (Germany); Kovacs, Gyoergy [Interdisciplinary Brachytherapy Unit, Univ. Clinic Schleswig-Holstein, Campus Luebeck (Germany); Meyer, Jens Eduard [Dept. of Head-and-Neck Surgery, Univ. Clinic Schleswig-Holstein, Campus Luebeck (Germany); Holland, Detlef [Dept. of Ophthalmology, Univ. Clinic Schleswig-Holstein, Campus Kiel (Germany); Claviez, Alexander [Dept. of Pediatrics, Univ. Clinic Schleswig-Holstein, Campus Kiel (Germany)


    Purpose: to evaluate the feasibility and toxicity of perioperative intensity-modulated brachytherapy (IMBT) as well as functional outcome in children with therapy-refractory orbital rhabdomyosarcomas (RMS). Patients and methods: since 1993, children with therapy-refractory orbital RMS have been treated by a multidisciplinary approach combining function-preserving, mostly R1 tumor resection and perioperative IMBT at the University Hospital of Schleswig-Holstein, Germany. All children with orbital RMS, who were enrolled in this multidisciplinary treatment protocol between 1993 and 2002, were prospectively assessed with respect to evaluation of side effects and functional outcome. Results: ten children (six boys, four girls) were included. Median age was 6.5 years (range, 1-19 years) at the beginning of our treatment and 6.0 years (range 1-17 years) at diagnosis. All children were in Intergroup Rhabdomyosarcoma Study Group (IRSG) group III and had embryonal subtype. Estimated 5-year survival was 62% {+-} 18%. There was no radiation-related toxicity grade 3 or 4 observed. The eyes were primarily preserved in all cases. One child underwent secondary orbital exenteration 10 months after completion of IMBT. Visual acuity could be preserved apart from one child developing significant visual deterioration due to radiation cataract grade 2. The cosmetic results were good or very good in eight and moderate in two children. Four children died of their disease. Conclusion: this interdisciplinary, individually tailored and function-preserving treatment procedure has proven to be a well-tolerated therapeutic option in cases with refractory orbital RMS. It provides both improvement of local tumor control and quality of life. (orig.)

  3. Effect of perioperative autologous versus allogeneic blood transfusion on the immune system in gastric cancer patients


    Background: Allogeneic blood transfusion-induced immunomodulation (TRIM) and its adverse effect on the prognosis of patients treated surgically for cancer remain complex and controversial. However, the potential risk associated with allogeneic blood transfusion has heightened interest in the use of autologous blood transfusion. In the present study, the serum concentrations of neopterin, interferon-gamma (IFN-γ), T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) and a possible association between these variables were investigated. The purpose was to further evaluate the effect of autologous versus allogeneic blood transfusion on immunological status in patients undergoing surgery for gastric cancer. Methods: Sixty ASA Ⅰ~Ⅱ(American Society of Anesthesiologists) patients undergoing elective radical resection for stomach cancer were randomly allocated to receive either allogeneic blood transfusion (n=30) or autologous blood transfusion (n=30). Serum concentrations of the neopterin, IFN-γ and T lymphocyte subsets in the recipients were measured before induction of anesthesia, after operation, and on the 5th postoperative day. Results: Both two groups, serum neopterin, IFN-γ, percentages of T-cell subsets (CD3+, CD4+), and CD4+/CD8+ ratio had significantly decreased after operation, but decreased more significantly in group H (receiving allogeneic blood transfusion) than those in group A (receiving autologous whole blood transfusion) (P<0.05). On the 5th postoperative day,serum neopterin, IFN-γ, CD3+, CD4+ T-cells, and CD4+/CD8+ ratio returned to the baseline values in group A. In contrast, the above remain decreasing in group H, where there were no significant relations between serum neopterin and IFN-γ. Conclusion:Perioperative surgical trauma and stress have an immunosuppressive impact on gastric cancer patients. Allogeneic blood transfusion exacerbates the impaired immune response. Autologous blood transfusion might be significantly beneficial for

