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Sample records for abdominal surgery randomized

  1. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial.

    LENUS (Irish Health Repository)

    McDonnell, John G

    2007-01-01

    The transversus abdominis plane (TAP) block is a novel approach for blocking the abdominal wall neural afferents via the bilateral lumbar triangles of Petit. We evaluated its analgesic efficacy in patients during the first 24 postoperative hours after abdominal surgery, in a randomized, controlled, double-blind clinical trial.

  2. A randomized trial of preoperative oral carbohydrates in abdominal surgery

    OpenAIRE

    Sada, Fatos; Krasniqi, Avdyl; Hamza, Astrit; Gecaj-Gashi, Agreta; Bicaj, Besnik; Kavaja, Floren

    2014-01-01

    Background Carbohydrate-rich liquid drinks (CRLDs) have been recommended to attenuate insulin resistance by shortening the preoperative fasting interval. The aim of our study the effect of preoperative oral administration of CRLDs on the well-being and clinical status of patients. Methods A randomized, double blind, prospective study of patients undergoing open colorectal operations (CR) and open cholecyctectomy (CH) was conducted. Patients were divided into three groups: study, placebo, and ...

  3. Thoracic paravertebral blocks in abdominal surgery - a systematic review of randomized controlled trials.

    Science.gov (United States)

    El-Boghdadly, K; Madjdpour, C; Chin, K J

    2016-09-01

    Thoracic paravertebral blocks (TPVBs) have an extensive evidence base as part of a multimodal analgesic strategy for thoracic and breast surgery and have gained popularity with the advent of ultrasound guidance. However, this role is poorly defined in the context of abdominal surgery. We performed a systematic review of randomized controlled trials, to clarify the impact of TPVB on perioperative analgesic outcomes in adult abdominal surgery. We identified 20 published trials involving a total of 1044 patients that met inclusion criteria; however there was significant heterogeneity in terms of type of surgery, TPVB technique, comparator groups and study quality. Pain scores and opioid requirements in the early postoperative period were generally improved when compared with systemic analgesia, but there was insufficient evidence for any definitive conclusions regarding comparison with epidural analgesia or other peripheral block techniques, or the benefit of continuous TPVB techniques. The reported primary block failure rate was 2.8% and the incidence of complications was 1.2% (6/504); there were no instances of pneumothorax. TPVB therefore appears to be a promising analgesic technique for abdominal surgery in terms of efficacy and safety. But further well-designed and adequately powered studies are needed to confirm its utility, particularly with respect to other regional anaesthesia techniques.

  4. Glutamine dipeptide for parenteral nutrition in abdominal surgery: A meta-analysis of randomized controlled trials

    Institute of Scientific and Technical Information of China (English)

    Ya-Min Zheng; Fei Li; Ming-Ming Zhang; Xiao-Ting Wu

    2006-01-01

    AIM: To assess the clinical and economical validity of glutamine dipeptide supplemented to parenteral nutrition(PN) in patients undergoing abdominal surgery.METHODS: A meta-analysis of all the relevant randomized controlled trials (RCTs) was performed. The trials compared the standard PN and PN supplemented with glutamine dipeptide in abdominal surgery. RCTs were identified from the following electronic databases:the Cochrane Library, MEDLINE, EMBASE and ISI web of knowledge (SCI). The search was undertaken in April 2006. Literature references were checked by computer or hand at the same time. Clinical trials were extracted and evaluated by two reviewers independently. Statistical analysis was performed by RevMan4.2 software from Cochrane Collaboration. A P value of <0.05 was considered statistically significant.RESULTS: Nine RCTs involving 373 patients were included. The combined results showed that glutamine dipeptide has a positive effect in improving postoperative cumulative nitrogen balance (weighted mean difference (WMD = 8.35, 95% CI [2.98, 13.71], P = 0.002),decreasing postoperative infectious morbidity (OR = 0.24,95% CI [0.06, 0.93], P = 0.04), shortening the length of hospital stay (WMD= -3.55, 95% CI [-5.26, -1.84], P<0.00001). No serious adverse effects were found.CONCLUSION: Postoperative PN supplemented with glutamine dipeptide is effective and safe to decrease the infectious rate, reduce the length of hospital stay and improve nitrogen balance in patients undergoing abdominal surgery. Further high quality trials in children and severe patients are required, and mortality and hospital cost should be considered in future RCTs with sufficient size and rigorous design.

  5. Randomized multicentre feasibility trial of intermediate care versus standard ward care after emergency abdominal surgery (InCare trial)

    DEFF Research Database (Denmark)

    Vester-Andersen, M; Waldau, T; Wetterslev, J;

    2015-01-01

    ward within 24 h of emergency abdominal surgery. Participants were randomized to either intermediate care or standard surgical ward care after surgery. The primary outcome was 30-day mortality. RESULTS: In total, 286 patients were included in the modified intention-to-treat analysis. The trial...... was terminated after the interim analysis owing to slow recruitment and a lower than expected mortality rate. Eleven (7·6 per cent) of 144 patients assigned to intermediate care and 12 (8·5 per cent) of 142 patients assigned to ward care died within 30 days of surgery (odds ratio 0·91, 95 per cent c.i. 0·38 to 2......BACKGROUND: Emergency abdominal surgery carries a considerable risk of death and postoperative complications. Early detection and timely management of complications may reduce mortality. The aim was to evaluate the effect and feasibility of intermediate care compared with standard ward care...

  6. Abdominal aortic aneurysm surgery

    DEFF Research Database (Denmark)

    Gefke, K; Schroeder, T V; Thisted, B;

    1994-01-01

    The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553......, 78% stated that their quality of life had improved or was unchanged after surgery and had resumed working. These data justify a therapeutically aggressive approach, including ICU therapy following AAA surgery, despite failure of one or more organ systems....

  7. Analgesic, Sedative and Hemodynamic Effects of Dexmedetomidine Following Major Abdominal Surgeries: A Randomized, Double Blinded Comparative Study with Morphine

    Directory of Open Access Journals (Sweden)

    Khaled Taha

    2003-09-01

    Full Text Available This was a randomized double-blinded study; in which 60 ASAI-II adult patients scheduled for major abdominal surgeries (colostomy, radical cystectomy, major gynecological surgery, and abdominal vascular surgery were received standard general anesthesia. Twenty minutes before the anticipated end of surgery, patients were randomized into two equal groups: dexmedetomidine group (group D and morphine group (group M. Group D received dexmedetomidine IV infusion 4µg/kg/h for 15 minutes (1µg/Kg followed by 0.4µg/kg/h for 3h. Group M received morphine sulfate IV (0.07mg/kg. All patients were given a morphine patient controlled analgesia (PCA pump in the post anesthesia care unit (PACU, delivering IV morphine 2mg with a lockout time of 5 minutes if pain score assessed through visual analog scale (VAS was more than 5 at any given 5-min assessment. During the PACU recovery period, morphine consumption; pain and sedation scores; hemodynamic variables (heart rate, mean arterial blood pressure, oxygen saturation and respiratory rate; and postoperative nausea, retching and vomiting (PONV were recorded every 30 min for 3h (study period by a member of staff blinded to the treatment. The study demonstrated that the use of dexmedetomidine led to significant decrease in the total amount of morphine consumed throughout the entire PACU recovery period (P0.05; significant decrease in mean arterial pressure (P0.05; without any significant changes in oxygen saturation (P<0.05 or respiratory rate (P<0.05. In conclusion, dexmedetomidine exhibited both analgesic and sedative properties. The associated cardiovascular protective pharmacological profile and the lack of respiratory depression made it potentially extremely interesting for postoperative analgesia after major abdominal surgeries.

  8. Influence of perioperative oxygen fraction on pulmonary function after abdominal surgery: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Staehr Anne K

    2012-07-01

    Full Text Available Abstract Background A high perioperative inspiratory oxygen fraction (FiO2 may reduce the frequency of surgical site infection. Perioperative atelectasis is caused by absorption, compression and reduced function of surfactant. It is well accepted, that ventilation with 100% oxygen for only a few minutes is associated with significant formation of atelectasis. However, it is still not clear if a longer period of 80% oxygen results in more atelectasis compared to a low FiO2. Our aim was to assess if a high FiO2 is associated with impaired oxygenation and decreased pulmonary functional residual capacity (FRC. Methods Thirty-five patients scheduled for laparotomy for ovarian cancer were randomized to receive either 30% oxygen (n = 15 or 80% oxygen (n = 20 during and for 2 h after surgery. The oxygenation index (PaO2/FiO2 was measured every 30 min during anesthesia and 90 min after extubation. FRC was measured the day before surgery and 2 h after extubation by a rebreathing method using the inert gas SF6. Results Five min after intubation, the median PaO2/FiO2 was 69 kPa [53-71] in the 30%-group vs. 60 kPa [47-69] in the 80%-group (P = 0.25. At the end of anesthesia, the PaO2/FiO2 was 58 kPa [40-70] vs. 57 kPa [46-67] in the 30%- and 80%-group, respectively (P = 0.10. The median FRC was 1993 mL [1610-2240] vs. 1875 mL [1545-2048] at baseline and 1615 mL [1375-2318] vs. 1633 mL [1343-1948] postoperatively in the 30%- and 80%-group, respectively (P = 0.70. Conclusion We found no significant difference in oxygenation index or functional residual capacity between patients given 80% and 30% oxygen for a period of approximately 5 hours. Trial registration ClinicalTrials.gov Identifier: NCT00637936.

  9. Variable versus conventional lung protective mechanical ventilation during open abdominal surgery: study protocol for a randomized controlled trial

    OpenAIRE

    Peter M Spieth; Güldner, Andreas; Uhlig, Christopher; Bluth, Thomas; Kiss, Thomas; Schultz, Marcus J.; Pelosi, Paolo; Koch, Thea; Gama de Abreu, Marcelo

    2014-01-01

    Background General anesthesia usually requires mechanical ventilation, which is traditionally accomplished with constant tidal volumes in volume- or pressure-controlled modes. Experimental studies suggest that the use of variable tidal volumes (variable ventilation) recruits lung tissue, improves pulmonary function and reduces systemic inflammatory response. However, it is currently not known whether patients undergoing open abdominal surgery might benefit from intraoperative variable ventila...

  10. Rationale and study design of PROVHILO - a worldwide multicenter randomized controlled trial on protective ventilation during general anesthesia for open abdominal surgery

    Directory of Open Access Journals (Sweden)

    Hedenstierna Göran

    2011-05-01

    Full Text Available Abstract Background Post-operative pulmonary complications add to the morbidity and mortality of surgical patients, in particular after general anesthesia >2 hours for abdominal surgery. Whether a protective mechanical ventilation strategy with higher levels of positive end-expiratory pressure (PEEP and repeated recruitment maneuvers; the "open lung strategy", protects against post-operative pulmonary complications is uncertain. The present study aims at comparing a protective mechanical ventilation strategy with a conventional mechanical ventilation strategy during general anesthesia for abdominal non-laparoscopic surgery. Methods The PROtective Ventilation using HIgh versus LOw positive end-expiratory pressure ("PROVHILO" trial is a worldwide investigator-initiated multicenter randomized controlled two-arm study. Nine hundred patients scheduled for non-laparoscopic abdominal surgery at high or intermediate risk for post-operative pulmonary complications are randomized to mechanical ventilation with the level of PEEP at 12 cmH2O with recruitment maneuvers (the lung-protective strategy or mechanical ventilation with the level of PEEP at maximum 2 cmH2O without recruitment maneuvers (the conventional strategy. The primary endpoint is any post-operative pulmonary complication. Discussion The PROVHILO trial is the first randomized controlled trial powered to investigate whether an open lung mechanical ventilation strategy in short-term mechanical ventilation prevents against postoperative pulmonary complications. Trial registration ISRCTN: ISRCTN70332574

  11. Evaluation of Preemptive Use of Analgesia of The Skin, Before and After Lower Abdominal Surgery: A Prospective, Double-Blind, Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    P Kashefi

    2005-03-01

    Full Text Available Background: Perioperative pain is prevalent and poorly treated. Apart from that it makes the recovery from surgery unpleasent, pain often remains as a residual side effect of surgery, even though the tissue healing is complete. An essential observation is that tissue injury and the resulting nociceptor barrage initiates a cascade of events that can indelibly alter pain perception. Preemptive analgesia is the concept of initiating analgesic therapy before the onset of the noxious stimulus so as to prevent the nociceptor barrage and its consequences. However, anticipated clinical potency of preemptive analgesia, though has firmly grounded in the neurobiology of pain, has not been yet realized. As data accumulates, it has become clear that clinical studies emulating those from the laboratory and designed around a relatively narrow definition of preemptive analgesia have been largely unsupportive of its use. Nevertheless, preemptive analgesic interventions that recognize the intensity, duration, and somatotopic extent of major surgery can help reduce perioperative pain and its longer-term sequelae. surgeons spend a lot of time treating the pain of lower abdominal surgery. Methods: A total number of 48 consecutive patients who were going to undergo elective lower abdominal surgery. Were randomly assigned in two groups of 24 each. In one group the patients received an injection of 0.5 % bupivacaine in the planned skin for incision just before lower abdominal surgery, and in the other group, they received an equal amount of 0.5% bupivacaine after the surgery had been done. Pain was objectified by a numerical visual pain score, in the 24 hours following the lower abdominal surgery. Results: There were no differences in postoperative pain scores on the visual analog scale (VAS: In groups 1and 2, VAS at hour 4 were 6.37±1.13 versus 6.29±1.19; At hour 8 were 5.54 ± 1.17 versus 5.37±1.09; and at hour 12 were 4.5 ± 1.31 versus 4.45 ± 1

  12. A randomized clinical trial comparing the efficacy and safety of ramosetron versus ondansetron in patients undergoing abdominal surgery under general anesthesia

    Directory of Open Access Journals (Sweden)

    Sriramamurthy Kaja

    2014-01-01

    Full Text Available Background: Post-operative nausea and vomiting is one of the most common and distressing complications after anesthesia and surgery. It may lead to serious post-operative complications. Ramosetron is a newer 5-HT3 receptor antagonist and has more potent and longer duration of antiemetic effects compared to first generation 5HT3 receptor antagonists. The purpose of this study was to compare the efficacy of Ramosetron for the prevention of post-operative nausea and vomiting with that of Ondansetron in patients undergoing abdominal surgeries under general anesthesia. Methods: In this randomized, double-blind study, 60 patients, 18-60 years of both genders falling under ASA I-II category scheduled for abdominal surgery were included. Group I received I.V ramosetron 0.3 mg while group II received I.V Ondansetron 4 mg at the time of extubation. The standard general anesthetic technique was used throughout. Postoperatively the incidences of nausea, vomiting, and safety assessments were performed at 1, 2, 6, and 24 h during the first 24 h after surgery. Results: There were no differences between groups with respect to patient demographics. The percentage of patients who had complete response (no PONV, and no need for another rescue antiemetic from 0 to 24 h after anesthesia was 56% with ramosetron and 33% with ondansetron. The corresponding rates at 1, 2, 6, and 24 h after anesthesia were 76% and 63%, 76% and 50%, 100 and 83%, 100 and 93%, respectively. Safety profiles of the two drugs were comparable, as no clinically serious adverse effects caused by study drugs were observed in either of the groups. Conclusion: Our study concludes that prophylactic therapy with ramosetron is highly efficacious than ondansetron in preventing PONV in patients undergoing abdominal surgery under general anesthesia.

  13. Double blind randomized comparative study of transdermal fentanyl patch for post operative pain relief in major abdominal surgery as a component of multimodal analgesic therapy

    Directory of Open Access Journals (Sweden)

    Kalyani Surya Dhanalakshmi Sangineni

    2016-02-01

    Conclusions: Transdermal Fentanyl Patch of 25 and micro;g/hr when applied 10-12 hours before surgery provides effective postoperative pain relief after major abdominal surgery as a part of multimodal analgesia. [Int J Basic Clin Pharmacol 2016; 5(1.000: 13-20

  14. Comparison of epidural butorphanol and fentanyl as adjuvants in the lower abdominal surgery: A randomized clinical study

    Directory of Open Access Journals (Sweden)

    Jasleen Kaur

    2014-01-01

    Full Text Available Background: Epidural opioids acting through the spinal cord receptors improve the quality and duration of analgesia along with dose-sparing effect with the local anesthetics. The present study compared the efficacy and safety profile of epidurally administered butorphanol and fentanyl combined with bupivacaine (B. Materials and Methods: A total of 75 adult patients of either sex of American Society of Anesthesiologist physical status I and II, aged 20-60 years, undergoing lower abdominal under epidural anesthesia were enrolled into the study. Patients were randomly divided into three groups of 25 each: B, bupivacaine and butorphanol (BB and bupivacaine + fentanyl (BF. B (0.5% 20 ml was administered epidurally in all the three groups with the addition of 1 mg butorphanol in BB group and 100 μg fentanyl in the BF group. The hemodynamic parameters as well as various block characteristics including onset, completion, level and duration of sensory analgesia as well as onset, completion and regression of motor block were observed and compared. Adverse events and post-operative visual analgesia scale scores were also noted and compared. Data was analyzed using ANOVA with post-hoc significance, Chi-square test and Fisher′s exact test. Value of P < 0.05 was considered significant and P < 0.001 as highly significant. Results: The demographic profile of patients was comparable in all the three groups. Onset and completion of sensory analgesia was earliest in BF group, followed by BB and B group. The duration of analgesia was significantly prolonged in BB group followed by BF as compared with group B. Addition of butorphanol and fentanyl to B had no effect on the time of onset, completion and regression of motor block. No serious cardio-respiratory side effects were observed in any group. Conclusions: Butorphanol and fentanyl as epidural adjuvants are equally safe and provide comparable stable hemodynamics, early onset and establishment of sensory

  15. Peritoneoscopy of the liver after abdominal surgery.

    Directory of Open Access Journals (Sweden)

    Kawaguchi,Kenji

    1983-02-01

    Full Text Available The incidence of intraperitoneal adhesion after abdominal surgery was studied. Peritoneoscopy was performed in 933 patients with liver diseases over the 6 year 5 month period from March 1974 to July 1980. Of the patients, 352 (37.7% had undergone an abdominal operation, and intraperitoneal adhesion was detected in 205 (58.2% of these patients. The liver was not observable in 5 out of 61 patients with adhesions after upper abdominal operations. Whereas, the liver was clearly observable in patients with lower abdominal operations in spite of adhesions. Out of the 581 patients without any abdominal operations, 30 patients (5.2% had adhesions in the abdominal cavity, and 6 of them had extensive adhesions that partially obscured the observation of liver surface. In all patients, peritoneoscopy was performed without complications by avoiding the surgical scar for puncture sites and ensuring a free air lumen before trocar puncture.

  16. Intraperitoneal wound in abdominal surgery

    OpenAIRE

    Kahokehr, Arman Adam

    2013-01-01

    The intraperitoneal wound is often forgotten after transperitoneal surgery. This review is a on the peritoneum and the implications of peritoneal injury after surgery. This review will focus on the intraperitoneal wound response after surgical injury.

  17. INTRATHECAL BUPRENORPHINE, CLONIDINE AND FENTANYL AS ADJUVANTS TO 0.5% HYPERBARIC BUPIVACAINE IN LOWER ABDOMINAL AND LOWER LIMB SURGERIES: A PROSPECTIVE, RANDOMIZED AND COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Rashmi

    2015-06-01

    Full Text Available BACKGROUND: Among all the spinal adjuvants, clonidine, an alpha - 2 agonist has the ability to alleviate both the somatic and visceral pain and is more potent at spinal site, favoring its neuraxial administration. OBJECTIVE: This study was done to compare the onset and duration of sensory and motor blocks, duration of analgesia, haemodynamic and adverse effects of Clonidine, buprenorhine and fentanyl used intrathecally with hyperbaric 0.5% bupuvacaine. SETTINGS & DESIGN: This prospective, randomized and comparative study included 90 ASA class 1 & 2 patients undergoing lower abdominal and lower limb surgeries under spinal anesthesia after approval from hospital ethics committee with written i nformed consent of patients. MATERIALS AND METHOD S: Patients were randomly allocated into three groups (n=30 and received 50μg of clonidine, 25μg of fentanyl and 75μg of buprenorphine respectively in group BC,BF and BB as adjuvants to 15mg of 0.5% hyperba ric bupivacaine (3.0ml. The onset time and duration of sensory and motor block, duration of analgesia, haemodynamic changes and side effects were recorded. RESULTS: The onset time of motor block and durations of sensory, motor blockade and analgesia were prolonged in - group BC as compared to group BF and BB (P.05. Group BC had lower heart rate and mean blood pressure and higher sedation score. CONCLUSION: Intr athecal Clonidine in a dose of 50μg is an effective adjuvant to local anesthetics in neuraxial blocks despite mild sedation and haemodynamic variations.

  18. Perioperative oxygen fraction - effect on surgical site infection and pulmonary complications after abdominal surgery: a randomized clinical trial. Rationale and design of the PROXI-Trial

    DEFF Research Database (Denmark)

    Meyhoff, Christian Sylvest; Wetterslev, Jørn; Jorgensen, Lars N;

    2008-01-01

    A high perioperative inspiratory oxygen fraction may reduce the risk of surgical site infections, as bacterial eradication by neutrophils depends on wound oxygen tension. Two trials have shown that a high perioperative inspiratory oxygen fraction (FiO(2) = 0.80) significantly reduced risk...... complications, such as atelectasis, pneumonia and respiratory failure. The aim of our trial is to assess the potential benefits and harms of a high perioperative oxygen fraction in patients undergoing abdominal surgery....