  4. Perioperative fractionated high-dose rate brachytherapy for malignant bone and soft tissue tumors

    Purpose: To investigate the viability of perioperative fractionated HDR brachytherapy for malignant bone and soft tissue tumors, analyzing the influence of surgical margin. Methods and Materials: From July 1992 through May 1996, 16 lesions of 14 patients with malignant bone and soft tissue tumors (3 liposarcomas, 3 MFHs, 2 malignant schwannomas, 2 chordomas, 1 osteosarcoma, 1 leiomyosarcoma, 1 epithelioid sarcoma, and 1 synovial sarcoma) were treated at the Osaka University Hospital. The patients' ages ranged from 14 to 72 years (median: 39 years). Treatment sites were the pelvis in 6 lesions, the upper limbs in 5, the neck in 4, and a lower limb in 1. The resection margins were classified as intracapsular in 5 lesions, marginal in 5, and wide in 6. Postoperative fractionated HDR brachytherapy was started on the 4th-13th day after surgery (median: 6th day). The total dose was 40-50 Gy/7-10 fr/ 4-7 day (bid) at 5 or 10 mm from the source. Follow-up periods were between 19 and 46 months (median: 30 months). Results: Local control rates were 75% at 1 year and 48% in 2 years, and ultimate local control was achieved in 8 (50%) of 16 lesions. Of the 8 uncontrolled lesions, 5 (63%) had intracapsular (macroscopically positive) resection margins, and all the 8 controlled lesions (100%) had marginal (microscopically positive) or wide (negative) margins. Of the total, 3 patients died of both tumor and metastasis, 3 of metastasis alone, 1 of tumor alone, and 7 showed no evidence of disease. Peripheral nerve palsy was seen in one case after this procedure, but no infection or delayed wound healing caused by tubing or irradiation has occurred. Conclusion: Perioperative fractionated HDR brachytherapy is safe, well tolerated, and applicable to marginal or wide surgical margin cases

  5. Effect of perioperative administration of dexketoprofen on opioid requirements and inflammatory response following elective hip arthroplasty.

    Iohom, G


    BACKGROUND: In this double-blind, randomized, placebo-controlled trial, the safety and analgesic efficacy of perioperative dexketoprofen were evaluated. METHODS: Thirty ASA I or II patients undergoing elective hip arthroplasty were randomized to one of two groups. One group (D) received dexketoprofen 25 mg tds for 24 h before and 48 h after surgery; the second group (P) received placebo tablets at equivalent times. Hyperbaric 0.5% bupivacaine (17.5 mg if greater than 70 kg and 15 mg if less than 70 kg) and preservative-free morphine (0.6 mg) were administered intrathecally. Postoperatively, PCA was provided (bolus morphine sulphate 1 mg; lockout 5 min; no continuous infusion). RESULTS: The two groups were similar in terms of age, gender, weight, height, ASA class, duration of operation, and level of sensory block on arrival to the recovery room. Groups were also similar in terms of blood loss, transfusion requirements, ventilatory frequency, and haemodynamic variables. According to visual analogue pain scores patients in group D experienced less pain at 15 h (P=0.02) postoperatively. Cumulative morphine consumption was also less in group D compared with group P at 6 (0.06 (0.2) vs 0.85 (1.4) mg, P=0.04) and 48 h postoperatively (10.1 (8) vs 26.2 (20) mg, P<0.01). Plasma interleukin 6 concentrations increased postoperatively to a significantly lesser extent in group D than in group P (P=0.02). Nausea and vomiting were less (P<0.01) in group D compared with group P at 18 h postoperatively. Sedation scores were less (P=0.03) in group D. CONCLUSIONS: Perioperative administration of dexketoprofen 25 mg 8 hourly markedly improves analgesia and decreases opioid requirements (and associated adverse effects) following hip arthroplasty. It appears that this regimen decreases the postoperative pro-inflammatory response.

  6. The future of particle accelerators

    Plasma-based accelerators are developing as credible, and compact, accelerators for the future. We review the status and prospects for electron and proton accelerators using laser Wakefield acceleration. (author)

  7. Phase II/III multicentre randomised controlled trial evaluating a strategy of primary surgery and adjuvant chemotherapy versus peri-operative chemotherapy for resectable gastric signet ring cell adenocarcinomas – PRODIGE 19 – FFCD1103 – ADCI002

    A dramatic increase in the incidence of the diffuse form of gastric adenocarcinomas and particularly signet ring cell carcinomas has been observed in Western countries. Evidence is accruing that signet ring cell carcinomas may have inherent chemo resistance leaving many clinicians unsure of the benefits of delaying surgery to pursue a neoadjuvant approach. PRODIGE-19-FFCD1103-ADCI002 is a prospective multicentre controlled randomised phase II/III trial comparing current standard of care of perioperative chemotherapy (2x3 cycles of Epirubicin, cisplatin, 5-fluorouracil) with a strategy of primary surgery followed by adjuvant chemotherapy (6 cycles of Epirubicin, cisplatin, 5-fluorouracil) in patients with a stage IB-III gastric signet ring cell tumour. The principal objective of the phase II study (84 patients) is to determine if the experimental arm (primary surgery followed by adjuvant chemotherapy) has sufficient interest in terms of percentage of living patients at 24 months to be evaluated in a phase III trial. If 7 or less patients in the experimental arm are alive at 24 months, phase III will not be initiated. The primary objective of phase III (230 additional patients) is to demonstrate superiority of the experimental arm in terms of overall survival. Secondary endpoints include overall survival at 36 months, disease free survival at 24 and 36 months, R0 resection rates, treatment tolerance, postoperative mortality and morbidity evaluated by Clavien-Dindo severity index, the prognostic impact of positive peritoneal cytology and the assessment of quality of life. An ancillary study will assess the emotional and cognitive impact of surgery and perioperative chemotherapy for both the patient and their partner. As inherent chemo resistance of signet ring cell tumours and delay in definitive surgery may favour tumour progression we hypothesise that a policy of primary surgery followed by adjuvant chemotherapy will improve overall survival compared to a standard

  8. Particle-accelerator decommissioning

    Generic considerations involved in decommissioning particle accelerators are examined. There are presently several hundred accelerators operating in the United States that can produce material containing nonnegligible residual radioactivity. Residual radioactivity after final shutdown is generally short-lived induced activity and is localized in hot spots around the beam line. The decommissioning options addressed are mothballing, entombment, dismantlement with interim storage, and dismantlement with disposal. The recycle of components or entire accelerators following dismantlement is a definite possibility and has occurred in the past. Accelerator components can be recycled either immediately at accelerator shutdown or following a period of storage, depending on the nature of induced activation. Considerations of cost, radioactive waste, and radiological health are presented for four prototypic accelerators. Prototypes considered range from small accelerators having minimal amounts of radioactive mmaterial to a very large accelerator having massive components containing nonnegligible amounts of induced activation. Archival information on past decommissionings is presented, and recommendations concerning regulations and accelerator design that will aid in the decommissioning of an accelerator are given

  9. The application of music therapy in children with chronic sinusitis in perioperative nursing%音乐疗法在儿童慢性鼻窦炎围手术期护理中的应用

    陈越; 王桂兰


    目的:探讨音乐疗法在儿童慢性鼻窦炎手术围手术期的应用。方法:将66例慢性鼻窦炎手术患儿随机分为试验组和对照组,试验组33例患儿在常规护理外,同时给以音乐疗法。对照组33例患儿仅给予常规心理护理。结果:试验组患儿术前行为顺应性良好,术后疼痛明显减轻,饮食恢复明显高于对照组( P<0.05)。结论:音乐疗法用于儿童慢性鼻窦炎围手术期,能够显著改善疾病的转归,减少痛苦,促进患者尽快康复,提高生活质量。%Objective To investigate the effect of music therapy in the surgical treatment of chronic sinusitis in children. Method 66 children with chronic sinusitis surgery were randomly divided into experimental and control groups,33 patients in the experimental group were gave the routine care and music therapy. In the control group,33 patients were only gave the conventional psychological care. Results In the experimental group,the preoperative behavior of compliance was better,postoperative pain was significantly relieved,diet recovery was significantly faster compared with the control group( P<0. 05). Conclusion Music therapy for children with chronic sinusitis perioper-ative period,can significantly improve the prognosis of the disease,reduce pain,promote the patient recover as soon as possible,improve the quality of life.