  19. Rationale and study design of PROVHILO - a worldwide multicenter randomized controlled trial on protective ventilation during general anesthesia for open abdominal surgery

    OpenAIRE

    Hedenstierna Göran; Binnekade Jan M; Hollmann Markus W; Tschernko Edda M; Hiesmayr Michael; Wrigge Hermann; Canet Jaume; Jaber Samir; Severgnini Paolo; Hemmes Sabrine NT; Putensen Christian; Abreu Marcelo; Pelosi Paolo; Schultz Marcus J

    2011-01-01

    Abstract Background Post-operative pulmonary complications add to the morbidity and mortality of surgical patients, in particular after general anesthesia >2 hours for abdominal surgery. Whether a protective mechanical ventilation strategy with higher levels of positive end-expiratory pressure (PEEP) and repeated recruitment maneuvers; the "open lung strategy", protects against post-operative pulmonary complications is uncertain. The present study aims at comparing a protective mechanical ven...

  20. Study of Evodia hot compress plus electro-acupuncture in patients who have undergone abdominal surgery

    OpenAIRE

    Chen, Zhiqiang; Cao, Lixing; Wen, Zehuai; Cui, Naiqiang; Li, Naiqing; Xie, Jianxing; Tan, Zhijian; Luo, Zhenbin; Wang, Shusheng; Qin, You; Chen, Xiuhua; Xu, Zhenhua; Ou, Aihua; Shang, Wenfan; Jiang, Zhi

    2015-01-01

    Background: The importance of postoperative gastrointestinal function recovery is being increasingly recognized. In this multi-center randomized controlled study, we evaluated the efficacy and safety of Evodia hot compress (ECS) plus electro-acupuncture (EA) for patients who developed postoperative gastrointestinal tract dysfunction after abdominal surgery. Methods: 1009 patients who developed postoperative gastrointestinal tract dysfunction after abdominal surgery were enrolled. All patients...

  1. [Surgical criteria for reoperation in abdominal surgery].

    Science.gov (United States)

    Bricot, R

    1975-07-01

    Analysis of the surgical criteria for reintervention in Abdominal Surgery led to the accentuation of a certain number of pictures of occlusion, general infectious syndromes, postoperative peritonitis, gastro-intestinal fistula and hemorrhagic syndrome. In all cases, the clinical examination can be misleading in particular in the case of peritonitis, and the history and non-surgical criteria must be strongly borne in mind. PMID:2036

  2. Effect of oxygen treatment on heart rate after abdominal surgery

    DEFF Research Database (Denmark)

    Rosenberg-Adamsen, S; Lie, C; Bernhard, A;

    1999-01-01

    . METHODS: The authors studied the effect of oxygen therapy on arterial oxygen saturation and heart rate in 100 consecutive unselected patients randomly and double blindly allocated to receive air or oxygen therapy between the first and fourth day after major abdominal surgery. RESULTS: The median arterial...... supplementation were found between patients with or without an epidural catheter or between the postoperative day studied. CONCLUSION: Postoperative oxygen therapy increased arterial oxygen saturation and decreased heart rate after uncomplicated abdominal surgery in a consecutive unselected group of patients who......BACKGROUND: Cardiac complications are common during the postoperative period and may be associated with hypoxemia and tachycardia. Preliminary studies in high-risk patients after operation have shown a possible beneficial effect of oxygen therapy on arterial oxygen saturation and heart rate...

  3. COMPARISON OF FLOW AND VOLUME ORIENTED INCENTIVE SPIROMETRY ON LUNG FUNCTION AND DIAPHRAGM MOVEMENT AFTER LAPAROSCOPIC ABDOMINAL SURGERY: A RANDOMIZED CLINICAL PILOT TRIAL

    OpenAIRE

    Gopala Krishna Alaparthi; Alfred Joseph Augustine *; Anand R; Ajith Mahale

    2013-01-01

    Objective:This study was designed to evaluate the efficacy of two types of incentive spirometer (flow andvolume) on pulmonary function and diaphragm excursion in patients who underwent laparoscopic surgery.Materials and Methods:Twenty sample sizes with eleven men and nine women who underwent laparoscopicsurgery were randomly divided as follows: 10 subjects performed flow oriented incentive spirometer group,and other 10 subjects performed volume oriented incentive spirometer group. (Other ther...

  4. Fatigue and cardiorespiratory function following abdominal surgery.

    Science.gov (United States)

    Christensen, T; Bendix, T; Kehlet, H

    1982-07-01

    Subjective feelings of fatigue were assessed before operation and 10, 20 and 30 days after uncomplicated elective abdominal surgery in 16 otherwise healthy patients, using a constructed fatigue scale model. In addition, all patients had an orthostatic stress test performed at the same times. Six of the patients also underwent a bicycle ergometer test measuring heart rate and oxygen consumption. Subjective feelings of fatigue were increased (P less than 0.01) at all three postoperative observations, and only 5 of 16 patients returned to their preoperative level. The increased subjective feeling of fatigue correlated positively (RS = 0.53, P less than 0.001) with the increased pulse rate seen during orthostatic stress after operation. Heart rate was about 5 per cent higher (n.s.) after operation when bicycling at the same work loads, while oxygen consumption decreased by about 2 per cent (P less than 0.01) at all three postoperative bicycle tests. It is concluded that even electric uncomplicated abdominal surgery is followed by a pronounced feeling of fatigue, which may persist 1 month after surgery in about one-third of patients. The fatigue scale model seems applicable for future studies on the pathogenesis and treatment of the postoperative fatigue syndrome.

  5. Perioperatory antibiotic prophylaxis in Pediatric Surgery (Part I: abdominal surgery

    Directory of Open Access Journals (Sweden)

    Sergio Luis González López

    2005-12-01

    Full Text Available The surgical wound infection is the biggest cause of infectious morbility in surgical patients. It is an important cause of morbility that causes lincreased hospital demurrages, increased cost of medical attention and serious inconveniences to the patients and their familiies. 25% of all nosocomial infections are surgical wound infection. One of the big advances of the surgery in the last three decades is an introduction of antibiotic prophylaxis in the surgical practice. Is considered that it has saved more lives than any other novel procedure in surgery in the last 20 years. We presented the Good Clinical Practices Guideline for Antibiotic prophylaxis in abdominal surgery, approved by consensus in the 1st National Good Clinical Practices Workshop in Pediatric Surgery (Cienfuegos, Cuba, March 7 – 9, 2002.

  6. Chylous complications after abdominal aortic surgery.

    Science.gov (United States)

    Haug, E S; Saether, O D; Odegaard, A; Johnsen, G; Myhre, H O

    1998-12-01

    Two patients developed chylous complications following abdominal aortic aneurysm repair. One patient had chylous ascitis and was successfully treated by a peritoneo-caval shunt. The other patient developed a lymph cyst, which gradually resorbed after puncture. Chylous complications following aortic surgery are rare. Patients in bad a general condition should be treated by initial paracentesis and total parenteral nutrition, supplemented by medium-chain triglyceride and low-fat diet. If no improvement is observed on this regimen, the next step should be implementation of a peritoneo-venous shunt, whereas direct ligation of the leak should be reserved for those who are not responding to this treatment. PMID:10204656

  7. Abdominal wall paresis as a complication of laparoscopic surgery

    NARCIS (Netherlands)

    G.H. van Ramshorst (Gabrielle); G.J. Kleinrensink (Gert Jan); J.J. Hermans (John); T. Terkivatan (Türkan); J.F. Lange (Johan)

    2009-01-01

    textabstractPurpose: Abdominal wall nerve injury as a result of trocar placement for laparoscopic surgery is rare. We intend to discuss causes of abdominal wall paresis as well as relevant anatomy. Methods: A review of the nerve supply of the abdominal wall is illustrated with a rare case of a patie

  8. [What do general, abdominal and vascular surgeons need to know on plastic surgery - aspects of plastic surgery in the field of general, abdominal and vascular surgery].

    Science.gov (United States)

    Damert, H G; Altmann, S; Stübs, P; Infanger, M; Meyer, F

    2015-02-01

    There is overlap between general, abdominal and vascular surgery on one hand and plastic surgery on the other hand, e.g., in hernia surgery, in particular, recurrent hernia, reconstruction of the abdominal wall or defect closure after abdominal or vascular surgery. Bariatric operations involve both special fields too. Plastic surgeons sometimes use skin and muscle compartments of the abdominal wall for reconstruction at other regions of the body. This article aims to i) give an overview about functional, anatomic and clinical aspects as well as the potential of surgical interventions in plastic surgery. General/abdominal/vascular surgeons can benefit from this in their surgical planning and competent execution of their own surgical interventions with limited morbidity/lethality and an optimal, in particular, functional as well as aesthetic outcome, ii) support the interdisciplinary work of general/abdominal/vascular and plastic surgery, and iii) provide a better understanding of plastic surgery and its profile of surgical interventions and options.

  9. Abdominal binders may reduce pain and improve physical function after major abdominal surgery - a systematic review

    DEFF Research Database (Denmark)

    Rothman, Josephine Philip; Gunnarsson, Ulf; Bisgaard, Thue

    2014-01-01

    . The PubMed, EMBASE and Cochrane databases were searched for studies on the use of abdominal binders after abdominal surgery or abdominoplasty. All types of clinical studies were included. Two independent assessors evaluated the scientific quality of the studies. The primary outcomes were pain, seroma...

  10. Optimising stroke volume and oxygen delivery in abdominal aortic surgery

    DEFF Research Database (Denmark)

    Bisgaard, J; Gilsaa, T; Rønholm, E;

    2012-01-01

    BACKGROUND: Post-operative complications after open elective abdominal aortic surgery are common, and individualised goal-directed therapy may improve outcome in high-risk surgery. We hypothesised that individualised goal-directed therapy, targeting stroke volume and oxygen delivery, can reduce...... group (P = 0.01). However, the number of complications per patient or length of stay in the intensive care unit or hospital did not differ between the groups. CONCLUSION: Perioperative individualised goal-directed therapy targeting stroke volume and oxygen delivery did not affect post...... complications and minimise length of stay in intensive care unit and hospital following open elective abdominal aortic surgery. METHODS: Seventy patients scheduled for open elective abdominal aortic surgery were randomised to individualised goal-directed therapy or conventional therapy. In the intervention...

  11. THE USE OF BIOLOGICAL PRODUCTS IN ABDOMINAL SURGERY AND LIVER TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    N. I. Gabrielyan

    2013-01-01

    Full Text Available This article provides an overview of new approaches to the prevention of infectious complications of bacterial nature after the high-technology operations in the abdominal surgery, first of all, after liver transplantation. At- tention is drawn to the first positive results of randomized studies on the use of biological preparations - probi- otics, prebiotics and synbiotics in patients after liver transplantation. The authors prove the prospects of further development of this subject based on successful model experiments on animals and various operational interven- tions in abdominal surgery

  12. Effect of nursing intervention on early rehabilitation of patients with abdominal surgery

    Institute of Scientific and Technical Information of China (English)

    Xing-Zhen Wang; Li-Hong Lu; Hui-Yan Deng

    2016-01-01

    Objective:To study effect of nursing intervention on early rehabilitation of patients with abdominal surgery.Methods: A total of 90 patients with abdominal surgery were randomly divided into observation group and control group by half. Patients in the control group were given routine nursing care, observation group given conventional gum chewing training and anal contraction movements.Results:In the observation group anal exhaust time, indwelling gastric tube and catheter time defecate, eating time, hospitalization days were significantly reduced compared with controls (P 0.05). Conclusions: Strengthened perioperative nursing, gum chewing training and anal contraction movements can promote gastrointestinal functional recovery after abdominal surgery. It can shorten hospitalization time, reduce the patients' pain. It is safety, effective and worthy clinical application.

  13. Virtual Patients in Undergraduate Surgery Education: A Randomized Controlled Study

    OpenAIRE

    Mohammad Shariati; Masuod Yunesian; Iraj Harirchi; Ahmad Khosravi

    2008-01-01

    Introduction: This study aims to clarify the effects of implementing a series of virtual patients in undergraduate surgery education on various dimensions of skills as applied to clinical problems. Methods: In a randomized controlled trial 48 surgery clerks were assigned to an intervention group who worked on 14 simulated cases of abdominal pain during 7 weeks in a computer lab and a control group without access to software. At the end of the intervention, both groups were tested by a structu...

  14. [The role of laparoscopy in emergency abdominal surgery].

    Science.gov (United States)

    Balén, E; Herrera, J; Miranda, C; Tarifa, A; Zazpe, C; Lera, J M

    2005-01-01

    Abdominal emergencies can also be operated on through the laparoscopic approach: the approach can be diagnostic laparoscopy, surgery assisted by laparoscopy or laparotomy directed according to the findings of the laparoscopy. The general contraindications refer above all to the state of haemodynamic instability of the patient and to seriously ill patients (ASA IV). In the absence of any specific counter-indications for the specific laparoscopic procedure to be carried out, many abdominal diseases requiring emergency surgery can be performed with the laparoscopic approach. The most frequent indications are appendicitis, acute colecistitis, gastroduodenal perforation, occlusion of the small intestine, and some abdominal traumas. With a correct selection of patients and the appropriate experience of the surgeon, the results are excellent and better than open surgery (less infection of the wound, complications, hospital stay and postoperative pain). A detailed explanation is given of the basic aspects of the surgical technique in the most frequent procedures of emergency laparoscopy.

  15. Advances in abdominal access for laparoscopic surgery: a review

    OpenAIRE

    Martel, Guillaume

    2014-01-01

    Maurice Ogaick,1 Guillaume Martel1,2 1Department of Surgery, 2Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada Abstract: There are several laparoscopic surgery abdominal wall access techniques. The most useful and well-established is the open Hasson technique. The Veress needle closed technique is another alternative, but its use is controversial owing to possibly higher rates of rare insertion complications. Optical trocars have been developed in an attempt to de...

  16. Abdominal surgery activates nesfatin-1 immunoreactive brain nuclei in rats.

    Science.gov (United States)

    Stengel, Andreas; Goebel, Miriam; Wang, Lixin; Taché, Yvette

    2010-02-01

    Abdominal surgery-induced postoperative gastric ileus is well established to induce Fos expression in specific brain nuclei in rats within 2-h after surgery. However, the phenotype of activated neurons has not been thoroughly characterized. Nesfatin-1 was recently discovered in the rat hypothalamus as a new anorexigenic peptide that also inhibits gastric emptying and is widely distributed in rat brain autonomic nuclei suggesting an involvement in stress responses. Therefore, we investigated whether abdominal surgery activates nesfatin-1-immunoreactive (ir) neurons in the rat brain. Two hours after abdominal surgery with cecal palpation under short isoflurane anesthesia or anesthesia alone, rats were transcardially perfused and brains processed for double immunohistochemical labeling of Fos and nesfatin-1. Abdominal surgery, compared to anesthesia alone, induced Fos expression in neurons of the supraoptic nucleus (SON), paraventricular nucleus (PVN), locus coeruleus (LC), Edinger-Westphal nucleus (EW), rostral raphe pallidus (rRPa), nucleus of the solitary tract (NTS) and ventrolateral medulla (VLM). Double Fos/nesfatin-1 labeling showed that of the activated cells, 99% were nesfatin-1-immunoreactive in the SON, 91% in the LC, 82% in the rRPa, 74% in the EW and VLM, 71% in the anterior parvicellular PVN, 47% in the lateral magnocellular PVN, 41% in the medial magnocellular PVN, 14% in the NTS and 9% in the medial parvicellular PVN. These data established nesfatin-1 immunoreactive neurons in specific nuclei of the hypothalamus and brainstem as part of the neuronal response to abdominal surgery and suggest a possible implication of nesfatin-1 in the alterations of food intake and gastric transit associated with such a stressor. PMID:19944727

  17. Transversus Abdominis Plane Catheter Bolus Analgesia after Major Abdominal Surgery

    Directory of Open Access Journals (Sweden)

    Nils Bjerregaard

    2012-01-01

    Full Text Available Purpose. Transversus abdominis plane (TAP blocks have been shown to reduce pain and opioid requirements after abdominal surgery. The aim of the present case series was to demonstrate the use of TAP catheter injections of bupivacaine after major abdominal surgery. Methods. Fifteen patients scheduled for open colonic resection surgery were included. After induction of anesthesia, bilateral TAP catheters were placed, and all patients received a bolus dose of 20 mL bupivacaine 2.5 mg/mL with epinephrine 5 μg/mL through each catheter. Additional bolus doses were injected bilaterally 12, 24, and 36 hrs after the first injections. Supplemental pain treatment consisted of paracetamol, ibuprofen, and gabapentin. Intravenous morphine was used as rescue analgesic. Postoperative pain was rated on a numeric rating scale (NRS, 0–10 at regular predefined intervals after surgery, and consumption of intravenous morphine was recorded. Results. The TAP catheters were placed without any technical difficulties. NRS scores were ≤3 at rest and ≤5 during cough at 4, 8, 12, 18, 24, and 36 hrs after surgery. Cumulative consumption of intravenous morphine was 28 (23–48 mg (median, IQR within the first 48 postoperative hours. Conclusion. TAP catheter bolus injections can be used to prolong analgesia after major abdominal surgery.

  18. SURGICAL SITE INFECTION IN ABDOMINAL SURGERIES: A CLINICAL STUDY

    Directory of Open Access Journals (Sweden)

    Amit

    2014-09-01

    Full Text Available Purpose: A prospective study of incisional surgical site infection in abdominal surgeries was conducted to find out incidence, common predisposing factors and microbiological profile. METHODS: 375 patients who underwent abdominal surgeries were studied in a span of 1 year. They were divided into two groups – group 1 – 316 cases who did not develop Surgical Site Infection (SSI, the 2nd group – 59 cases that developed SSI. These patients were studied by interviewing and examination according to a set proforma. The results were statistically analyzed by comparing averages using Chi square chart for finding significance of difference where applicable. RESULT: The overall SSI incidence was 15.7 % (59/375. In elective surgeries, the SSI rate was 5.7% and in emergency surgeries, it was 28.6%. It was found that SSI increased with increasing age linearly. Other significant factors involved were increasing class of wound (dirty > clean wound class, increased preoperative stay, presence of remote site infection, increased duration of surgery and use of drains. E. coli was found to be the most common organism causing SSI in abdominal operations. CONCLUSION: SSI can be reduced by decreasing the preoperative hospital stay, appropriate antibiotic administration policies, preoperative control of remote site infections, adequate preoperative patient preparation, reducing the duration of surgery to minimum, judicious use of drains and intraoperative maintenance of asepsis and following operation theatre discipline properly.

  19. Impact of smoking on endovascular abdominal aortic aneurysm surgery outcome.

    NARCIS (Netherlands)

    Lottman, P.E.M.; Marrewijk, C.J. van; Fransen, G.A.J.; Laheij, R.J.F.; Buth, J.

    2004-01-01

    OBJECTIVE: Smoking plays a major role in deficiencies of the vascular system, and seems to have consequences for the treatment of cardiovascular diseases. We hypothesized that smokers have a higher mortality and more complications after endovascular abdominal aortic aneurysm surgery than non-smokers

  20. Acute Postoperative Pain of Indonesian Patients after Abdominal Surgery

    Directory of Open Access Journals (Sweden)

    Chanif Chanif

    2012-08-01

    Full Text Available Background: Pain is the most common problem found in postoperative patients.Purpose: The study aimed to describe pain intensity and pain distress at the first 24-48 hours experienced by the patients after abdominal surgery.Method: The study employed a descriptive research design. The samples consisted of 40 adult patients older than 18 years who underwent major abdominal surgery under general anesthesia. The patients were admitted at Doctor Kariadi Hospital Semarang, Central Java Province Indonesia during November 2011 to February 2012. A Visual Numeric Rating Scale was used to measure the pain intensity scores and the pain distress scores at the 5th hour after subjects received 30 mg of Ketorolac injection intravenously, a major analgesic drug being used at the studied hospital. Minimum-maximum scores, mean, standard deviation, median and interquartile range were used to describe pain intensity and pain distress.Result: The findings revealed that on average, postoperative patients had experienced moderate to severe pain, both in their report of pain intensity and pain distress as evidenced by the range of scores from 4 to 9 out of 10 and median score of 5 and 6 (IQR = 2, respectively. It indicated that postoperative pain was common symptom found in patients after abdominal surgery.Keywords: pain intensity, pain distress, abdominal surgery.

  1. Laparoscopic cholecystectomy causes less sleep disturbance than open abdominal surgery

    DEFF Research Database (Denmark)

    Gögenur, I; Rosenberg-Adamsen, S; Kiil, C;

    2001-01-01

    BACKGROUND: The aim of this study was to examine subjective sleep quality before and after laparoscopic vs open abdominal surgery. METHODS: Twelve patients undergoing laparoscopic cholecystectomy and 15 patients undergoing laparotomy were evaluated with the aid of a sleep questionnaire from 4 day...