  10. The perioperative nursing of minimally invasive implant in elderly dentition defect patients%老年口腔牙列缺损患者微创种植围手术期的护理

    刘乙颖; 栗洪师; 刘洪臣


    Objective: To explore the perioperative nursing of minimally invasive implant in elderly dentition defect patients. Methods: From January 2010 to december 2012, 115 elderly edentulous patients of implant surgery were retrospectively analyzed and summarized the perioperative nursing implant of minimally invasive implant in Elderly edentulous patients. Results:All patients psychological condition, smooth, stable life signs of implants smoothly, low rate of postoperative complications. Conclusion: Good care of implant surgery is one of the key factors for success of oral implant, Intensive care could improve the implant survival complex, promote patients rehabilitation.%目的:探讨老年口腔牙列缺失患者微创种植牙的围手术期护理方法。方法:对2010年1月至2012年10月间在解放军总医院口腔种植科行微创种植手术的患者115例进行回顾性分析,总结老年微创种植牙的围手术护理方法。结果:全部患者在种植手术过程中生命体征平稳,种植体植入顺利患者感觉良好,种植体存活率达94.01%,术后未出现种植体周围炎等并发症,患者基本能按要求维护种植体。结论:口腔种植围手术期良好的护理是种植牙手术成功的关键因素之一,细致精心的口腔护理可提高种植体存活率,促进患者顺利康复。

  11. Standardising fast-track surgical nursing care in Denmark

    Hjort Jakobsen, Dorthe; Rud, Kirsten; Kehlet, Henrik;


    guidelines based on the principles of fast-track surgery-i.e. patient information, surgical stress reduction, effective analgesia, early mobilisation and rapid return to normal eating. Fast-track surgery was introduced systematically in Denmark by the establishment of the Unit of Perioperative Nursing (UPN......) in 2004. The unit was responsible for guideline construction and implementation using the 'workshop practice method': establishing a website, creating a knowledge centre, coordinating implementation agents, and arranging national workshops and conferences. The UPN has promoted implementation of fast......-track regimes in all surgical departments in Denmark. We recommend the workshop-practice method for implementation of new procedures in other areas of patient care....

  12. An introduction to acceleration mechanisms

    This paper discusses the acceleration of charged particles by electromagnetic fields, i.e., by fields that are produced by the motion of other charged particles driven by some power source. The mechanisms that are discussed include: Ponderamotive Forces, Acceleration, Plasma Beat Wave Acceleration, Inverse Free Electron Laser Acceleration, Inverse Cerenkov Acceleration, Gravity Acceleration, 2D Linac Acceleration and Conventional Iris Loaded Linac Structure Acceleration

  13. Perioperative indocyanine green clearance is predictive for prolonged intensive care unit stay after coronary artery bypass grafting - an observational study

    Sander, Michael; Spies, Claudia D.; Berger, Katharina; Schröder, Torsten; Grubitzsch, Herko; Wernecke, Klaus D; von Heymann, Christian


    Introduction During cardiac surgery with cardiopulmonary bypass (CPB) haemodilution occurs. Hepatic dysfunction after CPB is a rare, but serious, complication. Clinical data have validated the plasma-disappearance rate of indocyanine green (PDR ICG) as a marker of hepatic function and perfusion. Primary objective of this analysis was to investigate the impact of haemodilutional anaemia on hepatic function and perfusion by the time course of PDR ICG and liver enzymes in elective CABG surgery. ...

  14. Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial).

    Wind, J.; Hofland, J.; Preckel, B.; Hollman, M.W.; Bossuyt, P.M.M.; Gouma, D.J.; Berge Henegouwen, M.I.; Fuhring, J.W.; Dejong, C.H.C.; Dam, R.M. van; Cuesta, M.A.; Noordhuis, A.; Jong, D. de; Zalingen, E. van; Engel, A.F.; Goei, T.H.; Stoppelaar, I.E. de; Tets, W.F. van; Wagensveld, B.A. van; Swart, A.; Elsen, M.J.L.J. van den; Gerhards, M.F.; Wit, L.Th. De; Siepel, M.A.M.; Geloven, A.A.W. van; Juttmann, J.-W.; Clevers, J.C.; Bemelman, W.A.


    BACKGROUND: Recent developments in large bowel surgery are the introduction of laparoscopic surgery and the implementation of multimodal fast track recovery programs. Both focus on a faster recovery and shorter hospital stay.The randomized controlled multicenter LAFA-trial (LAparoscopy and/or FAst t

  15. Ion accelerators for ionometrical analyses of solids

    An ion accelerator for ionometrical analyses of solid states is described. The following problems are treated: high vacuum systems and their operation, small energy spread and beam collimation, system for automatic transmission of the ion beam. Due to the careful optimization of the discussed parameters and to the automatic beam transmission system beam currents of 5-10x10-9 A could be measured for more than 300 hours operation time, with deviations less than 20%. In a one year period the accelerator was in operation for more than 2300 hours. (T.G.)