  2. Advances in abdominal access for laparoscopic surgery: a review

    Directory of Open Access Journals (Sweden)

    Ogaick M

    2014-11-01

    Full Text Available Maurice Ogaick,1 Guillaume Martel1,2 1Department of Surgery, 2Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada Abstract: There are several laparoscopic surgery abdominal wall access techniques. The most useful and well-established is the open Hasson technique. The Veress needle closed technique is another alternative, but its use is controversial owing to possibly higher rates of rare insertion complications. Optical trocars have been developed in an attempt to decrease complication rates even further, although the evidence base supporting their use is limited. Single-incision laparoscopic surgery (SILS is used in certain centers to carry out various abdominal surgeries, but most commonly appendectomy and cholecystectomy. To date, SILS appears safe and feasible, with possibly greater costs and operative time. Natural orifice translumenal endoscopic surgery (NOTES is an evolving area of incisionless surgery. While some progress has been made in achieving transgastric or transvaginal peritoneal endoscopic access, this technique remains largely unproven and best-suited for experimental or clinical trial protocols. Keywords: laparoscopy, Hasson, Veress, optical trocar, SILS, NOTES

  3. Intra-abdominal pressure and abdominal compartment syndrome in acute general surgery.

    LENUS (Irish Health Repository)

    Sugrue, Michael

    2012-01-31

    BACKGROUND: Intra-abdominal pressure (IAP) is a harbinger of intra-abdominal mischief, and its measurement is cheap, simple to perform, and reproducible. Intra-abdominal hypertension (IAH), especially grades 3 and 4 (IAP > 18 mmHg), occurs in over a third of patients and is associated with an increase in intra-abdominal sepsis, bleeding, renal failure, and death. PATIENTS AND METHODS: Increased IAP reading may provide an objective bedside stimulus for surgeons to expedite diagnostic and therapeutic work-up of critically ill patients. One of the greatest challenges surgeons and intensivists face worldwide is lack of recognition of the known association between IAH, ACS, and intra-abdominal sepsis. This lack of awareness of IAH and its progression to ACS may delay timely intervention and contribute to excessive patient resuscitation. CONCLUSIONS: All patients entering the intensive care unit (ICU) after emergency general surgery or massive fluid resuscitation should have an IAP measurement performed every 6 h. Each ICU should have guidelines relating to techniques of IAP measurement and an algorithm for management of IAH.

  4. APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

    Institute of Scientific and Technical Information of China (English)

    Hong Zhao; Tie-hu Ye; Zhi-yi Gong; Yang Xue; Zhang-gang Xue; Wen-qi Huang

    2005-01-01

    Objective To assess the efficacy and safety of lomoxicam, one non-steroidal anti-inflammatory drug (NSAID) in patientcontrolled analgesia (PCA) in patients undergoing abdominal surgeries.Methods Thirty-nine patients scheduled for abdominal surgeries were randomly assigned to different PCA treatment groups using either lomoxicam or fentanyl postoperatively. Pain intensity difference (PID) and sum of pain intensity difference (SPID) were used to assess the analgesic efficacy of both drugs during a 24-hour period.Results The analgesic efficacy of lornoxicam is 1/66 of fentanyl, which was shown by SPID value of 3.250 and 3.058,respectively (P > 0.05). Lornoxicam caused fewer adverse events than fentanyl (33% vs. 68%, P < 0.05).Conclusion In clinic, we can use lomoxicam to treat postoperative pain effectively and with less adverse reactions compared with fentanyl.

  5. The effects of two analgesic regimes on behavior after abdominal surgery in Steller sea lions.

    Science.gov (United States)

    Walker, Kristen A; Horning, Markus; Mellish, Jo-Ann E; Weary, Daniel M

    2011-10-01

    This study examined the effects of two non-steroidal anti-inflammatory drug (NSAID) treatment protocols on the behavioral responses of juvenile Steller sea lions after abdominal surgery. Sea lions were randomly assigned to one of two treatments designed to control post-operative pain. The flunixin group (n=6) received flunixin meglumine (1mg/kg) administered as a single intramuscular (IM) injection before extubation from surgery. The carprofen group (n=5) received carprofen (4.4 mg/kg) as an IM injection before extubation, then orally at 24, 48 and 72 h after surgery. Seven behaviors related to post-operative pain were monitored by observers, blinded to treatment, for a total of 10 days (3 days pre-, day of surgery, and 6 days post-surgery). All seven behaviors changed after surgery regardless of NSAID treatment, two of which returned to baseline within 6 days of surgery. Only one behavior was mildly affected by analgesic treatment: sea lions in the carprofen group tended to spend less time lying down in Days 1-3 following surgery (i.e., the days which they received oral carprofen). These results suggested that neither treatment, at the dose administered, was effective in controlling pain in the days following this surgery.

  6. Unexpectedly ease surgery for a worrisome abdominal mass: Pedunculated GISTs☆

    Science.gov (United States)

    Baskiran, Adil; Otan, Emrah; Aydin, Cemalettin; Kayaalp, Cuneyt

    2013-01-01

    INTRODUCTION Discovery of abdominal masses often poses significant diagnostic difficulties. GISTs are mesenchymal masses, with specific histological features. Dimensions may vary from millimeters to giant tumours. We would like to present our case, which had an unexpectedly easy operative course which was easily handled with a simple surgical excision with a short operative duration. PRESENTATION OF CASE A 38 years old female patient was diagnosed to have an abdominal heterogen mass of 15 cm × 12 cm × 10 cm in dimension. Abdominal computed tomography revealed the solid mass between the stomach and pancreas corpus and tail, possibly orginating from the pancreas. With the preoperative diagnosis of locally invasive distal pancreas cancer the patient underwent laparotomy, following the dissection, the mass was observed to be originating from the posterior gastric Wall, extending exophytically with a peduncle of 5 cm in width, without any visual evidence for peritoneal invasion and metastasis. The tumour and the peduncle was resected with stapler device. Total operation time was 30 min. Postoperative course was uneventful. Pathologic diagnosis was gastrointestinal stromal tumour (GIST). DISCUSSION Pedunculated large GISTs are not frequent and they can enlarge as 15 cm in diameter and compress the neighbouring organs. When they were huge, it is difficult to differentiate the origin of the masses. GISTs should be considered in differential diagnosis of giant abdominal masses. CONCLUSION When GISTs are huge and pedunculated, it can be difficult to differentiate the origin of the masses. This case report presents unexpectedly ease surgery for a worrysome abdominal mass. PMID:23999120

  7. Native valve candida endocarditis complicating pregnancy after abdominal surgery

    Directory of Open Access Journals (Sweden)

    P Saphina

    2015-01-01

    Full Text Available Candida endocarditis is an emerging infectious disease, usually involving patients with intravascular prosthetic devices, and associated with substantial morbidity and mortality. A 28-year-old primigravida at 32 weeks of gestation was admitted with low-grade fever and lower abdominal pain for 2 weeks. She had undergone open appendicectomy 2 months before admission. Echocardiogram showed a pedunculated 24 mm × 21 mm mass attached to the undersurface of anterior mitral leaflet near the tip and moderate mitral regurgitation. Repeated blood cultures showed growth of nonalbicans candida. She was immediately started on liposomal amphotericin and was taken up for surgery, but despite all efforts she succumbed to her illness.

  8. Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery

    DEFF Research Database (Denmark)

    Meyhoff, Christian S; Wetterslev, Jørn; Jorgensen, Lars N;

    2009-01-01

    the frequency of surgical site infection without increasing the frequency of pulmonary complications in patients undergoing abdominal surgery. DESIGN, SETTING, AND PATIENTS: The PROXI trial, a patient- and observer-blinded randomized clinical trial conducted in 14 Danish hospitals between October 2006...... and October 2008 among 1400 patients undergoing acute or elective laparotomy. INTERVENTIONS: Patients were randomly assigned to receive either 80% or 30% oxygen during and for 2 hours after surgery. MAIN OUTCOME MEASURES: Surgical site infection within 14 days, defined according to the Centers for Disease...... Control and Prevention. Secondary outcomes included atelectasis, pneumonia, respiratory failure, and mortality. RESULTS: Surgical site infection occurred in 131 of 685 patients (19.1%) assigned to receive 80% oxygen vs 141 of 701 (20.1%) assigned to receive 30% oxygen (odds ratio [OR], 0.94; 95...

  9. FORCED-AIR WARMING AND FLUID WARMING MINIMIZE CORE HYPOTHERMIA DURING ABDOMINAL SURGERY

    Institute of Scientific and Technical Information of China (English)

    Jing Zhao; Ai-lun Luo; Li Xu; Yu-guang Huang

    2005-01-01

    Objective To evaluate the effect of intraoperative combined forced-air warming and fluid warming system on patient's core temperature, blood loss, transfusion demand, extubation time, and incidence of postoperative shivering.Methods Forty patients with American Society of Anesthesiologists physical status Ⅰ and Ⅱ, aged 18-70 years, scheduled for elective abdominal surgery were randomly assigned to receive intraoperative warming from a forced-air blanket and fluid warming system or conventional cotton blanket, 20 in each group. The core temperature was recorded every 20 minutes during the operation, as well as the blood loss, blood transfusion, extubation time, and incidence of postoperative shivering.Results The core temperature at the end of the surgery in the wanning group was significantly different from that in the control group (36.4±0.4C vs. 35.3±0.5°C, P<0.001). Application of intraoperative warming significantly shortened the time between the end of the surgery and extubation (P<0.01). Postoperative shivering occurred in 30% of the patients in the control group compared to no patient in the warming group (P <0.01).Conclusion Active warming with air-forced blanket and fluid warming system provides sufficient heat to prevent hypothermia during abdominal surgery.

  10. Perioperatory antibiotic prophylaxis in Pediatric Surgery (Part II: non-abdominal surgery.

    Directory of Open Access Journals (Sweden)

    Sergio Luis González López

    2005-12-01

    Full Text Available The surgical wound infection is the biggest cause of infectious morbility in surgical patients. It is an important cause of morbility that causes lincreased hospital demurrages, increased cost of medical attention and serious inconveniences to the patients and their familiies. 25% of all nosocomial infections are surgical wound infection. One of the big advances of the surgery in the last three decades is an introduction of antibiotic prophylaxis in the surgical practice. Is considered that it has saved more lives than any other novel procedure in surgery in the last 20 years. We presented the Good Clinical Practices Guideline for Antibiotic prophylaxis in no-abdominal surgery, approved by consensus in the 1st National Good Clinical Practices Workshop in Pediatric Surgery (Cienfuegos, Cuba, March 7 – 9, 2002.

  11. Can colonoscopy diagnose transmural ischaemic colitis after abdominal aortic surgery? An evidence-based approach

    DEFF Research Database (Denmark)

    Houe, T; Thorböll, J E; Sigild, U;

    2000-01-01

    to assess the diagnostic value of colonoscopy in ischaemic colitis following abdominal aortic surgery, based on a literature review, and to introduce the concept of evidence-based medicine.......to assess the diagnostic value of colonoscopy in ischaemic colitis following abdominal aortic surgery, based on a literature review, and to introduce the concept of evidence-based medicine....

  12. [Mortality and morbidity in surgery for abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Banke, A.B.; Andersen, Jakob Steen; Heslet, L.;

    2008-01-01

    INTRODUCTION: Patients undergoing surgery for ruptured abdominal aortic aneurysm (rAAA) have a mortality of 40-50%. The purpose of the present investigation is to document the mortality and morbidity of such patients at Rigshospitalet (RH) in 2005. The results are compared with the best results...... published internationally (benchmark) and with predicted mortality. Factors in postoperative intensive therapy that can improve morbidity and mortality are identified. MATERIAL AND METHODS: This is a retrospective calculation and analysis of mortality and morbidity. Data were collected from an Intensive...... was significantly higher than the overall ICU mortality. The ICU mortality and morbidity increased with the amount of postoperative blood loss. Patients with an initial serum creatinine concentration of mortality that was lower than that of patients with a higher initial serum creatinine...

  13. Endocrine, metabolic and cardiovascular responses to adrenaline after abdominal surgery

    DEFF Research Database (Denmark)

    Hilsted, J; Wilken-Jensen, Charlotte; Birch, K;

    1990-01-01

    Adrenaline-induced changes in heart rate, blood pressure, plasma adrenaline and noradrenaline, cortisol, glucagon, insulin, cAMP, glucose lactate, glycerol and beta-hydroxybutyrate were studied preoperatively and 4 and 24 h after skin incision in 8 patients undergoing elective cholecystectomy. Late...... postoperative responses of blood glucose, plasma cAMP, lactate and glycerol to adrenaline infusion were reduced, whereas other responses were unaffected. Blood glucose appearance and disappearance rate as assessed by [3H]3-glucose infusion was unchanged pre- and postoperatively. The increase in glucose...... appearance rate following adrenaline was similar pre- and postoperatively. These findings suggest that several beta-receptor-mediated responses to adrenaline are reduced after abdominal surgery....

  14. Abdominal surgery process modeling framework for simulation using spreadsheets.

    Science.gov (United States)

    Boshkoska, Biljana Mileva; Damij, Talib; Jelenc, Franc; Damij, Nadja

    2015-08-01

    We provide a continuation of the existing Activity Table Modeling methodology with a modular spreadsheets simulation. The simulation model developed is comprised of 28 modeling elements for the abdominal surgery cycle process. The simulation of a two-week patient flow in an abdominal clinic with 75 beds demonstrates the applicability of the methodology. The simulation does not include macros, thus programming experience is not essential for replication or upgrading the model. Unlike the existing methods, the proposed solution employs a modular approach for modeling the activities that ensures better readability, the possibility of easily upgrading the model with other activities, and its easy extension and connectives with other similar models. We propose a first-in-first-served approach for simulation of servicing multiple patients. The uncertain time duration of the activities is modeled using the function "rand()". The patients movements from one activity to the next one is tracked with nested "if()" functions, thus allowing easy re-creation of the process without the need of complex programming. PMID:26004999

  15. Bilateral interpleural versus lumbar epidural bupivacaine-morphine analgesia for upper abdominal surgery.

    Science.gov (United States)

    Demian, Atef D; Wahba, Ashraf M; Atia, Emad M; Hussein, Sami H

    2003-10-01

    This randomized study was designed to compare the effectiveness of bilateral interpleural analgesia with lumbar epidural analgesia, on postoperative pain relief in upper abdominal surgery. The studied patients were randomely allocated into either interpleural group "IP" (n = 15) or epidural group "EP" (n = 15). In "IP" group, preanesthetic bilateral interpleural block was done using a mixture of bupivacaine 0.5% (0.8 mg/kg) and 2 mg morphine diluted to 50 ml saline for each side. In "EP" group, the same mixture-diluted in 20 ml saline-was injected in the epidural space (L2-3). The general anesthetic technique was the same in both groups. Hemodynamic, gasometric, verbal pain score (VPS) values and complications were compared in both techniques. Heart rate (HR) and mean arterial pressure (MAP) readings were in the accepted normal range in the perioperative period although significant lower readings were detected in "EP" group. No significant differences were displayed in blood gasometric variables between the two groups. There were considerable level of analgesia in both groups in the postoperative period although "EP" analgesia was superior to "IP". More pain free patients (9 versus 4) and significant lower consumption of nalbuphine were detected in "EP" group. The results of this study indicate that bilateral "IP" analgesia may offer a satisfactory analgesia for upper abdominal surgery when the use of other analgesic techniques may be contraindicated. PMID:14740589

  16. Bilateral interpleural versus lumbar epidural bupivacaine-morphine analgesia for upper abdominal surgery.

    Science.gov (United States)

    Demian, Atef D; Wahba, Ashraf M; Atia, Emad M; Hussein, Sami H

    2003-10-01

    This randomized study was designed to compare the effectiveness of bilateral interpleural analgesia with lumbar epidural analgesia, on postoperative pain relief in upper abdominal surgery. The studied patients were randomely allocated into either interpleural group "IP" (n = 15) or epidural group "EP" (n = 15). In "IP" group, preanesthetic bilateral interpleural block was done using a mixture of bupivacaine 0.5% (0.8 mg/kg) and 2 mg morphine diluted to 50 ml saline for each side. In "EP" group, the same mixture-diluted in 20 ml saline-was injected in the epidural space (L2-3). The general anesthetic technique was the same in both groups. Hemodynamic, gasometric, verbal pain score (VPS) values and complications were compared in both techniques. Heart rate (HR) and mean arterial pressure (MAP) readings were in the accepted normal range in the perioperative period although significant lower readings were detected in "EP" group. No significant differences were displayed in blood gasometric variables between the two groups. There were considerable level of analgesia in both groups in the postoperative period although "EP" analgesia was superior to "IP". More pain free patients (9 versus 4) and significant lower consumption of nalbuphine were detected in "EP" group. The results of this study indicate that bilateral "IP" analgesia may offer a satisfactory analgesia for upper abdominal surgery when the use of other analgesic techniques may be contraindicated.

  17. [Anesthesia and recovery of infrarenal abdominal aortic aneurysm surgery].

    Science.gov (United States)

    Beye, S A; Kane, O; Tchikangoua, T N; Ndiaye, A; Dieng, P A; Ciss, G; Ba, P S; Ndiaye, M

    2009-01-01

    The aim of this study was to evaluate the anaesthetic assumption of responsibility of the surgery of the aneurism of under renal abdominal aorta. It was a retrospective study over two years (April 2005 - April 2007). Seven patients were operated, the mean age was 69,4 years. An operational pre evaluation was carried out among all patients including/understanding an interrogation, a clinical examination and a clinical assessment. All the patients profited from a general anaesthesia with controlled ventilation. Arterial hypertension (5 cases) was the independent factor of risk followed by the nicotinism (2 cases) with a patient at the stage of obstructive chronic broncho-pneumonopathy (BPCO). A patient was allowed in a table of rupture with acute abdominal pain and a cardiovascular collapse. Electrocardioscopic anomalies were noted among three patients with type of: HVD+ HBAG; HVG; HAG. A patient presented a hypertrophy cardiopathy with deterioration of the function of the VG and an important pulmonary arterial hypertension. A tensionnelle fall was found among three patients after induction with the midazolam. The aortic time of clampage varied between 20 and 120 mn with an average of 57, 6 mn. The incidents at the time of the clampage were: a bradycardia, a hypertensive push and a hypotension. No incident was observed at the time of the declampage. The blood losses per operational were estimated on average at 1000 ml and the numbers of transfusion by patient was on average of 4 pockets. The post operative issue was simple among 5 patients. A surgical recovery was necessary in front of a case of thrombosis of prosthesis. An oligoanurie, an acute respiratory insufficiency was found at the patient admitted in a table of rupture. The intermediate duration of stay threw 11 days. The maintenance of a homodynamic stability per and post operational remainder a good strategy to prevent the operational complications post. PMID:19666389

  18. The Effects of Enteral Immunonutrient Products and Total Parenteral Nutrition in Patients Who Underwent Major Abdominal Surgery

    OpenAIRE

    GENCER, Abdulhamit; Yavuz ÖZDEMİR; Sücüllü, İlker; Filiz, Ali İlker; YÜCEL, Ergün; AKIN, M. Levhi; Yıldız, Mehmet

    2010-01-01

    Objective: We aimed to investigate the effects of enteral immunonutrition and Total Parenteral Nutrition (TPN) on the immune system and acute inflammatory response of patients who underwent major abdominal surgery. Material and Methods: Sixty gastric or colorectal cancer patients were randomized into two groups. Enteral immunonutrition was given to the first group and TPN was given to the second group. Albumin, prealbumin, retinol binding globulin (RBP), transferrin, IL-2, IL-6, CRP...

  19. Hand-assisted laparoscopic surgery of abdominal large visceral organs

    Institute of Scientific and Technical Information of China (English)

    Li-Hua Dai; Bo Xu; Guang-Hui Zhu

    2006-01-01

    AIM: To design a hand-assisted laparoscopic approach in an attempt to provide an option for laparoscopic resection of abdominal large viscera.METHODS: A 5-6 cm incision (for HandPort) and 2 trocars were employed. The main vessel of the target organ was taken as a "core", and all tissues around the core were taken as peripheral structures. The peripheral structures were dissected first, and the core vessels were treated last. Twenty-six patients underwent laparoscopic deroofing of the hepatic huge cysts, resection of the segments lying at the outer edge of the liver (segments 2 to 6), splenectomy, hemicolectomy, ileocecectomy and subtotal gastrectomy with HandPort device, harmonic scalpel, or Ligasure.RESULTS: The duration of the procedure was within 2 hours. Blood loss amounted to 8-120 mL. The conversion rate was 3.8% (1/26). All patients had uneventful postoperative courses with less pain, earlier oral intake,and faster recovery, compared with conventional surgery.CONCLUSION: This method combines the advantages of both open and laparoscopic techniques, achieving better hemostasis effect, shortening the operative time,and is beneficial to the patients.

  20. [Risk stratification in selective surgery of abdominal aortic aneurysm].