  16. Accelerator and radiation physics

    Basu, Samita; Nandy, Maitreyee


    "Accelerator and radiation physics" encompasses radiation shielding design and strategies for hadron therapy accelerators, neutron facilities and laser based accelerators. A fascinating article describes detailed transport theory and its application to radiation transport. Detailed information on planning and design of a very high energy proton accelerator can be obtained from the article on radiological safety of J-PARC. Besides safety for proton accelerators, the book provides information on radiological safety issues for electron synchrotron and prevention and preparedness for radiological emergencies. Different methods for neutron dosimetry including LET based monitoring, time of flight spectrometry, track detectors are documented alongwith newly measured experimental data on radiation interaction with dyes, polymers, bones and other materials. Design of deuteron accelerator, shielding in beam line hutches in synchrotron and 14 MeV neutron generator, various radiation detection methods, their characteriza...

  17. Leaky Fermi accelerators

    Shah, Kushal; Rom-Kedar, Vered; Turaev, Dmitry


    A Fermi accelerator is a billiard with oscillating walls. A leaky accelerator interacts with an environment of an ideal gas at equilibrium by exchange of particles through a small hole on its boundary. Such interaction may heat the gas: we estimate the net energy flow through the hole under the assumption that the particles inside the billiard do not collide with each other and remain in the accelerator for sufficiently long time. The heat production is found to depend strongly on the type of the Fermi accelerator. An ergodic accelerator, i.e. one which has a single ergodic component, produces a weaker energy flow than a multi-component accelerator. Specifically, in the ergodic case the energy gain is independent of the hole size, whereas in the multi-component case the energy flow may be significantly increased by shrinking the hole size.

  18. Accelerator reliability workshop

    Hardy, L.; Duru, Ph.; Koch, J.M.; Revol, J.L.; Van Vaerenbergh, P.; Volpe, A.M.; Clugnet, K.; Dely, A.; Goodhew, D


    About 80 experts attended this workshop, which brought together all accelerator communities: accelerator driven systems, X-ray sources, medical and industrial accelerators, spallation sources projects (American and European), nuclear physics, etc. With newly proposed accelerator applications such as nuclear waste transmutation, replacement of nuclear power plants and others. Reliability has now become a number one priority for accelerator designers. Every part of an accelerator facility from cryogenic systems to data storage via RF systems are concerned by reliability. This aspect is now taken into account in the design/budget phase, especially for projects whose goal is to reach no more than 10 interruptions per year. This document gathers the slides but not the proceedings of the workshop.

  19. Nuclear physics accelerator facilities

    This paper describes many of the nuclear physics heavy-ion accelerator facilities in the US and the research programs being conducted. The accelerators described are: Argonne National Laboratory--ATLAS; Brookhaven National Laboratory--Tandem/AGS Heavy Ion Facility; Brookhaven National Laboratory--Relativistic Heavy Ion Collider (RHIC) (Proposed); Continuous Electron Beam Accelerator Facility; Lawrence Berkeley Laboratory--Bevalac; Lawrence Berkeley Laboratory--88-Inch Cyclotron; Los Alamos National Laboratory--Clinton P. Anderson Meson Physics Facility (LAMPF); Massachusetts Institute of Technology--Bates Linear Accelerator Center; Oak Ridge National Laboratory--Holifield Heavy Ion Research Facility; Oak Ridge National Laboratory--Oak Ridge Electron Linear Accelerator; Stanford Linear Accelerator Center--Nuclear Physics Injector; Texas AandM University--Texas AandM Cyclotron; Triangle Universities Nuclear Laboratory (TUNL); University of Washington--Tandem/Superconducting Booster; and Yale University--Tandem Van de Graaff

  20. Accelerator reliability workshop

    About 80 experts attended this workshop, which brought together all accelerator communities: accelerator driven systems, X-ray sources, medical and industrial accelerators, spallation sources projects (American and European), nuclear physics, etc. With newly proposed accelerator applications such as nuclear waste transmutation, replacement of nuclear power plants and others. Reliability has now become a number one priority for accelerator designers. Every part of an accelerator facility from cryogenic systems to data storage via RF systems are concerned by reliability. This aspect is now taken into account in the design/budget phase, especially for projects whose goal is to reach no more than 10 interruptions per year. This document gathers the slides but not the proceedings of the workshop