    Science.gov (United States)

    Iaitskiĭ, N A; Bedrov, A Ia; Moiseev, A A; Nesterova, I V

    2014-01-01

    A retrospective analysis of data of 188 patients, who underwent a selective surgery for abdominal aortic aneurism showed, that all the patients had a cardiac pathology. Ischemic heart disease and arterial hypertension had 175 (93.0%) and 177 (94.1%) of patients, respectively. Chronic nonspecific lung disease was noted in 65.4% patients and kidney disease--in 48.9%. Different complications developed in early postoperative period in 47 (25%) patients, that resulted in fatal outcome in 20(10,6%). The most frequent complication was an acute renal insufficiency, which led to fatal outcome in 40% patients. Myocardial infarction and pneumonia took the second place in the structure of postoperative complications, one half of the fatal cases was due to these. Retrospective risk stratification assessment of the development of early postoperative complications and lethality was made by Glasgow Aneurysm Score (GAS) and angiosurgical model scale V-POSSUM. It was stated, that score was up to 84 according to GAS scale and up to 28 (V-POSSUM). That fact is the evidence of high risk of the operation. On the basis of ROC curves building, the conclusion was made about greater predictive ability of V-POSSUM scoring system. PMID:25055502

  1. Effects of Glutamine Supplementation on Patients Undergoing Abdominal Surgery

    Institute of Scientific and Technical Information of China (English)

    Yue-ping Fan; Jian-chun Yu; Wei-ming Kang; Qun Zhang

    2009-01-01

    Objective To evaluate the effects of supplementation of glutamine (GLN) on maintaining glutathione (GSH) level, immune system function, liver function, and clinical outcome of patients receiving abdominal operation. Methods Forty patients undergoing elective abdominal surgical treatment were randomly divided into 2 groups: study group (n = 20) and control group (n = 20). All patients received total parenteral nutrition (TPN) for up to 7 days during perioperative period. The study group received TPN supplemented with GLN dipeptide while the control group received TPN without GLN dipeptide. Patients in both groups received equivalent nitrogen and caloric intake. Blood sample was taken on preoperative day, and the 1st, 3rd, 6th postoperative day to measure GSH level, immune indexes, and liver function indexes. Results The decrease of GSH level in plasma and red blood cell (RBC) in study group was less than that in control group during postoperative period. Ratio of GSH/glutathione disulfide (GSSG) in plasma in study group was higher than that in control group on the 3rd postoperative day (52.53 ± 11.46 vs. 31.43 ± 7.27, P = 0.001). Albumin level in study group was higher than that in control group on the 3rd postoperative day (37.7 ± 3.8 g/L vs. 33.8 ± 4.2 g/L, P = 0.02). There was no significant difference in the levels of immunoglobin (IgG, IgM, IgA) or T lymphocyte subgroup (CD4, CD8, CD4/CD8) in both groups during postoperative period. There was one case with infectious complication in control group, while none in study group. A trend of shortened hospital stay was observed in study group compared with control group (22.3 ± 2.1 d vs. 24.9 ± 1.7 d, P = 0.32). Conclusions Supplementation of GLN-enriched TPN has beneficial effects on maintaining GSH levels in plasma and RBC, sustaining GSH/GSSG ratio and albumin level, and keeping antioxidant abilities during postoperative period in patients with abdominal operation, with the trends of decreasing incidence of

  2. Comparison of Intravenous Paracetamol and Tramadol in Children Undergoing Major Abdominal Surgery

    Directory of Open Access Journals (Sweden)

    Aysu Aydogan

    2015-06-01

    Conclusion: It was concluded that, intravenous paracetamol was provided effective analgesia but it was not superior to intravenous tramadol in children undergoing major abdominal surgery. [Cukurova Med J 2015; 40(2.000: 275-281

  3. Bacterial Translocation and Change in Intestinal Permeability in Patients after Abdominal Surgery

    Institute of Scientific and Technical Information of China (English)

    Zhi QIAO; Zhanliang LI; Jiye LI; Lianrong LU; Yi LV; Junyou LI

    2009-01-01

    sely related with bacterial translocation. Intestinal bacterial translocation (most commonly E. coli) might occur at early stage (2 h) after ab-dominal surgery. Postoperative SIRS and infection might bear a close relationship with bacterial translocation.

  4. The comparative study of epidural levobupivacaine and bupivacaine in major abdominal surgeries

    Directory of Open Access Journals (Sweden)

    Ali Uzuner

    2011-01-01

    Conclusions: The results of our study suggest that same concentration of epidural levobupivacaine and bupivacaine with fentanyl provide stable postoperative analgesia and both were found safe for the patients undergoing major abdominal surgery.

  5. Post-operative analgesia for major abdominal surgery and its effectiveness in a tertiary care hospital

    OpenAIRE

    Aliya Ahmed; Naveed Latif; Robyna Khan

    2013-01-01

    Background: Post-operative pain is often inadequately treated. Optimal utilization of the available resources is essential for improving pain management. Aims: The aim of our study was to determine pain management strategies employed after major abdominal surgeries at our institute and their efficacy and safety. Settings and Design: Prospective observational study conducted at a tertiary care hospital. Materials and Methods: Patients undergoing elective major abdominal surgeries w...

  6. Prevention of respiratory complications after abdominal surgery: a randomised clinical trial.

    OpenAIRE

    Hall, J. C.; Tarala, R. A.; Tapper, J.; Hall, J L

    1996-01-01

    OBJECTIVE--To evaluate the prevention of respiratory complications after abdominal surgery by a comparison of a global policy of incentive spirometry with a regimen consisting of deep breathing exercises for low risk patients and incentive spirometry plus physiotherapy for high risk patients. DESIGN--Stratified randomised trial. SETTING--General surgical service of an urban teaching hospital. PATIENTS--456 patients undergoing abdominal surgery. Patients less than 60 years of age with an Ameri...

  7. Decreasing candidaemia rate in abdominal surgery patients after introduction of fluconazole prophylaxis*

    DEFF Research Database (Denmark)

    Holzknecht, Barbara; Thorup, Jens Frederik; Arendrup, M C;

    2011-01-01

    Clin Microbiol Infect ABSTRACT: Although abdominal surgery is an established risk factor for invasive candidiasis, the precise role of antifungal prophylaxis in these patients is not agreed upon. In 2007, fluconazole was added to the prophylactic antibiotic treatment for patients with gastrointes......Clin Microbiol Infect ABSTRACT: Although abdominal surgery is an established risk factor for invasive candidiasis, the precise role of antifungal prophylaxis in these patients is not agreed upon. In 2007, fluconazole was added to the prophylactic antibiotic treatment for patients...

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

    Science.gov (United States)

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

    2013-01-01

    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

  9. Preoperative povidone-iodine vaginal gel in abdominal hysterectomy: a randomized clinical trial

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    Beigi A

    2007-09-01

    Full Text Available Background: Infectious complications of hysterectomy remain common despite the use of antibiotic. The usual existing methods of preoperative antisepsis do not control the vaginal bacteria that are the primary cause of contamination at the surgical site. Our goal was to assess whether febrile morbidity after total abdominal hysterectomy is decreased by the addition of povidone-iodine gel at the vaginal apex after the routine vaginal preparation with povidone-iodine solution.Methods: We carried out a prospective randomized trial on women admitted for elective abdominal hysterectomy. Inclusion criteria included planned abdominal hysterectomy for benign or malignant gynecologic conditions. Exclusion criteria consisted of emergency surgery, current treatment for pelvic infection, and known povidone-iodine allergy. A total of 168 patients were randomized to either the control group or the intervention group, who received 20 cc povidone-iodine gel placed at the vaginal apex immediately before the operation. Both groups received the routine preoperative preparation of antimicrobial prophylaxis, abdominal and vaginal scrubbing with povidone-iodine solution prior to the operation. The primary outcome was post-operative febrile morbidity. Other outcomes included abdominal wound infection, vaginal cuff cellulitis or pelvic abscess. Data was analyzed using Fisher's exact test. p<0.05 was considered statistically significant.Results: The overall rate of febrile morbidity was 20.5%. Febrile morbidity occurred in ten of 80 (12.5% women receiving the povidone-iodine gel preparation and 24 of 86 (27.9% women not receiving the gel (p<0.05. The rate of abdominal wound infection was 18.6% (16 in the control group, and 5% (4 in the gel group (p<0.05. Vaginal cuff cellulitis was seen in three patients from the control group versus one woman from the gel group (p>0.05. Pelvic abscess was diagnosed in one patient from the control group and in no patients from the

  10. Surgery of gigantic infrarenal aneurysm of abdominal aorta

    OpenAIRE

    N. Rustempašić; I. Arslani; D. Totić; A. Hadžimehmedagić; H. Vranić; E. Solaković

    2005-01-01

    The case shows gigantic aneurysm of abdominal aorta, localized infrarenally, as well as aneurysms of bilateral iliac arteries, which were solved successfully by resection of aneurism of abdominal aorta, closure of iliac arteries near aortic bifurcation, and interposition of aorta-bifemural vascular graft. There were no postoperative complications,and final outcome was fully satisfactory.

  11. Surgery of gigantic infrarenal aneurysm of abdominal aorta

    Directory of Open Access Journals (Sweden)

    N. Rustempašić

    2005-08-01

    Full Text Available The case shows gigantic aneurysm of abdominal aorta, localized infrarenally, as well as aneurysms of bilateral iliac arteries, which were solved successfully by resection of aneurism of abdominal aorta, closure of iliac arteries near aortic bifurcation, and interposition of aorta-bifemural vascular graft. There were no postoperative complications,and final outcome was fully satisfactory.

  12. A PROSPECTIVE, RANDOMIZED, DOUBLE BLIND, CONTROLLED CLINICAL STUDY OF ADJUVANT EFFECT OF FENTANYL (1 µg/kg OR CLONIDINE (2µg / kg TO ROPIVACAINE 0.2% 1ML/KG FOR CAUDAL ANALGESIA IN CHILDREN UNDERGOING LOWER ABDOMINAL SURGERIES

    Directory of Open Access Journals (Sweden)

    Manjunath

    2014-10-01

    Full Text Available Ropivacaine having better safety profile and less motor blockade than bupivacaine is well suited for caudal analgesia. Since studies done regarding the effect of fentanyl and clonidine as adjuvants to ropivacaine for prolongation of caudal analgesia are scant and have shown conflicting results, the present study was conducted. METHODS: A total of 90 children aged between 3-6yrs belonging to ASA class I and II undergoing surgical procedures below the umbilicus were randomly allocated to one of two groups: Group R received ropivacaine 0.2%, 1 ml/kg with saline 0.02ml/kg and Group RF received ropivacaine 0.2%, 1 ml/kg with fentanyl 1 μg/kg (0.02ml/kg and Group RC (clonidine received 1ml/kg of 0.2% Ropivacaine plus clonidine 2µg / kg caudally after induction of general endotracheal anaesthesia. The pain score was evaluated using Hannallah pain scale, motor blockade using modified bromage scale and sedation assessed using 4 point sedation score at 30 minutes after extubation and at 1, 2, 4, 6, 12 and 24 h. The time to awakening, first analgesic requirement time, number of doses of rescue analgesic and side-effects in a 24 hours period were also recorded. The results were evaluated using SPSS 17 statistical method. RESULTS: There were no differences in demographic characteristics between the groups. However, mean duration of caudal analgesia was 659.5 minutes in group R, 784.5 minutes in group RF and 960.5 minutes in group RC which was statistically highly significant (P<0.01.The total dose of rescue analgesic in 24 hours was lower in groups RF and RC. Also the number of children receiving rescue analgesia at 12 hours was higher in placebo group than fentanyl group and clonidine group which was statistically highly significant (P<0.01. Increased incidence of urinary retention and pruritis was noted in group RF which was statistically not significant (P=0.366. CONCLUSION: Addition of inj. Fentanyl 1µg/kg or clonidine 2µg/kg to Ropivacaine 0.2% 1ml

  13. Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery

    DEFF Research Database (Denmark)

    Rasmussen, Morten Schnack; Jørgensen, Lars Nannestad; Wille-Jørgensen, Peer

    2009-01-01

    BACKGROUND: Major abdominal and pelvic surgery carries a high risk of venous thromboembolism (VTE). The efficacy of thromboprophylaxis with low-molecular weight heparin (LMWH) administered during the in-hospital period is well documented, but the optimal duration of thromboprophylaxis after surgery...

  14. A randomized controlled trial to compare pregabalin with gabapentin for postoperative pain in abdominal hysterectomy

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    Anju Ghai

    2011-01-01

    Full Text Available Background: Pregabalin is a potent ligand for alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system, which exhibits potent anticonvulsant, analgesic and anxiolytic activity. The pharmacological activity of pregabalin is similar to that of gabapentin and shows possible advantages. Although it shows analgesic efficacy against neuropathic pain, very limited evidence supports its postoperative analgesic efficacy. We investigated its analgesic efficacy in patients experiencing acute pain after abdominal hysterectomy and compared it with gabapentin and placebo. Methods: A randomized, double-blind, placebo-controlled study was conducted in 90 women undergoing abdominal hysterectomy who were anaesthetized in a standardized fashion. Patients received 300 mg pregabalin, 900 mg gabapentin or placebo, 1-2 hours prior to surgery. Postoperative analgesia was administered at visual analogue scale (VAS ≥3. The primary outcome was analgesic consumption over 24 hours and patients were followed for pain scores, time to rescue analgesia and side effects as secondary outcomes. Results: The diclofenac consumption was statistically significant between pregabalin and control groups, and gabapentin and control groups; however, pregabalin and gabapentin groups were comparable. Moreover, the consumption of tramadol was statistically significant among all the groups. Patients in pregabalin and gabapentin groups had lower pain scores in the initial hour of recovery. However, pain scores were subsequently similar in all the groups. Time to first request for analgesia was longer in pregabalin group followed by gabapentin and control groups. Conclusion: A single dose of 300 mg pregabalin given 1-2 hours prior to surgery is superior to 900 mg gabapentin and placebo after abdominal hysterectomy. Both the drugs are better than placebo.

  15. A COMPARATIVE EVALUATION OF GABAPENTIN AND CLONIDINE PREMEDICATION ON POST OPERATIVE ANALGESIA REQUIREMENT FOLLOWING ABDOMINAL SURGERIES UNDER GENERAL ANAESTHESIA

    Directory of Open Access Journals (Sweden)

    Ashish

    2014-08-01

    Full Text Available AIM: Aim of our study was to compare the relative effectiveness of gabapentin and clonidine premedication on patients undergoing elective abdominal surgeries under G.A. OBJECTIVE: gabapentine and clonidine have anti-nociceptive properties .This study assess their efficacy in prolonging the analgesic effect intra-operative and postoperative analgesic requirement. MATERIAL AND METHOD: 225 patients of either sex of age between 20-60 years, ASA grade I & II, patient admitted to Hamidia hospital for elective abdominal surgeries under general anaesthesia were included in the study. The patients were randomly allocated into three groups 75 each group I : Control group (patients received placebo tablet at 90 min before the surgery,group II Gabapentin 300 mg tablet orally 90 min before surgery ,groupIII:clonidine150µg tablet orally given 90 min before surgery. Duration of postoperative analgesia, Degree of postoperative pain (VAS scoreand added rescue analgesia required in 24 hrs were recorded postoperatively. RESULT: Analysis reveled that there was no difference in the HR, SBP among the three group during the study. Duration of postoperative analgesia, observed from time of reversal to first demand of analgesia in the recovery room was more in group II compared to group I and group III (p-value <0.001, highly significant. Pain perception was highly blunted in groups II compared to group I & group III. Total rescue analgesic requirement during the postoperative 24hrs period was much lower in group II inj Diclofenac compared to group I and group III . ( p-value < 0.001, highly significant.CONCLUSION: Given 90 min before induction of GA oral gabapentin(300 mg or clonidine(150 µg preoperatively was effective in lowering postoperative VAS pain score and consumption of analgesics, it was also shows that gabapentin significantly decreases postoperative pain intensity and analgesic consumption after abdominal surgeries.

  16. COMPARATIVE STUDY OF CAUDAL ROPIVACAINE WITH CAUDAL ROPIVACAINE AND DEXMEDETOMIDINE IN PEDIATRIC LOWER ABDOMINAL SURGERIES

    Directory of Open Access Journals (Sweden)

    Monika

    2014-03-01

    Full Text Available PURPOSE: The objectives of this study were to compare the effects of caudal dexmedetomidine combined with Ropivacaine to provide postoperative analgesia in children and also to establish its safety in the pediatric patients. METHODS: In a randomized, prospective, parallel group, double-blinded study, 80 children of 1 year to 6years posted for lower abdominal surgeries were recruited and allocated into two groups: Group RD (n=40 received 0.25% Ropivacaine 1 ml/kg with dexmedetomidine2 μg/kg, making the volume to 0.5 ml and Group R (n=40 received 0.25% Ropivacaine1 ml/kg + 0.5 ml normal saline. Induction of anesthesia was achieved with Inj. Ketamine 2mg/kg + Inj. Succinylcholine 2mg/kg. Intubated with appropriate-sized Endotracheal tube and caudal block was performed in all patients. Maintained with 66% nitrous oxide in Oxygen and isoflurane 0.2-0.4%.Post-operative pain assessed with FLACC score. RESULTS: The duration of postoperative analgesia recorded a mean of 339 minutes (5.6hrs ± 2.4 hrs. in Group R compared with 884 minutes (14.7 hrs. ±5hrs in Group RD, with a p value of <0.001. Group RD patients achieved a statistically significant higher FLACC score compared with Group RD patients. The peri-operative hemodynamics were stable among both the groups. CONCLUSION: Caudal dexmedetomidine (2 μg/kg with 0.25%Ropivacaine (1 ml/kg for pediatric lower abdominal surgeries provides significant postoperative pain relief and better quality of sleep and a prolonged duration of arousable sedation.

  17. Electrical Impedance Tomography-guided PEEP Titration in Patients Undergoing Laparoscopic Abdominal Surgery.

    Science.gov (United States)

    He, Xingying; Jiang, Jingjing; Liu, Yuli; Xu, Haitao; Zhou, Shuangqiong; Yang, Shibo; Shi, Xueyin; Yuan, Hongbin

    2016-04-01

    The aim of the study is to utilize electrical impedance tomography (EIT) to guide positive end-expiratory pressure (PEEP) and to optimize oxygenation in patients undergoing laparoscopic abdominal surgery.Fifty patients were randomly assigned to the control (C) group and the EIT (E) group (n = 25 each). We set the fraction of inspired oxygen (FiO2) at 0.30. The PEEP was titrated and increased in a 2-cm H2O stepwise manner, from 6 to 14 cm H2O. Hemodynamic variables, respiratory mechanics, EIT images, analysis of blood gas, and regional cerebral oxygen saturation were recorded. The postoperative pulmonary complications within the first 5 days were also observed.We chose 10 cm H2O and 8 cm H2O as the "ideal" PEEP for the C and the E groups, respectively. EIT-guided PEEP titration led to a more dorsal shift of ventilation. The PaO2/FiO2 ratio in the E group was superior to that in the C group in the pneumoperitoneum period, though the difference was not significant (330 ± 10 vs 305.56 ± 4 mm Hg; P = 0.09). The C group patients experienced 8.7% postoperative pulmonary complications versus 5.3% among the E group patients (relative risk 1.27, 95% confidence interval 0.31-5.3, P = 0.75).Electrical impedance tomography represents a new promising technique that could enable anesthesiologists to assess regional ventilation of the lungs and optimize global oxygenation for patients undergoing laparoscopic abdominal surgery. PMID:27057904

  18. An Experimental Animal Model for Abdominal Fascia Healing after Surgery

    DEFF Research Database (Denmark)

    Burcharth, J; Pommergaard, H-C; Klein, M;

    2013-01-01

    both 7 and 28 days. Conclusion: It was possible to create a healed but weak abdominal fascia in rats with a minimum of defects after incision using a running suture technique in the fascia. In contrast to other models, regular tissue defects were absent, and the model can therefore be used to evaluate......Background: Incisional hernia (IH) is a well-known complication after abdominal surgical procedures. The exact etiology of IH is still unknown even though many risk factors have been suggested. The aim of this study was to create an animal model of a weakly healed abdominal fascia that could...... be used to evaluate the actively healing fascia. Such an animal model may promote future research in the prevention of IH. Methods: 86 male Sprague-Dawley rats were used to establish a model involving six experiments (experiments A-F). Mechanical testing of the breaking strength of the healed fascia...

  19. [Mechanical ileus in children with no prior history of abdominal surgery].

    Science.gov (United States)

    van Poll, Daan; de Beer, Sjoerd A; de Jong, Justin R; Heij, Hugo A

    2015-01-01

    In children with no prior history of abdominal surgery and no signs of intussusception or incarcerated inguinal hernia, mechanical ileus may have a congenital cause such as malrotation with volvulus or a persistent omphalomesenteric duct. Acquired causes include sigmoid volvulus. We present two cases of mechanical ileus in children. The first case involved a 6-year-old boy who presented with acute abdominal pain and vomiting. An emergency laparotomy was performed, with resection of the omphalomesenteric duct. Recovery was uneventful. The other case concerned a 9-year-old boy who presented with increasing abdominal pain, bilious vomiting and general clinical deterioration. An emergency laparotomy was performed, revealing malrotation with volvulus and intestinal ischaemia. Children with no prior abdominal history who present with symptoms that may be caused by mechanical obstruction should be managed with a view to surgery and without delay, in order to prevent a catastrophic outcome resulting from a congenital or acquired mechanical obstruction. PMID:26443112

  20. Near infrared spectroscopy for frontal lobe oxygenation during non-vascular abdominal surgery

    DEFF Research Database (Denmark)

    Sørensen, Henrik; Grocott, Hilary P; Secher, Niels H

    2015-01-01

    PURPOSE: Cerebral deoxygenation, as determined by near infrared spectroscopy (NIRS), seems to predict postoperative complications following cardiac surgery. We identify the type of non-vascular abdominal surgery associated with cerebral deoxygenation and/or hyperoxygenation, how such deviations...... to baseline) manifested with reverse Trendelenburg's positioning and in 24% (median) of especially elderly patients undergoing open surgery and demonstrated a correlation to hospital stay (LOS). However, if cerebral deoxygenation was reversed promptly, improved postoperative cognitive function (28 versus 26...... by NIRS and could lead to adverse neurological outcome, that is seizures, transient hemiparesis and stroke. CONCLUSION: NIRS seems important for predicting neurological complications associated with LTx. Also, surgery in reverse Trendelenburg's position and in other types of abdominal surgery about one...

  1. Patients' experiences of postoperative intermediate care and standard surgical ward care after emergency abdominal surgery

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Vester-Andersen, Morten; Nielsen, Martin Vedel;

    2015-01-01

    AIMS AND OBJECTIVES: To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. BACKGROUND: Emergency abdominal surgery is common, but little is known about how...... patients experience postoperative care. The patient population is generally older with multiple comorbidities, and the short-term postoperative mortality rate is 15-20%. Thus, vigilant surgeon and nursing attention is essential. The present study is a qualitative sub-study of a randomised trial evaluating...... postoperative intermediate care after emergency abdominal surgery, the InCare trial. DESIGN: A qualitative study with individual semi-structured interviews. METHODS: We analysed interviews using Systematic Text Condensation. RESULTS: Eighteen patients (nine intervention/nine controls) were strategically sampled...

  2. Current practice of abdominal wall closure in elective surgery – Is there any consensus?

    Directory of Open Access Journals (Sweden)

    Ridwelski Karsten

    2009-05-01

    Full Text Available Abstract Background Development of incisional hernia after open abdominal surgery remains a major cause of post-operative morbidity. The aim of this study was to determine the current practice of surgeons in terms of access to and closure of the abdominal cavity in elective open surgery. Methods Twelve surgical departments of the INSECT-Trial group documented the following variables for 50 consecutive patients undergoing abdominal surgery: fascial closure techniques, applied suture materials, application of subcutaneous sutures, subcutaneous drains, methods for skin closure. Descriptive analysis was performed and consensus of treatment variables was categorized into four levels: Strong consensus >95%, consensus 75–95%, overall agreement 50–75%, no consensus Results 157 out of 599 patients were eligible for analysis (85 (54% midline, 54 (35% transverse incisions. After midline incisions the fascia was closed continuously in 55 patients (65%, using slowly absorbable (n = 47, 55%, braided (n = 32, 38% sutures with a strength of 1 (n = 48, 57%. In the transverse setting the fascia was closed continuously in 39 patients (72% with slowly absorbable (n = 22, 41% braided sutures (n = 27, 50% with a strength of 1 (n = 30, 56%. Conclusion In the present evaluation midline incision was the most frequently applied access in elective open abdominal surgery. None of the treatments for abdominal wall closure (except skin closure in the midline group is performed on a consensus level.

  3. Virtual Patients in Undergraduate Surgery Education: A Randomized Controlled Study

    Directory of Open Access Journals (Sweden)

    Mohammad Shariati

    2008-01-01

    Full Text Available Introduction: This study aims to clarify the effects of implementing a series of virtual patients in undergraduate surgery education on various dimensions of skills as applied to clinical problems. Methods: In a randomized controlled trial 48 surgery clerks were assigned to an intervention group who worked on 14 simulated cases of abdominal pain during 7 weeks in a computer lab and a control group without access to software. At the end of the intervention, both groups were tested by a structured, seven-part paper-based exam evaluating certain areas of competence. Results: In this study, from 48 medical students, forty-five students took the exam. Results showed a significant improvement in history taking (P < 0.001 and no improvement in scores related to appropriate use of radiology and lab tests, proposing differential diagnoses and management plans and factual knowledge. From the intervention group, 20 students completed a virtual case exam whose results had a poor correlation with the written exam. Conclusion: Overall, our findings indicate that virtual patients are strong tools in enhancing history-taking skills of students, but they do not affect other areas of competence significantly. Educators are recommended to be sceptical about enthusiastic reports on various computer applications and avoid falling into false expectations of their implementation

  4. A CLINICAL COMPARATIVE STUDY OF ANALGESIC EFFECT OF TRAMADOL AND PENTAZOCINE IN POST - OPERATIVE PATIENTS FOLLOWING UPPER ABDOMINAL SURGERY

    Directory of Open Access Journals (Sweden)

    Jamuna

    2015-06-01

    Full Text Available The post - operative pain can be treated by various approaches. Aim of this randomised prospective study was to compare two drugs (Tramadol and Pentazocine . 100 adult patients of both sexes of ASA status 1 & 2 posted for elective upper abdominal surgery were randomly assigned into two groups of 50 each, where Group 1 received Tramadol intravenously and Group 2 received Pentazocine intravenously as post - opera tive pain management. The efficacy of the analgesic effect of intravenous Tramadol & Pentazocine was compared during post - operative pain management. It was observed that Tramadol has got more potent analgesic action compared to equianalgesic dose of Pentaz ocine.

  5. Differential Effects of Intraoperative Positive End-expiratory Pressure (PEEP) on Respiratory Outcome in Major Abdominal Surgery Versus Craniotomy

    DEFF Research Database (Denmark)

    de Jong, Myrthe A C; Ladha, Karim S; Melo, Marcos F Vidal;

    2015-01-01

    by surgery type. BACKGROUND: Protective mechanical ventilation with lower tidal volumes and PEEP reduces compounded postoperative complications after abdominal surgery. However, data regarding the use of intraoperative PEEP is conflicting. METHODS: In this observational study, we included 5915 major...... abdominal surgery patients and 5063 craniotomy patients. Analysis was performed using multivariable logistic regression. The primary outcome was a composite of major postoperative respiratory complications (respiratory failure, reintubation, pulmonary edema, and pneumonia) within 3 days of surgery. RESULTS...

  6. Past, Present, and Future of Minimally Invasive Abdominal Surgery.

    Science.gov (United States)

    Antoniou, Stavros A; Antoniou, George A; Antoniou, Athanasios I; Granderath, Frank-Alexander

    2015-01-01

    Laparoscopic surgery has generated a revolution in operative medicine during the past few decades. Although strongly criticized during its early years, minimization of surgical trauma and the benefits of minimization to the patient have been brought to our attention through the efforts and vision of a few pioneers in the recent history of medicine. The German gynecologist Kurt Semm (1927-2003) transformed the use of laparoscopy for diagnostic purposes into a modern therapeutic surgical concept, having performed the first laparoscopic appendectomy, inspiring Erich Mühe and many other surgeons around the world to perform a wide spectrum of procedures by minimally invasive means. Laparoscopic cholecystectomy soon became the gold standard, and various laparoscopic procedures are now preferred over open approaches, in the light of emerging evidence that demonstrates less operative stress, reduced pain, and shorter convalescence. Natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS) may be considered further steps toward minimization of surgical trauma, although these methods have not yet been standardized. Laparoscopic surgery with the use of a robotic platform constitutes a promising field of investigation. New technologies are to be considered under the prism of the history of surgery; they seem to be a step toward further minimization of surgical trauma, but not definite therapeutic modalities. Patient safety and medical ethics must be the cornerstone of future investigation and implementation of new techniques. PMID:26508823

  7. COMPARATIVE STUDY OF BUPIVACAINE 0.25% VERSUS ROPIVACAINE 0.5% IN TRANSVERSUS ABDOMINIS PLANE BLOCK FOR POSTOPERATIVE ANALGESIA IN LOWER ABDOMINAL SURGERIES: A RANDOMISED CONTROLLED TRIAL

    Directory of Open Access Journals (Sweden)

    Neha

    2014-04-01

    Full Text Available BACKGROUND: Transversus Abdominis Plane Block (TAPB is a regional anesthesia technique. It provides analgesia after lower abdominal surgery particularly where parietal wall pain forms major component of pain. It allows sensory blockade of lower abdominal wall skin and muscles via local anesthetic deposition above Transversus Abdominis muscle. We evaluated efficacy of unilateral TAPB with bupivacaine and ropivacaine for postoperative analgesia in lower abdominal surgeries like hernia repair, appendicectomy in a hospital based, single blind, and prospective, randomized controlled clinical trial. METHOD: 75 adult patients undergoing elective unilateral lower abdominal surgery were randomized to undergo TAPB with ropivacaine (n = 25 or bupivacaine (n = 25 or Normal saline (n = 25. At end of surgery performed under spinal anesthesia unilateral TAPB on side of surgery was performed using 20 ml of 0.5 % ropivacaine or 0.25 % bupivacaine or saline. Each patient was assessed postoperatively by a blinded investigator in post-anesthesia care unit every 5 minutes for half an hour, then every 15 minutes till 2 hours and at 4, 6, 12, 24, 48 hours postoperatively in ward. RESULT: Mean duration of analgesia was 420.6 minutes with SD of +14.01 in Bupivacaine group and 2187 minutes with SD of +1011.09 in Ropivacaine group which was found to be statistically significant. CONCLUSION: Hence 0.5% ropivacaine provided longer duration of analgesia than 0.25 % bupivacaine when used in TAPB on patients of lower abdominal surgeries. There were no complications attributable to TAPB or drugs under study

  8. Circadian distribution of sleep phases after major abdominal surgery

    DEFF Research Database (Denmark)

    Gogenur, I.; Wildschiotz, G.; Rosenberg, J.

    2008-01-01

    Background. It is believed that the severely disturbed night-time sleep architecture after surgery is associated with increased cardiovascular morbidity with rebound of rapid eye movement (REM). The daytime sleep pattern of patients after major general surgery has not been investigated before. We...... nights after operation. Sleep was scored independently by two blinded observers and the recordings were reported as awake, light sleep (LS, stages I and II), slow wave sleep (SWS, stages III and IV), and REM sleep. Results. There was significantly increased REM sleep (P=0.046), LS (P=0.020), and reduced...... time awake (P=0.016) in the postoperative daytime period compared with the preoperative daytime period. Five patients had REM sleep during the daytime after surgery. Three of these patients did not have REM sleep during the preceding postoperative night. There was significantly reduced night-time REM...

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

    OpenAIRE

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

    2013-01-01

    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...

  10. Does epidural sufentanil provide effective analgesia per- and postoperatively for abdominal aortic surgery?

    NARCIS (Netherlands)

    Broekema, AA; Kuizenga, K; Hennis, PJ

    1996-01-01

    assess the efficacy of epidural sufentanil in providing per- and postoperative analgesia, 40 patients undergoing elective abdominal aortic surgery received either 50 mu g sufentanil in 10 ml normal saline solution (n=20, ES group) or 10 mi normal saline (n=20, control group) via a thoracic epidural

  11. Variable versus conventional lung protective mechanical ventilation during open abdominal surgery

    OpenAIRE

    Peter M Spieth; Güldner, Andreas; Uhlig, Christopher; Bluth, Thomas; Kiss, Thomas; Schultz, Marcus J.; Pelosi, Paolo; Koch, Thea; Gamba de Abreu, Marcelo

    2015-01-01

    Background: General anesthesia usually requires mechanical ventilation, which is traditionally accomplished with constant tidal volumes in volume- or pressure-controlled modes. Experimental studies suggest that the use of variable tidal volumes (variable ventilation) recruits lung tissue, improves pulmonary function and reduces systemic inflammatory response. However, it is currently not known whether patients undergoing open abdominal surgery might benefit from intraoperative variable ventil...

  12. Electromagnetic tracking for abdominal interventions in computer aided surgery.

    Science.gov (United States)

    Zhang, Hui; Banovac, Filip; Lin, Ralph; Glossop, Neil; Wood, Bradford J; Lindisch, David; Levy, Elliot; Cleary, Kevin

    2006-05-01

    Electromagnetic tracking has great potential for assisting physicians in precision placement of instruments during minimally invasive interventions in the abdomen, since electromagnetic tracking is not limited by the line-of-sight restrictions of optical tracking. A new generation of electromagnetic tracking has recently become available, with sensors small enough to be included in the tips of instruments. To fully exploit the potential of this technology, our research group has been developing a computer aided, image-guided system that uses electromagnetic tracking for visualization of the internal anatomy during abdominal interventions. As registration is a critical component in developing an accurate image-guided system, we present three registration techniques: 1) enhanced paired-point registration (time-stamp match registration and dynamic registration); 2) orientation-based registration; and 3) needle shape-based registration. Respiration compensation is another important issue, particularly in the abdomen, where respiratory motion can make precise targeting difficult. To address this problem, we propose reference tracking and affine transformation methods. Finally, we present our prototype navigation system, which integrates the registration, segmentation, path-planning and navigation functions to provide real-time image guidance in the clinical environment. The methods presented here have been tested with a respiratory phantom specially designed by our group and in swine animal studies under approved protocols. Based on these tests, we conclude that our system can provide quick and accurate localization of tracked instruments in abdominal interventions, and that it offers a user-friendly display for the physician.

  13. Surgery for abdominal aortic aneurysms. A survey of 656 patients

    DEFF Research Database (Denmark)

    Olsen, P S; Schroeder, T; Agerskov, Kim;

    1991-01-01

    Between 1979 and 1988, 656 patients were operated upon for abdominal aortic aneurysm. Elective operation was performed in 287 patients (44%) and acute operation in 369 patients. A ruptured aneurysm was found in 218 patients (33%). Patients with arteriosclerotic heart disease, hypertension, impaired...... renal function or chronic pulmonary disease showed an increased perioperative mortality. Development of postoperative cardiac and renal complications could not be related to previous cardiac or renal diseases. The major postoperative complications were renal failure in 81 patients (12%), pulmonary...... insufficiency in 77 patients (11%) and cardiac complications in 96 patients (13%). Failure of one or more organs occurred in 153 patients (23%) and the mortality rate for patients with multiorgan failure was 68%. Complications leading to reoperation occurred in 93 patients (14%). The perioperative mortality...

  14. Diagnostic application of labelled leukocytes in gastroenterology and abdominal surgery

    International Nuclear Information System (INIS)

    A total of 18 patients suspected of inflammatory process or abcessus in the abdominal cavity have been studied by scintiscanning with autologous leukocytes labelled with 111In-oxine (10-12 MBq) or 99mTc-HMPAO (300 MBq). Evaluation of the process activity is done on the ground activity index adopted which is received after the computer processing of the results. Three levels of process activity are determined: 1) when the leukocyte accumulation (LA) corresponds to that in the bone marrow; 2) when the LA corresponds to that in the liver; 3) when the LA corresponds to that in the spleen. The recorded sensitivity, specificity and accuracy of the method amount to 87.5%, 100% and 92.9% respectively. The method allows localization of the inflammatory process and indicates the degree of affecting the intestines. 2 figs., 6 refs

  15. Pseudozyma aphidis fungemia after abdominal surgery: First adult case

    Directory of Open Access Journals (Sweden)

    Agathe Herb

    2015-06-01

    Full Text Available Pseudozyma aphidis is an environmental Basidiomycete yeast, and has been involved in the ten past years in rare cases of invasive infection. Pseudozyma species are naturally resistant to caspofungin and often present decreased susceptibility or resistance to fluconazole. This fungus may be difficult to recognize and misidentifications are reported with conventional phenotypical methods. We report a case of P. aphidis invasive infection in an adult with a metastatic ampulloma who had gone through digestive surgery.

  16. Pseudozyma aphidis fungemia after abdominal surgery: First adult case.

    Science.gov (United States)

    Herb, Agathe; Sabou, Marcela; Delhorme, Jean-Baptiste; Pessaux, Patrick; Mutter, Didier; Candolfi, Ermanno; Letscher-Bru, Valérie

    2015-06-01

    Pseudozyma aphidis is an environmental Basidiomycete yeast, and has been involved in the ten past years in rare cases of invasive infection. Pseudozyma species are naturally resistant to caspofungin and often present decreased susceptibility or resistance to fluconazole. This fungus may be difficult to recognize and misidentifications are reported with conventional phenotypical methods. We report a case of P. aphidis invasive infection in an adult with a metastatic ampulloma who had gone through digestive surgery. PMID:25870786

  17. Past, Present, and Future of Minimally Invasive Abdominal Surgery

    OpenAIRE

    Antoniou, Stavros A.; Antoniou, George A.; Antoniou, Athanasios I.; Granderath, Frank-Alexander

    2015-01-01

    Laparoscopic surgery has generated a revolution in operative medicine during the past few decades. Although strongly criticized during its early years, minimization of surgical trauma and the benefits of minimization to the patient have been brought to our attention through the efforts and vision of a few pioneers in the recent history of medicine. The German gynecologist Kurt Semm (1927–2003) transformed the use of laparoscopy for diagnostic purposes into a modern therapeutic surgical concep...

  18. Perioperative Nutrition in Abdominal Surgery: Recommendations and Reality

    Directory of Open Access Journals (Sweden)

    Yannick Cerantola

    2011-01-01

    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.

  19. Challenges of randomized controlled trial design in plastic surgery.

    Science.gov (United States)

    Hassanein, Aladdin H; Herrera, Fernando A; Hassanein, Omar

    2011-01-01

    Randomized controlled trials are the gold standard of evidence-based medicine. In the field of plastic surgery, designing these studies is much more challenging than in pharmaceutical medicine. Randomized trials in plastic surgery encompass several road blocks including problems shared with other surgical trials: equipoise, high cost, placebo issues and learning curves following the establishment of a novel approach. In addition, plastic surgery has more subjective outcomes, thus making study design even more difficult in assessing the end result.

  20. Decreasing candidaemia rate in abdominal surgery patients after introduction of fluconazole prophylaxis*

    DEFF Research Database (Denmark)

    Holzknecht, B J; Thorup, J; Arendrup, M C;

    2011-01-01

    Clin Microbiol Infect ABSTRACT: Although abdominal surgery is an established risk factor for invasive candidiasis, the precise role of antifungal prophylaxis in these patients is not agreed upon. In 2007, fluconazole was added to the prophylactic antibiotic treatment for patients with gastrointes......Clin Microbiol Infect ABSTRACT: Although abdominal surgery is an established risk factor for invasive candidiasis, the precise role of antifungal prophylaxis in these patients is not agreed upon. In 2007, fluconazole was added to the prophylactic antibiotic treatment for patients...... with gastrointestinal tract perforations or reoperation after colorectal surgery in two university hospitals in Copenhagen. Changes in candidaemia rates associated with this intervention were examined and potential interfering factors evaluated. Rates and clinical characteristics of candidaemias and other blood stream...... infections (BSIs) in abdominal surgery patients were compared before (1 January 2006 to 30 June 2007) and after the intervention (1 January 2008 to 30 June 2009). The departments' activity was assessed by number of bed-days, admissions and surgical procedures, and the consumption of antifungals was analysed...

  1. The Zelnorm epidemiologic study (ZEST: a cohort study evaluating incidence of abdominal and pelvic surgery related to tegaserod treatment

    Directory of Open Access Journals (Sweden)

    Seeger John D

    2012-11-01

    Full Text Available Abstract Background Pre-marketing clinical studies of tegaserod suggested an increased risk of abdominal surgery, particularly cholecystectomy. We sought to quantify the association between tegaserod use and the occurrence of abdominal or pelvic surgery, including cholecystectomy. Methods This cohort study was conducted within an insured population. Tegaserod initiators and similar persons who did not initiate tegaserod were followed for up to six months for the occurrence of abdominal or pelvic surgery. Surgical procedures were identified from health insurance claims validated by review of medical records. The incidence of confirmed outcomes was compared using both as-matched and as-treated analyses. Results Among 2,762 tegaserod initiators, there were 94 abdominal or pelvic surgeries (36 gallbladder: among 2,762 comparators there were 134 abdominal or pelvic surgeries (37 gallbladder (hazard ratio HR] = 0.70, 95% confidence interval [C.I.] = 0.54-0.91 overall, HR = 0.98, 95% C.I. = 0.62-1.55 for gallbladder. Current tegaserod exposure compared to nonexposure was associated with a rate ratio [RR] of 0.68 (95% C.I. = 0.48-0.95 overall, while the RR was 0.99 (95% C.I. = 0.56-1.77 for gallbladder surgery. Conclusions In this study, tegaserod use was not found to increase the risk of abdominal or pelvic surgery nor the specific subset of gallbladder surgery.

  2. Arnebia euchroma ointment can reduce abdominal fat thickness and abdominal circumference of overweight women: A randomized controlled study

    Directory of Open Access Journals (Sweden)

    Mansour Siavash

    2016-01-01

    Full Text Available Background: Obesity is a worldwide health problem which is associated with a lot of complications. One of these comorbidities is the metabolic syndrome that is in correlation with abdominal fat thickness and waist circumference. Various methods were used to reduce abdominal fat thickness such as liposuction. A noninvasive method is the topical agent. In this study, we investigated the effectiveness of Arnebia euchroma (AE ointment on the abdominal fat thickness. Materials and Methods: This study was a double-blind clinical trial which was done at the endocrinology clinic in Khorshid Hospital, Isfahan, Iran, in 2014. After explaining the procedure and obtaining informed consent, the candidates were randomly divided into the case and control groups. The participants of the case and control groups applied AE ointment or placebo for 6 weeks on their abdominal area. Body mass index, waist and buttock circumference, and abdominal fat thickness were measured in both case and control groups at their first visit and then at the next 2, 4, and 6 weeks. We used t-test for comparing parametric variables between groups, paired t-test for changes from baseline to final, and repeated measure ANOVA for changes at different steps. Results: Sixty female candidates participated in this study (thirty in each group. Ten patients left the study and fifty participants finished the trial. At the end of the study, participants had a significant weight loss (2.96 ± 1.6 kg, P < 0.001 that was slightly more in the case group (3.15 ± 1.5 kg vs. 2.75 ± 1.7, P = 0.375. Abdominal circumference also decreased significantly in the participants (11.3 ± 6.7 cm, P < 0.001, but the changes were more significant in the case group (13.9 vs. 6.5 cm, P = 0.004. Similarly, abdominal fat thickness decreased significantly in the participants (2.3 ± 1.1 cm, P < 0.001, although changes were not significantly different between two groups (2.53 vs. 2.04 cm, P = 0.139. Conclusion: Topical

  3. Comparison of streamlined liner of the pharynx airway (SLIPA TM with the laryngeal mask airway Proseal TM for lower abdominal laparoscopic surgeries in paralyzed, anesthetized patients

    Directory of Open Access Journals (Sweden)

    Ashraf Abualhassan Abdellatif

    2011-01-01

    Full Text Available Context: Supraglottic airway devices have been used as an alternative to tracheal intubation during laparoscopic surgery. Aims: The study was designed to compare the efficacy of Streamlined Liner of the Pharynx Airway (SLIPA for positive pressure ventilation and postoperative complications with the Laryngeal Mask Airway ProSeal (PLMA for patients undergoing lower abdominal laparoscopies under general anesthesia with controlled ventilation. Settings and Design: Prospective, crossover randomized controlled trial performed on patients undergoing lower abdominal laparoscopic surgeries. Methods: A total of 120 patients undergoing lower abdominal laparoscopic surgeries were randomly allocated into two equal groups; PLMA and SLIPA groups. Number of intubation attempts, insertion time, ease of insertion, and fiberoptic bronchoscopic view were recorded. Lung mechanics data were collected 5 minutes after securing the airway, then after abdominal insufflation. Blood traces and regurgitation were checked for; postoperative sore throat and other complications were recorded. Statistical Analysis: Arithmetic mean and standard deviation values were calculated and statistical analyses were performed for each group. Independent sample t-test was used to compare continuous variables exhibiting normal distribution, and Chi-squared test for noncontinuous variables. P value <0.05 was considered significant. Results: Insertion time, first insertion success rate, and ease of insertion were comparable in both groups. Fiberoptic bronchoscopic view was significantly better and epiglottic downfolding was significantly lower in SLIPA group. Sealing pressure and lung mechanics were similar. Gastric distension was not observed in both groups. Postoperative sore throat was significantly higher in PACU in PLMA group. Blood traces on the device were significantly more in SLIPA group. Conclusions: SLIPA can be used as a useful alternative to PLMA in patients undergoing lower

  4. Computerized monitoring of physical activity and sleep in postoperative abdominal surgery patients

    DEFF Research Database (Denmark)

    Bisgaard, T; Kjaersgaard, M; Bernhard, A;

    1999-01-01

    OBJECTIVE: Assessment of early postoperative activity is important in the documentation of improvements of peri-operative care. This study was designed to validate computerized activity-based monitoring of physical activity and sleep (actigraphy) in patients after abdominal surgery. METHODS...... registration were found in the volunteers (85%, SD 15%) compared with the patients (77%, SD 11%) (p activity value awake was higher in the volunteers than in the patients (p Computerized activity monitoring by actigraphy is a reliable and easy method for monitoring......: The study included twelve hospitalized patients after major abdominal surgery studied on day 2 to 4 after operation and twelve unhospitalized healthy volunteers. Measurements were performed for 24 consecutive hours. The actigraphy measurements were compared with self-reported activity- and sleep...

  5. Post-operative analgesia for major abdominal surgery and its effectiveness in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Aliya Ahmed

    2013-01-01

    Conclusion: Epidural, PCIA and opioid infusions are used for pain relief after major abdominal surgeries at our hospital. Although there is limited drug availability, regular assessments and appropriate dose adjustments by acute pain management service (APMS and use of multimodal analgesia led to a high level of patient satisfaction. We recommend that feedback to the primary anesthesiologists by APMS is of utmost importance to enable improvement in practice.

  6. Increased long-term mortality after a high perioperative inspiratory oxygen fraction during abdominal surgery

    DEFF Research Database (Denmark)

    Meyhoff, Christian Sylvest; Jorgensen, Lars N; Wetterslev, Jørn;

    2012-01-01

    A high perioperative inspiratory oxygen fraction (80%) has been recommended to prevent postoperative wound infections. However, the most recent and one of the largest trials, the PROXI trial, found no reduction in surgical site infection, and 30-day mortality was higher in patients given 80% oxygen....... In this follow-up study of the PROXI trial we assessed the association between long-term mortality and perioperative oxygen fraction in patients undergoing abdominal surgery....

  7. Postsurgical pain outcome of vertical and transverse abdominal incision: Design of a randomized controlled equivalence trial [ISRCTN60734227

    Directory of Open Access Journals (Sweden)

    Motsch Johann

    2003-11-01

    Full Text Available Abstract Background There are two ways to open the abdominal cavity in elective general surgery: vertically or transversely. Various clinical studies and a meta-analysis have postulated that the transverse approach is superior to other approaches as regards complications. However, in a recent survey it was shown that 90 % of all abdominal incisions in visceral surgery are still vertical incisions. This discrepancy between existing recommendations of clinical trials and clinical practice could be explained by the lack of acceptance of these results due to a number of deficits in the study design and analysis, subsequent low internal validity, and therefore limited external generalisability. The objective of this study is to address the issue from the patient's perspective. Methods This is an intraoperatively randomized controlled observer and patient-blinded two-group parallel equivalence trial. The study setting is the Department of General-, Visceral-, Trauma Surgery and Outpatient Clinic of the University of Heidelberg, Medical School. A total of 172 patients of both genders, aged over 18 years who are scheduled for an elective abdominal operation and are eligible for either a transverse or vertical incision. To show equivalence of the two approaches or the superiority of one of them from the perspective of the patient, a primary endpoint is defined: the pain experienced by the patient (VAS 0–100 on day two after surgery and the amount of analgesic required (piritramide [mg/h]. A confidence interval approach will be used for analysis. A global α-Level of 0.05 and a power of 0.8 is guaranteed, resulting in a size of 86 patients for each group. Secondary endpoints are: time interval to open and close the abdomen, early-onset complications (frequency of burst abdomen, postoperative pulmonary complications, and wound infection and late complications (frequency of incisional hernias. Different outcome variables will be ranked by patients and

  8. Epidural anaesthesia with goal-directed administration of ropivacaine improves haemodynamic stability when combined with general anaesthesia in elderly patients undergoing major abdominal surgery.

    Science.gov (United States)

    Zhou, Q H; Xiao, W P; Yun, X

    2013-01-01

    The use of epidural ropivacaine may result in significant haemodynamic fluctuations during combined epidural and general anaesthesia. We designed this study to investigate whether epidural anaesthesia with a goal-directed approach, when combined with general anaesthesia, improved haemodynamic stability in elderly patients undergoing major abdominal surgery. Seventy-five elderly patients undergoing major abdominal surgery were randomly and evenly assigned to one of three groups receiving intraoperative epidural anaesthesia with either ropivacaine 0.1% (Group 1), ropivacaine 0.375% (Group 2) or ropivacaine 0.375% for abdominal wall pain and ropivacaine 0.1% for visceral pain (Group 3). General anaesthesia was induced using a target-controlled infusion of combined propofol and remifentanil. The remifentanil target concentration was adjusted according to the mean arterial pressure and heart rate, and vasoactive agents were administered to maintain stable haemodynamics. The need for vasoactive drug administrations was 1.4 (standard deviation 0.9) in Group 3 (n=24), representing a significantly lower frequency of administration compared with Groups 1 (n=24) and 2 (n=24) (P epidural anaesthesia with different ropivacaine concentrations can improve haemodynamic stability when combined with general anaesthesia for elderly patients undergoing major abdominal surgery.

  9. A prospective cohort study comparing early opioid requirement between Chinese from Hong Kong and Caucasian Australians after major abdominal surgery

    DEFF Research Database (Denmark)

    Konstantatos, A H; Imberger, G; Angliss, M;

    2012-01-01

    The relationship between ethnicity and early opioid consumption is not well understood. Our prospective cohort study tested whether Chinese patients in Hong Kong require less opioid after major abdominal surgery compared with Caucasian patients in Australia.......The relationship between ethnicity and early opioid consumption is not well understood. Our prospective cohort study tested whether Chinese patients in Hong Kong require less opioid after major abdominal surgery compared with Caucasian patients in Australia....

  10. Design and current status of CONTINT: continuous versus interrupted abdominal wall closure after emergency midline laparotomy - a randomized controlled multicenter trial [NCT00544583

    Directory of Open Access Journals (Sweden)

    Rahbari Nuh N

    2012-05-01

    Full Text Available Abstract Background The optimal strategy for abdominal wall closure has been an issue of ongoing debate. Available studies do not specifically enroll patients who undergo emergency laparotomy and thus do not consider the distinct biological characteristics of these patients. The present randomized controlled trial evaluates the efficacy and safety of two commonly applied abdominal wall closure strategies in patients undergoing primary emergency midline laparotomy. Methods/design The CONTINT trial is a multicenter, open label, randomized controlled trial with a two-group parallel design. Patients undergoing a primary emergency midline laparotomy are enrolled in the trial. The two most commonly applied strategies of abdominal wall closure after midline laparotomy are compared: the continuous, all-layer suture technique using slowly absorbable monofilament material (two Monoplus® loops and the interrupted suture technique using rapidly absorbable braided material (Vicryl® sutures. The primary endpoint within the CONTINT trial is an incisional hernia within 12 months or a burst abdomen within 30 days after surgery. As reliable data on this primary endpoint is not available for patients undergoing emergency surgery, an adaptive interim analysis will be conducted after the inclusion of 80 patients, allowing early termination of the trial if necessary or modification of design characteristics such as recalculation of sample size. Discussion This is a randomized controlled multicenter trial with a two-group parallel design to assess the efficacy and safety of two commonly applied abdominal wall closure strategies in patients undergoing primary emergency midline laparotomy. Trial registration NCT00544583

  11. The application of nutrition support in conservative treatment of chylous ascites after abdominal surgery

    Directory of Open Access Journals (Sweden)

    Pan W

    2016-04-01

    Full Text Available Wu Pan,1 Shen-Yang Cai,2 Hai-Long Luo,2 Shu-Rui Ouyang,1 Wen-Duo Zhang,1 Zai-Rong Wei,1 Da-Li Wang1 1Department of Plastic & Vascular Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, 2Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China Background: Chylous ascites is the pathologic leakage of triglycerides-rich lymphatic fluid into the peritoneal cavity. Chylous ascites is a rare complication in abdominal surgery. This study aimed to find a relatively better method for nutrition support in the treatment of chylous ascites after abdominal surgery. Methods: This study was a retrospective study. This study retrospectively reviewed patients who underwent abdominal surgery and developed chylous ascites, from the year 2010 to 2014, at the West China Hospital of Sichuan University and the Affiliated Hospital of Zunyi Medical College. Fifty-eight patients who developed chylous ascites after abdominal surgery were included in the study. The clinical effect of somatostatin was evaluated. The differences in the curative efficacy among a daily diet, a low-fat diet supplemented with medium-chain triglyceride (MCT, and total parenteral nutrition (TPN were also analyzed in this study. Results: Complete clinical success was reached earlier in patients treated with somatostatin (P<0.001. The tube removal time, the time to resumption of an oral diet, and the length of hospital stay after chylous leakage were significantly different between patients treated with and without somatostatin. The curative efficacies of the enteral nutrition (EN + MCT plan and the TPN plan were quite similar, with no significant difference, however, were significantly different from the MCT regime, which was the worst. However, using the EN + MCT plan was more cost-effective (P=0.038. Conclusion: In treating chylous ascites, EN + MCT instead of TPN was the best nutrition support

  12. COMPARATIVE STUDY OF HEMODYNAMIC STABILITY AND COST EFFECTIVENESS BETWEEN GENERAL AND SPINAL ANAESTHESIA IN PATIENTS AGE GROUP (0-5YEARS IN LOWER ABDOMINAL AND LOWER EXTREMITIES SURGERIES

    Directory of Open Access Journals (Sweden)

    Jaitawat

    2015-12-01

    Full Text Available BACKGROUND AND AIMS Aim of this study was to compare the changes in heart rate, blood pressure, oxygen saturation and cost effectiveness between general anaesthesia and spinal anaesthesia in pediatric patients undergoing lower abdominal and lower limb surgeries for the same duration. MATERIAL AND METHODS Fifty ASA1 patients in age group 0-5 years of either sex undergoing lower abdominal and lower limb surgeries were randomly divided in to two groups (Group-I GA group-n25 and Group-II SA group-n25. Group1 was given general anaesthesia and group-II was given spinal anaesthesia. Haemodynamic parameters and side effects during intra operative and immediate post-operative period were recorded and cost of GA and SA was calculated. RESULTS Patients in both the groups were comparable in surgical procedures and duration of surgery. Haemodynamically children in spinal group (Group-II remained more stable intra operatively and no untoward incidence was observed in group-II. Spinal Anaesthesia was much more cost effective as compared to general anaesthesia. CONCLUSION Pediatric spinal anaesthesia is a safe and effective anaesthetic technique for lower abdominal and lower limb surgeries. It is much more cost effective as compared to general anaesthesia.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    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 potentially....... 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...

  14. Comparative study of epidural bupivacaine with butorphanol and bupivacaine with tramadol for postoperative pain relief in abdominal surgeries

    Science.gov (United States)

    Swathi, N.; Ashwini, N.; Shukla, Mukesh I.

    2016-01-01

    Introduction: To compare the efficacy of combination of epidural local anesthetic with tramadol and butorphanol in major abdominal surgeries. Aims: To evaluate duration of analgesia, analgesic efficacy, and safety profile of two groups of drugs-epidural butorphanol with bupivacaine and epidural tramadol with bupivacaine. Materials and Methods: A prospective, randomized controlled, double-blinded study was undertaken in 50 patients scheduled for major abdominal surgeries. Group B received epidural butorphanol 2 mg + bupivacaine 0.125% first dose and subsequent doses, butorphanol 1 mg + bupivacaine 0.125% (total volume 10 ml). Group T received epidural tramadol 2 mg/kg + bupivacaine 0.125% first dose and subsequent doses, tramadol 1 mg/kg + bupivacaine 0.125% (total volume 10 ml). Observed parameters were the quality of analgesia, sedation, and hemodynamic parameters in the intra and post-operative period. Time for request of rescue analgesia was noted in all the patients. Continuous data are analyzed by Student's t-test using IBM SPSS software version 20. P ≤0.05 was considered to be statistically significant. P ≤ 0.001 was considered to be statistically highly significant. Results: Visual analog scale better with butorphanol group than tramadol (0.12 ± 0.332 and 0.84 ± 0.746 for Group B and Group T) at 30 min after first dose. Onset of action (8.44 ± 1.158 min in Group B and 12.80 ± 1.354 min in Group T) faster with butorphanol but duration of analgesia longer with tramadol (5.92 ± 0.76 h in Group B vs. 7.68 ± 0.76 h in Group T). Sedation was seen in patients with butorphanol group. Nausea and vomiting more frequent with tramadol group. Conclusions: Epidural tramadol with antiemetic is better than butorphanol for its longer duration in ambulatory surgery, elderly patients, obese patients, and suitable high-risk patients. PMID:27746533

  15. Factors Influencing Selection of Vaginal, Open Abdominal, or Robotic Surgery to Treat Apical Vaginal Vault Prolapse

    Science.gov (United States)

    Anand, Mallika; Weaver, Amy L.; Fruth, Kristin M.; Gebhart, John B.

    2016-01-01

    Objectives To determine factors influencing selection of Mayo-McCall culdoplasty (MMC), open abdominal sacrocolpopexy (ASC), or robotic sacrocolpopexy (RSC) for posthysterectomy vaginal vault prolapse. Methods We retrospectively searched for the records of patients undergoing posthysterectomy apical vaginal prolapse surgery between January 1, 2000, and June 30, 2012, at our institution. Baseline characteristics and explicit selection factors were abstracted from the electronic medical records. Factors were compared between groups using χ2 tests for categorical variables, ANOVA for continuous variables, and Kruskal-Wallis tests for ordinal variables. Results Among the 512 patients identified who met inclusion criteria, the MMC group (n=174) had more patients who were older, American Society of Anesthesiologists class 3+ or greater, had anterior vaginal prolapse grade 3+, desired to avoid abdominal surgery, and did not desire a functional vagina. Patients in the ASC (n=237) and RSC (n=101) groups had more failed prolapse surgeries, suspected abdominopelvic pathologic processes, and chronic pain. Advanced prolapse was more frequently cited as an explicit selection factor for ASC than for either MMC or RSC. Conclusions The most common factors that influenced the type of apical vaginal vault prolapse surgery overlapped with characteristics that differed at baseline. In general, MMC was chosen for advanced anterior vaginal prolapse and baseline characteristics that increased surgical risks, ASC for advanced apical prolapse, and ASC or RSC for recurrent prolapse, suspected abdominal pathology, and patients with chronic pain or lifestyles including heavy lifting. Thus, efforts should be made to attempt to control for selection bias when comparing these procedures. PMID:26945273

  16. Abdominal damage control surgery and reconstruction: world society of emergency surgery position paper

    OpenAIRE

    Godat, Laura; Kobayashi, Leslie; Costantini, Todd; Coimbra, Raul

    2013-01-01

    Abstract Damage control laparotomy was first described by Dr. Harlan Stone in 1983 when he suggested that patients with severe trauma should have their primary procedures abbreviated when coagulopathy was encountered. He recommended temporizing patients with abdominal packing and temporary closure to allow restoration of normal physiology prior to returning to the operating room for definitive repair. The term damage control in the trauma setting was coined by Rotondo et al., in 1993. ...

  17. Cardiopulmonary Effects of Constant-Rate Infusion of Lidocaine for Anesthesia during Abdominal Surgery in Goats.

    Science.gov (United States)

    Malavasi, Lais M; Greene, Stephen A; Gay, John M; Grubb, Tammy L

    2016-01-01

    Lidocaine is commonly used in ruminants but has an anecdotal history of being toxic to goats. To evaluate lidocaine's effects on selected cardiopulmonary parameters. Isoflurane-anesthetized adult goats (n = 24) undergoing abdominal surgery received a loading dose of lidocaine (2.5 mg/kg) over 20 min followed by constant-rate infusion of lidocaine (100 μg/kg/min); control animals received saline instead of lidocaine. Data collected at predetermined time points during the 60-min surgery included heart rate, mean arterial blood pressure, pO2, and pCO2. According to Welch 2-sample t tests, cardiopulmonary variables did not differ between groups. For example, after administration of the loading dose, goats in the lidocaine group had a mean heart rate of 88 ± 28 bpm, mean arterial blood pressure of 70 ± 19 mm Hg, pCO2 of 65 ± 13 mm Hg, and pO2 of 212 ± 99 mm Hg; in the saline group, these values were 90 ± 16 bpm, 76 ± 12 mm Hg, 61 ± 9 mm Hg, and 209 ± 83 mm Hg, respectively. One goat in the saline group required an additional dose of butorphanol. Overall our findings indicate that, at the dose provided, intravenous lidocaine did not cause adverse cardiopulmonary effects in adult goats undergoing abdominal surgery. Adding lidocaine infusion during general anesthesia is an option for enhancing transoperative analgesia in goats. PMID:27423150

  18. Transcutaneous electric acupoint stimulation at Jiaji points reduce abdominal pain after colonoscopy: a randomized controlled trial

    OpenAIRE

    Chen, Yanqing; Wu, Weilan; Yao, Yusheng; Yang, Yang; Zhao, Qiuyan; Qiu, Liangcheng

    2015-01-01

    Background: Transcutaneous electric acupoint stimulation (TEAS) at Jiaji acupuncture points has therapeutic potential for relieving viscera pain and opioid-related side effects. This prospective, randomized, triple-blinded, placebo-controlled trial was to investigate the efficacy of TEAS on abdominal pain after colonoscopy. Methods: Consecutive outpatients with American Society of Anesthesiologists (ASA) physical status I or II underwent selective colonoscopy were randomly assigned into two g...

  19. Health-related quality-of-life in patients after elective surgery for abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Ehlers, Lars Holger; Laursen, Kathrine Bang; Berg Jensen, Morten

    2011-01-01

    Purpose: The purpose of this study was to describe the health-related quality-of-life (QoL) in patients after elective surgery for abdominal aortic aneurysm (AAA) compared to a normal population and to study the association between QoL and number of years since surgery. Methods: All Danish men who...... underwent elective surgery for AAA at the age of 65 or more in the period from 1989–2007 in Denmark were invited to participate in the survey. Of 722 patients, 375 were alive and 328 (87%) responded. The nstruments EQ-5D (European Quality of life), EQ-VAS and SF-12 (Short Form Health Survey) were applied...... for measuring health-related QoL. Multiple regression analysis was used to study the association between QoL and number of years since AAA surgery. Results: A significantly poorer QoL was found in patients having had AAA surgery compared to the normal population as measured with the SF-12 and the EQ...

  20. Episodic arterial oxygen desaturation and heart rate variations following major abdominal surgery

    DEFF Research Database (Denmark)

    Rosenberg, J; Dirkes, W E; Kehlet, H

    1989-01-01

    In 20 patients undergoing elective major abdominal surgery, heart rate and arterial oxygen saturation were monitored continuously during the night 2 days before operation and during the first and second nights after operation (23:00 to 07:30). Mean heart rate increased by 16 beat min-1 (P less than...... arrhythmias on the morning of the third day after operation. In another patient the episodes of desaturation correlated with increases in heart rate. There was no correlation between administration of opioids and heart rate and saturation disturbances. The mechanism and clinical relevance of episodic...

  1. Effect of epidural blockade and oxygen therapy on changes in subcutaneous oxygen tension after abdominal surgery

    DEFF Research Database (Denmark)

    Rosenberg, J; Pedersen, U; Erichsen, C J;

    1994-01-01

    The effect of oxygen therapy (37% by face mask) and epidural local anesthetic blockade (9 ml 0.5% bupivacaine at Th9-11 level) on wound oxygenation was evaluated in eight otherwise healthy patients undergoing elective colorectal resection. The patients were monitored continuously for subcutaneous...... any of the measured values. Oxygen therapy before epidural blockade increased median subcutaneous oxygen tension from 60 to 71 mmHg (P oxygen tension with oxygen therapy was 30 (15-55) min...... without epidural blockade and 15 (10-20) min with blockade (P oxygen tension with or without oxygen therapy after elective uncomplicated major abdominal surgery....

  2. Linaclotide in Chronic Idiopathic Constipation Patients with Moderate to Severe Abdominal Bloating: A Randomized, Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Brian E Lacy

    Full Text Available Abdominal bloating is a common and bothersome symptom of chronic idiopathic constipation. The objective of this trial was to evaluate the efficacy and safety of linaclotide in patients with chronic idiopathic constipation and concomitant moderate-to-severe abdominal bloating.This Phase 3b, randomized, double-blind, placebo-controlled clinical trial randomized patients to oral linaclotide (145 or 290 μg or placebo once daily for 12 weeks. Eligible patients met Rome II criteria for chronic constipation upon entry with an average abdominal bloating score ≥5 (self-assessment: 0 10-point numerical rating scale during the 14-day baseline period. Patients reported abdominal symptoms (including bloating and bowel symptoms daily; adverse events were monitored. The primary responder endpoint required patients to have ≥3 complete spontaneous bowel movements/week with an increase of ≥1 from baseline, for ≥9 of 12 weeks. The primary endpoint compared linaclotide 145 μg vs. placebo.The intent-to-treat population included 483 patients (mean age=47.3 years, female=91.5%, white=67.7%. The primary endpoint was met by 15.7% of linaclotide 145 μg patients vs. 7.6% of placebo patients (P<0.05. Both linaclotide doses significantly improved abdominal bloating vs. placebo (P<0.05 for all secondary endpoints, controlling for multiplicity. Approximately one-third of linaclotide patients (each group had ≥50% mean decrease from baseline in abdominal bloating vs. 18% of placebo patients (P<0.01. Diarrhea was reported in 6% and 17% of linaclotide 145 and 290 μg patients, respectively, and 2% of placebo patients. AEs resulted in premature discontinuation of 5% and 9% of linaclotide 145 μg and 290 μg patients, respectively, and 6% of placebo patients.Once-daily linaclotide (145 and 290 μg significantly improved bowel and abdominal symptoms in chronic idiopathic constipation patients with moderate-to-severe baseline abdominal bloating; in particular

  3. Postoperative outcomes following preoperative inspiratory muscle training in patients undergoing open cardiothoracic or upper abdominal surgery: protocol for a systematic review

    Directory of Open Access Journals (Sweden)

    Mans Christina M

    2012-12-01

    Full Text Available Abstract Background In patients undergoing open cardiothoracic and upper abdominal surgery, postoperative pulmonary complications remain an important cause of postoperative morbidity and mortality, impacting upon hospital length of stay and health care resources. Adequate preoperative respiratory muscle strength may help protect against the development of postoperative pulmonary complications and therefore preoperative inspiratory muscle training has been suggested to be of potential value in improving postoperative outcomes. Methods/Design A systematic search of electronic databases will be undertaken to identify randomized trials of preoperative inspiratory muscle training in patients undergoing elective open cardiothoracic and upper abdominal surgery. From these trials, we will extract available data for a list of predefined outcomes, including postoperative pulmonary complications, hospital length of stay and respiratory muscle strength. We will meta-analyze comparable results where possible, and report a summary of the available pool of evidence. Discussion This review will provide the most comprehensive answer available to the question of whether preoperative inspiratory muscle training is clinically useful in improving postoperative outcomes in patients undergoing cardiothoracic and upper abdominal surgery. It will help inform clinicians working in the surgical arena of the likely effectiveness of instituting preoperative inspiratory muscle training programs to improve postoperative outcomes.

  4. Perioperative growth hormone treatment and functional outcome after major abdominal surgery

    DEFF Research Database (Denmark)

    Kissmeyer-Nielsen, Peter; Jensen, Martin Bach; Laurberg, Søren

    1999-01-01

    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...

  5. Orthostatic hypotension during postoperative continuous thoracic epidural bupivacaine-morphine in patients undergoing abdominal surgery

    DEFF Research Database (Denmark)

    Crawford, M E; Møiniche, S; Orbæk, Janne;

    1996-01-01

    Fifty patients undergoing colonic surgery received combined thoracic epidural and general anesthesia followed by continuous epidural bupivacaine 0.25% and morphine 0.05 mg/mL, 4 mL/h, for 96 h postoperatively plus oral tenoxicam 20 mg daily. Heart rate (HR) and arterial blood pressure (BP) were...... postoperatively compared with preoperatively (P Epidural infusion was discontinued in three patients due to either persisting resting or orthostatic hypotension. There was no correlation between ASA classification, intraoperative bleeding, or postoperative dizziness and incidence of orthostatic...... hypotension. The results suggest that patients undergoing abdominal surgery and treated with continuous small-dose thoracic epidural bupivacaine-morphine are subjected to a decrease of BP at rest and during mobilization, but not to an extent that seriously impairs ambulation in most patients....

  6. Outcomes of implementation of enhanced goal directed therapy in high-risk patients undergoing abdominal surgery

    Directory of Open Access Journals (Sweden)

    Lakshmi Kumar

    2015-01-01

    Full Text Available Background and Aims: Advanced monitoring targeting haemodynamic and oxygenation variables can improve outcomes of surgery in high-risk patients. We aimed to assess the impact of goal directed therapy (GDT targeting cardiac index (CI and oxygen extraction ratio (O 2 ER on outcomes of high-risk patients undergoing abdominal surgery. Methods: In a prospective randomised trial, forty patients (American Society of Anaesthesiologists II and III undergoing major abdominal surgeries were randomised into two groups. In-Group A mean arterial pressure ≥ 65 mmHg, central venous pressure ≥ 8-10 mmHg, urine output ≥ 0.5 mL/kg/h and central venous oxygen saturation ≥ 70% were targeted intra-operatively and 12 h postoperatively. In-Group-B (enhanced GDT, in addition to the monitoring in-Group-A, CI ≥ 2.5 L/min/m 2 and O 2 ER ≤ 27% were targeted. The end-points were lactate levels and base deficit during and after surgery. The secondary end points were length of Intensive Care Unit (ICU and hospital stay and postoperative complications. Wilcoxon Mann Whitney and Chi-square tests were used for statistical assessment. Results: Lactate levels postoperatively at 4 and 8 h were lower in-Group-B (P < 0.05. The mean base deficit at 3, 4, 5 and 6 h intra-operatively and postoperatively after 4, 8 and 12 h were lower in-Group-B (P < 0.05. There were no significant differences in ICU stay (2.10 ± 1.52 vs. 2.90 ± 2.51 days or hospital stay (10.85 + 4.39 vs. 13.35 + 6.77 days between Group A and B. Conclusions: Implementation of enhanced GDT targeting CI and OER was associated with improved tissue oxygenation.

  7. Optical design of a robotic TV camera probe for minimally invasive abdominal surgery

    Science.gov (United States)

    Todaro, Susanna; He, Weiyi; Killinger, Dennis

    2011-03-01

    Minimally invasive techniques are a promising new field of surgery; however, they limit the surgeon's access points and maneuverability. In order to increase the number of access points in minimally invasive abdominal surgery, a proposed implantable medical probe braces to the abdominal wall and provides illumination and video signal. The probe is cylindrical, about 25 mm long and 10 mm in diameter. A ring of LEDs on the end of the probe illuminates the tissue, and the resulting image is focused onto an HD video detector. It was necessary to apply beam-shaping reflectors to collimate the light onto a small target area, to avoid illuminating areas not picked up by the video. These reflectors were designed and simulated using the optical ray tracing software TracePro. Two LED chip geometries and three types of reflector geometries were analyzed, and the parameters for each geometry were optimized. For the straight-edged reflectors, the intensity patterns and optimization were compared to experimental results. Although parabolic reflectors produced the best collimation, cone reflectors with a 20-degree half-angle produced significant collimation at a much cheaper price. This work was supported by NSF REU program (award No DMR-1004873).

  8. Clinical significance of hepatic artery variations originating from the superior mesenteric artery in abdominal tumor surgery

    Institute of Scientific and Technical Information of China (English)

    HUANG Yuan; LIU Chao; LIN Jin-ling

    2013-01-01

    Background Hepatic artery variations are frequent clinical occurrences.The aim of this study was to investigate the characteristic course of variant hepatic arteries originating from the superior mesenteric artery for the purpose of providing instructions for abdominal tumor surgery.Methods The course of variant hepatic arteries originating from the superior mesenteric artery was studied in 400 patients with liver cancer confirmed by digital subtraction angiography (DSA) and multi-slice spiral computed tomography angiography (MSCTA),and 86 patients with gastric cancer confirmed by preoperative MSCTA between June 2008 and June 2010 in the First Affiliated Hospital of Guangxi Medical University.Results Hepatic artery variations originating from the superior mesenteric artery were noticed in 49 liver cancer patients and 14 gastric cancer patients (total 63 cases),with a variation rate of 12.96%,including two cases (3.17%) where the hepatic arteries ran along the anterior pancreas,and 61 cases (96.83%) where the hepatic arteries ran along the posterior pancreas.Conclusions Hepatic artery variations originating from the superior mesenteric artery present as two types:the pre-pancreas type and the post-pancreas type with the latter predominating.This finding is of clinical significance in abdominal tumor surgeries where clearance of portal lymph nodes is needed.

  9. Safety and Feasibility of Laparoscopic Abdominal Surgery in Patients With Mechanical Circulatory Assist Devices.

    Science.gov (United States)

    Ashfaq, Awais; Chapital, Alyssa B; Johnson, Daniel J; Staley, Linda L; Arabia, Francisco A; Harold, Kristi L

    2016-10-01

    Objectives Increasing number of mechanical circulatory assist devices (MCADs) are being placed in heart failure patients. Morbidity from device placement is high and the outcome of patients who require noncardiac surgery after, is unclear. As laparoscopic interventions are associated with decreased morbidity, we examined the impact of such procedures in these patients. Methods A retrospective review was conducted on 302 patients who underwent MCAD placement from 2005 to 2012. All laparoscopic abdominal surgeries were included and impact on postoperative morbidity and mortality studied. Results Ten out of 16 procedures were laparoscopic with 1 conversion to open. Seven patients had a HeartMate II, 2 had Total Artificial Hearts, and 1 had CentriMag. Four patients had devices for ischemic cardiomyopathy and 6 cases were emergent. Surgeries included 6 laparoscopic cholecystectomies, 2 exploratory laparoscopies, 1 laparoscopic colostomy takedown, and 1 laparoscopic ventral hernia repair with mesh. Median age of the patients was 63 years (range, 29-79 years). Median operative time was 123 minutes (range, 30-380 minutes). Five of 10 patients were on preoperative anticoagulation with average intraoperative blood loss of 150 mL (range, 20-700 mL). There were 3 postoperative complications; acute respiratory failure, acute kidney injury and multisystem organ failure resulting in death not related to the surgical procedure. Conclusion The need for noncardiac surgery in post-MCAD patients is increasing due to limited donors and due to more durable and longer support from newer generation assist devices. While surgery should be approached with caution in this high-risk group, laparoscopic surgery appears to be a safe and successful treatment option. PMID:26839214

  10. Hybrid procedure for a descending thoracic and subclavian artery aneurysm in a patient with previous abdominal aortic surgery: Case report

    OpenAIRE

    Radak Đorđe; Tanasković Slobodan; Unić-Stojanović Dragana; Jović Miomir; Babić Srđan; Sagić Dragan

    2015-01-01

    Introduction. Hybrid procedures represent staged or simultaneous endovascular and open surgical techniques in the treatment of complex pathologies of the thoracic and abdominal aorta. We are presenting a patient with previous abdominal aortic surgery in whom hybrid vascular procedure for descending aorta and left subclavian artery aneurysm was performed. Case Outline. A 63-year-old female patient was admitted for computed tomography angiography. Descending ...

  11. Application of negative pressure wound therapy in patients with wound dehiscence after abdominal open surgery: a single center experience

    OpenAIRE

    Jang, Ji Young; Shim, Hongjin; Lee, Yun Jin; Lee, Seung Hwan; Lee, Jae Gil

    2013-01-01

    Purpose Since the 1990's, negative pressure wound therapy (NPWT) has been used to treat soft tissue defects, burn wounds, and to achieve skin graft fixation. In the field of abdominal surgery, the application of NPWT is increasing in cases with an open abdominal wound requiring temporary wound closure and a second look operation. In the present study, the authors analyzed patients that underwent NPWT for postoperative wound dehiscence. Methods The computerized records of patients that had und...

  12. Effect of positive end-expiratory pressure on pulmonary shunt and dynamic compliance during abdominal surgery

    DEFF Research Database (Denmark)

    Spadaro, S.; Karbing, Dan Stieper; Mauri, T.;

    2016-01-01

    52 patients undergoing either laparotomy or laparoscopic surgery. Three levels of PEEP were applied in random order: (1) zero (ZEEP), (2) 5 cmH2O and (3) 10 cmH2O. Pulmonary shunt and ventilation/perfusion mismatch were assessed by the automatic lung parameter estimator system. RESULTS: Pulmonary......BACKGROUND: General anaesthesia decreases pulmonary compliance and increases pulmonary shunt due to the development of atelectasis. The presence of capnoperitoneum during laparoscopic surgery may further decrease functional residual capacity, promoting an increased amount of atelectasis compared...... of 10 cmH2O. Although laparoscopic surgery was associated with a lower pulmonary compliance, increasing levels of PEEP were able to ameliorate it in both groups. CONCLUSION: Both surgeries have similar negative effects on pulmonary shunt, while the presence of capnoperitoneum reduced only the...

  13. EFFICACY OF DEXMEDETOMIDINE AS AN ADJUVANT TO BUPIVACAINE FOR CAUDAL ANALGESIA IN PAEDIATRIC PATIENTS UNDERGOING LOWER ABDOMINAL SURGERIES

    Directory of Open Access Journals (Sweden)

    Vijay

    2014-07-01

    Full Text Available CONTEXT: Various adjuvants such as opioids or α2 agonists are being used to improve the quality and duration of caudal analgesia with local anesthetics. Dexmedetomidine a α2 agonist is used frequently in adult patients to enhance the local anesthetic effect. However there is little literature regarding its effectiveness in pediatric caudal analgesia. The objective of this study was to assess the efficacy of dexmedetomidine when used as an adjuvant to bupivacaine in increasing the duration of caudal analgesia. AIM: The aim of this study was to investigate the effect of adding Dexmedetomidine to caudal Bupivacaine and observe the effect on the duration of analgesia in the post-operative period. SETTINGS AND DESIGN: One year hospital based Double Blind Randomized Controlled Trial. METHODS AND MATERIAL: Sixty children, aged 1-6 years, undergoing lower abdominal surgeries were included in this prospective randomized double-blind study. The patients were randomly divided into two groups: Group I received Bupivacaine (0.25% 1ml/kg plus 1 ml of normal saline in the caudal epidural space. Group II was administered Bupivacaine (0.25% 1ml/ with Dexmedetomidine 2 mcg/ ml diluted to 1 ml of normal saline in the caudal epidural space. All anesthetic and surgical techniques were standardized. Heart rate, blood pressure, oxygen saturation, respiratory rate were monitored continuously. Surgery was started 10-15 minutes after the injection and confirming adequacy of caudal block. Duration of analgesia was assessed using FLACC scale (Face, Legs, Activity, Cry, Consolability scale. The time from administration of caudal anesthesia to the first time the FLACC score equal or greater than 4 was considered as the duration of caudal analgesia. Paracetamol suppository was used as rescue analgesia with a loading dose of 40mg/kg. STATISTICAL ANALYSIS: Mann-Whitney test and Student ‘t’test was used to compare the data obtained in the two groups. RESULTS: The

  14. Patterns of Brain Activation and Meal Reduction Induced by Abdominal Surgery in Mice and Modulation by Rikkunshito.

    Directory of Open Access Journals (Sweden)

    Lixin Wang

    Full Text Available Abdominal surgery inhibits food intake and induces c-Fos expression in the hypothalamic and medullary nuclei in rats. Rikkunshito (RKT, a Kampo medicine improves anorexia. We assessed the alterations in meal microstructure and c-Fos expression in brain nuclei induced by abdominal surgery and the modulation by RKT in mice. RKT or vehicle was gavaged daily for 1 week. On day 8 mice had no access to food for 6-7 h and were treated twice with RKT or vehicle. Abdominal surgery (laparotomy-cecum palpation was performed 1-2 h before the dark phase. The food intake and meal structures were monitored using an automated monitoring system for mice. Brain sections were processed for c-Fos immunoreactivity (ir 2-h after abdominal surgery. Abdominal surgery significantly reduced bouts, meal frequency, size and duration, and time spent on meals, and increased inter-meal interval and satiety ratio resulting in 92-86% suppression of food intake at 2-24 h post-surgery compared with control group (no surgery. RKT significantly increased bouts, meal duration and the cumulative 12-h food intake by 11%. Abdominal surgery increased c-Fos in the prelimbic, cingulate and insular cortexes, and autonomic nuclei, such as the bed nucleus of the stria terminalis, central amygdala, hypothalamic supraoptic (SON, paraventricular and arcuate nuclei, Edinger-Westphal nucleus (E-W, lateral periaqueduct gray (PAG, lateral parabrachial nucleus, locus coeruleus, ventrolateral medulla and nucleus tractus solitarius (NTS. RKT induced a small increase in c-Fos-ir neurons in the SON and E-W of control mice, and in mice with surgery there was an increase in the lateral PAG and a decrease in the NTS. These findings indicate that abdominal surgery inhibits food intake by increasing both satiation (meal duration and satiety (meal interval and activates brain circuits involved in pain, feeding behavior and stress that may underlie the alterations of meal pattern and food intake inhibition

  15. Fluid optimization with hydroxyethyl starch 130/0.4 compared with modified fluid gelatin guided by esophageal Doppler during major abdominal surgeries.

    Science.gov (United States)

    El-Fandy, Gehan G; Omar, Sohaila H; El-Desouky, Ayman A; Kamel, Hend H; Refaat, Ahmed I

    2014-04-01

    Perioperative fluid therapy has a direct bearing on patient outcome and accordingly should be tailored individually. Thus the efficacy of HES 130/0.4 was compared to modified fluid gelatin for volume expansion during major abdominal surgery guided by transesophageal Doppler (TED). Fifty adult patients ASA physical status I-II undergoing major abdominal surgery were anesthetized with standard technique. In addition to basal fluid requirement, patients were randomly allocated into two equal groups (25 patients each) to receive 200 cc of either 6% HES 130/0.4 (HES group) or 3% modified fluid gel (GEL group) as intraoperative colloid replacement guided by TED. Heart rate, mean arterial blood pressure, central venous pressure, and Doppler derived measurements were recorded at the following timings: T1; after induction, T2; after skin incision, T3; two hours after that and T4; at the end of surgery. Fluid administration and transfusion requirements were recorded. Laboratory tests for hemostasis, hepatic and renal functions were continued till the fifth postoperative day. Both groups were comparable regarding Doppler derived data and fluid balance. Platelet count showed a significant drop (p surgeries. HES 130/0.4 has a more favorable effect on platelet counts than modified gelatin.

  16. Effects of high-frequency current therapy on abdominal obesity in young women: a randomized controlled trial

    OpenAIRE

    Kim, Jin-seop; Oh, Duck-Won

    2015-01-01

    [Purpose] The aim of this study was to determine the effects of high-frequency current therapy on the abdominal obesity levels of young women. [Subjects] Twenty-two women with abdominal obesity were randomly allocated to either an experimental group (n 1 = 10) or a control group (n 2 = 12). [Methods] The experimental group subjects received high-frequency current therapy for the abdominal region 3 times per week for 6 weeks (a total of 18 sessions). Outcome measures were waist circumference, ...

  17. Prediction of Outcome After Emergency High-Risk Intra-abdominal Surgery Using the Surgical Apgar Score

    DEFF Research Database (Denmark)

    Cihoric, Mirjana; Toft Tengberg, Line; Bay-Nielsen, Morten;

    2016-01-01

    BACKGROUND: With current literature quoting mortality rates up to 45%, emergency high-risk abdominal surgery has, compared with elective surgery, a significantly greater risk of death and major complications. The Surgical Apgar Score (SAS) is predictive of outcome in elective surgery, but has never...... the incidence of both outcomes. Area under the curve was used to demonstrate the scores' discriminatory power. RESULTS: One hundred eighty-one (51.0%) patients developed minor or no complications. The overall incidence of major complications was 32.7% and the overall death rate was 16.3%. Risk of major...... been validated exclusively in an emergency setting. METHODS: A consecutive prospective single-center cohort study of 355 adults undergoing emergency high-risk abdominal surgery between June 2013 and May 2014 is presented. The primary outcome measure was 30-day mortality. Secondary outcome measures were...

  18. Characteristics of abdominal cavity drainage fluid in Chinese patients without postoperative complications after surgery for gastrointestinal or retroperitoneal tumors

    OpenAIRE

    Zhou, Jing

    2015-01-01

    Jing Zhou,1 Hongying Pi,2 Yingying Zheng1 1General Surgery, 2Nursing Department, Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of China Background: Abdominal cavity drainage fluid can be used as an early diagnostic tool of postoperative complications, and observing its characteristics can help us to judge and handle postoperative complications. There is no accurate standard reference range on its characteristics after surgeries for gastroi...

  19. Distal small bowel motility and lipid absorption in patients following abdominal aortic aneurysm repair surgery

    Institute of Scientific and Technical Information of China (English)

    Robert J Fraser; Paul Jury; John Dent; Marc Ritz; Addolorata C Di Matteo; Rosalie Vozzo; Monika Kwiatek; Robert Foreman; Brendan Stanley; Jack Walsh; Jim Burnett

    2006-01-01

    AIM: To investigate distal small bowel motility and lipid absorption in patients following elective abdominal aortic aneurysm (AAA) repair surgery.METHODS: Nine patients (aged 35-78 years; body mass index (BMI) range: 23-36 kg/m2) post-surgery for AAA repair, and seven healthy control subjects (20-50 years;BMI range: 21-29 kg/m2) were studied. Continuous distal small bowel manometry was performed for up to 72 h, during periods of fasting and enteral feeding (Nutrison(R)). Recordings were analyzed for the frequency,origin, length of migration, and direction of small intestinal burst activity. Lipid absorption was assessed on the first day and the third day post surgery in a subset of patients using the 13C-triolein-breath test, and compared with healthy controls. Subjects received a 20-min intraduodenal infusion of 50 mL liquid feed mixed with 200 μL 13C-triolein. End-expiratory breath samples were collected for 6 h and analyzed for 13CO2 concentration.RESULTS: The frequency of burst activity in the proximal and distal small intestine was higher in patients than in healthy subjects, under both fasting and fed conditions (P<0.005). In patients there was a higher proportion of abnormally propagated bursts (71% abnormal), which began to normalize by d 3 (25% abnormal) post-surgery.Lipid absorption data was available for seven patients on d 1 and four patients on d 3 post surgery. In patients,absorption on d 1 post-surgery was half that of healthy control subjects (AUC 13CO2 1323 ± 244 vs 2 646 ±365;P< 0.05, respectively), and was reduced to the one-fifth that of healthy controls by d 3 (AUC 13CO2 470 ± 832 vs 2646 ± 365; P< 0.05, respectively).CONCLUSION: Both proximal and distal small intestinal motor activity are transiently disrupted in critically ill patients immediately after major surgery,with abnormal motility patterns extending as far as the ileum. These motor disturbances may contribute to impaired absorption of enteral nutrition, especially when

  20. Validity and reliability of a pain location tool for pediatric abdominal surgery.

    Science.gov (United States)

    Hamill, James K; Cole, Alana M; Liley, Andrew; Hill, Andrew G

    2015-06-01

    For children with surgical problems, pain location conveys important clinical information. We developed a Location and Level of Intensity of Postoperative Pain (Lolipops) tool consisting of a body outline with a seven-sector abdominal grid, the International Association for the Study of Pain Revised Faces Pain Scale, and a recording chart. The aim of the study was to assess the validity and reliability of Lolipops. Children aged 5-14 years who had undergone laparoscopic appendectomy took both nurse- and investigator-administered Lolipops, and an investigator administered Varni Thompson Pediatric Pain Questionnaires, within 24 hours of surgery. The average age of the 42 participants was 10.7 years; 64% were boys; 24 (57.1%) had acute appendicitis, 13 (31%) had perforated appendicitis, and 5 (11.9%) were uninflamed. Pain scores were higher at the laparoscopic port incision sites than in upper abdominal sites distant from incisions or expected inflammation, mean (SD) 3.3 (2.3) and 1.1 (1.8), respectively (p pain scores were higher in the right iliac fossa than in upper abdominal sites, mean (SD) 3.3 (2.5) and 0.4 (0.7), respectively (p = .001). In children with perforated appendicitis, Lolipops demonstrated a more widespread pain pattern. Correlations between nurse and investigator were fair to moderate with an overall intraclass correlation coefficient of 0.597. This study presents a new tool to measure the location of pain in pediatric surgical patients and shows it to be valid and reliable.

  1. Aesthetic aspects of abdominal wall and external genital reconstructive surgery in bladder exstrophy-epispadias complex.

    Science.gov (United States)

    VanderBrink, Brian A; Stock, Jeffrey A; Hanna, Moneer K

    2006-03-01

    Long-term follow-up of patients born with classical bladder exstrophy-epispadias complex (EEC) reveals that many of them suffer from poor self-image, and the aesthetic aspects of the genitalia and lower abdomen acquire greater significance with age. In this article, we review the aesthetic outcomes in performing puboplasty, umbilicoplasty, and genitoplasty in patients born with EEC. Retrospective review of the cosmetic and functional outcomes in 116 patients born with EEC treated by puboplasty, umbilicoplasty, or genitoplasty was performed. Satisfaction with the cosmetic and functional outcomes of these three reconstructive surgeries was high following initial reconstructive efforts (> 90%). Attention to cosmesis during abdominal wall and genital reconstruction for EEC helps to improve a patient's perception of body image and self-esteem. Our experience with these procedures over the past 25 years demonstrated that the efforts directed toward aesthetics have been well worthwhile. PMID:16527001

  2. Damage control surgery in patient with delayed rupture of pseudoaneurysm after blunt abdominal trauma.

    Science.gov (United States)

    Park, Chan Yong; Ju, Jae Kyun; Kim, Jung Chul

    2012-08-01

    Delayed rupture of post-traumatic pseudoaneurysms of the visceral arteries, especially the pancreaticoduodenal artery, is uncommon. Here, we describe a 55-year-old man hemorrhaging from a pseudoaneurysm of the inferior pancreaticoduodenal artery (IPDA). Computed tomography of the abdomen showed active bleeding in the IPDA and large amounts of hemoperitoneum and hemoretroperitoneum. Selective mesenteric angiography showed that the pseudoaneurysm arose from the IPDA, and treatment by angioembolization failed because the involved artery was too tortuous to fit with a catheter. Damage control surgery with surgical ligation and pad packing was successfully performed. The patient had an uncomplicated postoperative course and was discharged 19 days after the operation. To our knowledge, this is the first report of ruptured pseudoaneurysm of an IPDA after blunt abdominal trauma from Korea. PMID:22880189

  3. EARLY SURGERY TO PATIENTS SUFFERING FULMINANT ACUTE PANCREATITIS WITH ABDOMINAL COMPARTMENT SYNDROME

    Institute of Scientific and Technical Information of China (English)

    YU Xiao; LI Yong-guo; CHEN Dao-jin; LI Xiao-rong; ZHANG Sheng-dao; LEI Ruo-qing; TANG Yao-qing

    2006-01-01

    Objective To retrospectively analyze and compare conservative versus surgical treatment of patients with fulminant acute pancreatitis (FAP) plus abdominal compartment syndrome (ACS). Methods From January 1998 to September 2005, 21 patients with FAP plus ACS were retrospectively analyzed. Ten patients were conservatively treated by means of intensive care medicine without surgery, and 11 patients received open surgical management and suction drainage. Results Seven of the 10 non-surgical patients died, comprising one with mild, four with moderate and two with severe ACS (70% mortality rate). Of the 11 patients receiving open surgical management in the early phase (within 3 days of disease initiation), three died, comprising one with moderate and two with severe ACS (27.3% mortality rate). The difference in mortality rates was found to be statistically significant. Conclusion Our data indicate patients suffering FAP with severe ACS should be treated with open management of the abdomen in the early phase (within 3 days), even in the absence of infection. This approach appears superior to that of conservative management. Surgical treatment resulted in abdominal decompression and subsequently significantly decreased the mortality rate and improved overall prognosis.

  4. Late Onset of CSF Rhinorrhea in a Postoperative Transsphenoidal Surgery Patient Following Robotic-Assisted Abdominal Hysterectomy

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    Justin T. Dowdy MD

    2014-01-01

    Full Text Available Cerebrospinal fluid (CSF leak is the most commonly encountered perioperative complication in transsphenoidal surgery for pituitary lesions. Direct closure with a combination of autologous fat, local bone, and/or synthetic grafts remains the standard of care for leaks encountered at the time of surgery as well as postoperatively. The development of the vascularized nasoseptal flap as a closure technique has increased the surgeon’s capacity to correct even larger openings in the dura of the sella as well as widely exposed anterior skull base defects. Yet these advances in the technical nuances for management of post-transsphenoidal CSF leak are useless without the ability to recognize a CSF leak by physical examination, clinical history, biochemical testing, or radiographic assessment. Here, we report a case of a patient who developed a CSF leak 28 years after transsphenoidal surgery, precipitated by a robotic-assisted hysterectomy during which increased intra-abdominal pressure and steep Trendelenberg positioning were both factors. Given the remote nature of the patient’s transsphenoidal surgery and relative paucity of data regarding such a complication, the condition went unrecognized for several months. We review the available literature regarding risk and pathophysiology of CSF leak following abdominal surgery and propose the need for increased vigilance in identification of such occurrences with the increasing acceptance and popularity of minimally invasive abdominal and pelvic surgeries as standards in the field.

  5. An Intra-Abdominal Pseudocyst around a Ventriculoperitoneal Shunt due to Streptococcus Infection 7 Years after Shunt Surgery

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    Arata Tomiyama

    2014-01-01

    Full Text Available In 1999, a 50-year-old woman underwent ventriculoperitoneal (VP shunt surgery for hydrocephalus after subarachnoid hemorrhage. She was hospitalized for fever and recurrent systemic seizures in November 2006. Head computed tomography (CT showed only old changes. The seizures and fever were controlled by medicinal therapy. However, in December, her consciousness level suddenly decreased, and she showed progressive lower abdominal distension. Head CT showed marked ventriculomegaly, and abdominal CT showed a giant cystic mass at the shunt-tube tip in the lower abdominal cavity. Because thick pus was aspirated from the intra-abdominal mass, we diagnosed the patient with acute obstructive hydrocephalus due to an infected abdominal pseudocyst. Laparotomy and direct cyst drainage were performed, and antibiotic therapy against Streptococcus, the causative pathogen, was administered. The VP shunt tube was replaced. The postoperative course was uneventful, and postoperative CT showed hydrocephalus improvement and no pseudocyst recurrence. Abdominal pseudocysts, which are rare after VP shunt surgeries, usually occur after the subacute postoperative course in younger cerebral hemorrhagic cases. Our case was quite rare because the cyst developed in the chronic phase in an older patient and was caused by streptococcal infection. The cyst components should be examined before cyst drainage when choosing surgical strategies.

  6. Evolution of transversus abdominis plane infiltration techniques for postsurgical analgesia following abdominal surgeries

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    Gadsden J

    2015-12-01

    Full Text Available Jeffrey Gadsden,1 Sabry Ayad,2 Jeffrey J Gonzales,3 Jaideep Mehta,4 Jan Boublik,5 Jacob Hutchins6,7 1Department of Anesthesiology, Duke University Medical Center, Durham, NC, 2Department of Anesthesiology and Pain Management, Cleveland Clinic, Cleveland, OH, 3Department of Anesthesiology, University of Colorado Hospital, Aurora, CO, 4Department of Anesthesiology, UT Health, The University of Texas Health Science Center at Houston, Houston, TX, 5Department of Anesthesiology, NYU Langone Medical Center – Hospital for Joint Diseases, New York, NY, 6Department of Anesthesiology, 7Department of Surgery, University of Minnesota, Minneapolis, MN, USA Abstract: Transversus abdominis plane (TAP infiltration is a regional anesthesia technique that has been demonstrated to be effective for management of postsurgical pain after abdominal surgery. There are several different clinical variations in the approaches used for achieving analgesia via TAP infiltration, and methods for identification of the TAP have evolved considerably since the landmark-guided technique was first described in 2001. There are many factors that impact the analgesic outcomes following TAP infiltration, and the various nuances of this technique have led to debate regarding procedural classification of TAP infiltration. Based on our current understanding of fascial and neuronal anatomy of the anterior abdominal wall, as well as available evidence from studies assessing local anesthetic spread and cutaneous sensory block following TAP infiltration, it is clear that TAP infiltration techniques are appropriately classified as field blocks. While the objective of peripheral nerve block and TAP infiltration are similar in that both approaches block sensory response in order to achieve analgesia, the technical components of the two procedures are different. Unlike peripheral nerve block, which involves identification or stimulation of a specific nerve or nerve plexus, followed by

  7. Impact of obesity on recovery and pulmonary functions of obese women undergoing major abdominal gynecological surgeries.

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    Moustafa, Ahmed A M; Abdelazim, Ibrahim A

    2016-06-01

    To determine impact of obesity on recovery parameters and pulmonary functions of women undergoing major abdominal gynecological surgeries. Eighty women undergoing major gynecological surgeries were included in this study. Anesthesia was induced by remifentanil bolus, followed by propofol and cisatracurium to facilitate oro-tracheal intubation and was maintained by balanced anesthesia of remifentanil intravenous infusion and sevoflurane in oxygen and air. Time from discontinuation of maintenance anesthesia to fully awake were recorded at 1-min intervals and time from discontinuation of anesthesia until patient was transferred to post-anesthesia care unit (PACU) and discharged from PACU was also recorded. Pulmonary function tests were performed before surgery and repeated 4 h, days 1, 2 and 3 post-operative for evaluation of forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate. Occurrence of post-operative complications, re-admission to ICU, hospital stay and morbidities were also recorded. Induction of anesthesia using remifentanil bolus injection resulted in significant decrease of heart rate and arterial pressures compared to pre-operative and pre-induction values. Recovery times were significantly shorter in obese compared to morbidly obese women. Post-operative pulmonary function tests showed significant deterioration compared to pre-operative measures but showed progressive improvement through first 3 post-operative days. Hospital stay was significantly shorter for obese compared to morbid obese women. Obesity delays recovery from general anesthesia, adversely affects pulmonary functions and increases post-operative complications. Remifentanil infusion and sevoflurane could be appropriate combination for obese and morbidly obese women undergoing major surgeries.

  8. Impact of obesity on recovery and pulmonary functions of obese women undergoing major abdominal gynecological surgeries.

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    Moustafa, Ahmed A M; Abdelazim, Ibrahim A

    2016-06-01

    To determine impact of obesity on recovery parameters and pulmonary functions of women undergoing major abdominal gynecological surgeries. Eighty women undergoing major gynecological surgeries were included in this study. Anesthesia was induced by remifentanil bolus, followed by propofol and cisatracurium to facilitate oro-tracheal intubation and was maintained by balanced anesthesia of remifentanil intravenous infusion and sevoflurane in oxygen and air. Time from discontinuation of maintenance anesthesia to fully awake were recorded at 1-min intervals and time from discontinuation of anesthesia until patient was transferred to post-anesthesia care unit (PACU) and discharged from PACU was also recorded. Pulmonary function tests were performed before surgery and repeated 4 h, days 1, 2 and 3 post-operative for evaluation of forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate. Occurrence of post-operative complications, re-admission to ICU, hospital stay and morbidities were also recorded. Induction of anesthesia using remifentanil bolus injection resulted in significant decrease of heart rate and arterial pressures compared to pre-operative and pre-induction values. Recovery times were significantly shorter in obese compared to morbidly obese women. Post-operative pulmonary function tests showed significant deterioration compared to pre-operative measures but showed progressive improvement through first 3 post-operative days. Hospital stay was significantly shorter for obese compared to morbid obese women. Obesity delays recovery from general anesthesia, adversely affects pulmonary functions and increases post-operative complications. Remifentanil infusion and sevoflurane could be appropriate combination for obese and morbidly obese women undergoing major surgeries. PMID:26072156

  9. Nutritional Risk Screening 2002 as a Predictor of Postoperative Outcomes in Patients Undergoing Abdominal Surgery: A Systematic Review and Meta-Analysis of Prospective Cohort Studies.

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    Zhen Sun

    Full Text Available The nutritional risk screening (NRS 2002 has been applied increasingly in patients who underwent abdominal surgery for nutritional risk assessment. However, the usefulness of the NRS 2002 for predicting is controversial. This meta-analysis was to examine whether a preoperative evaluation of nutritional risk by NRS 2002 provided prediction of postoperative outcomes in patients undergoing abdominal surgery.A systematic literature search for published papers was conducted using the following online databases: MEDLINE, EMBASE, the Cochrane library, EBSCO, CRD databases, Cinahl, PsycInfo and BIOSIS previews. The pooled odds ratio (OR or weight mean difference (WMD was calculated using a random-effect model or a fix-effect model.Eleven studies with a total of 3527 patients included in this study. Postoperative overall complications were more frequent in nutritional risk patients versus patients without nutritional risk (the pooled OR 3.13 [2.51, 3.90] p<0.00001. The pooled OR of mortality for the nutritional risk group and non-nutritional risk group was 3.61 [1.38, 9.47] (p = 0.009. Furthermore, the postoperative hospital stay was significant longer in the preoperative nutritional risk group than in the nutritional normal group (WMD 5.58 [4.21, 6.95] p<0.00001.The present study has demonstrated that patients at preoperative nutritional risk have increased complication rates, high mortality and prolonged hospital stay after surgery. However, NRS 2002 needs to be validated in larger samples of patients undergoing abdominal surgery by better reference method.

  10. Management of postoperative pain in abdominal surgery in Spain. A multicentre drug utilization study

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    Vallano, Antonio; Aguilera, Cristina; Arnau, Josep Maria; Baños, Josep-Eladi; Laporte, Joan-Ramon

    1999-01-01

    Participating centres: Hospital Universitario San Juan, Alicante: Maria Jesús Olaso, Javier Agulló, Clara Faura. Hospital Torrecárdenas, Almería: Carmen Fernández Sánchez, Miguel Lorenzo Campos, Juan Manuel Rodríguez Alonso. Hospital Quirúrgic Adriano, Barcelona: Carmen Alerany Pardo, Paquita Alvarez González, Teresa Martín Benito. Hospital Universitari del Mar-IMIM, Barcelona: Magí Farré, Maite Terán. Corporació Sanitària Parc Taulí, Sabadell: Montserrat Cañellas, Sergio Zavala, Josep Planell. Hospital Universitari de la Santa Creu i Sant Pau: Gonzalo Calvo, Rosa Morros, Silvia Mateo. Hospital General Vall d’Hebron, Barcelona: Carmen Bosch, María José Martínez. Hospital Universitario Virgen de la Victoria, Málaga: Maribel Lucena, José Antonio González, Gabriel Carranque. Hospital Clínico Universitario San Carlos, Madrid: Emilio Vargas, Amparo Gil López-Oliva, Míriam García Mateos. Hospital Universitario Marqués de Valdecilla, Santander: Mario González, Antonio Cuadrado. Hospital Universitario Virgen de la Macarena, Sevilla: Juan Antonio Durán, Pilar Máyquez, María Isabel Serrano. Hospital Universitario Virgen del Rocío, Sevilla: Jaume Torelló, Juan Ramón Castillo, María de las Nieves Merino. Aims Postoperative pain is common in hospital-admitted patients. Its management is determined by different therapeutic traditions and by the attitudes of health professionals in each hospital. The aim of this study was to describe the patterns of prescription and administration of analgesic drugs used for postoperative pain after abdominal surgery in Spanish hospitals, to know the prevalence and the severity of postoperative pain, and to determine the extent of variability in the management of postoperative pain among the participating centres. Methods The study was a multicentre descriptive cross-sectional drug utilization study in 12 Spanish hospitals. The subjects were an unselected sample of consecutive patients undergoing abdominal

  11. Efeitos de duas técnicas de incentivo respiratório na mobilidade toracoabdominal após cirurgia abdominal alta Effects of two respiratory incentive techniques on chest wall mobility after upper abdominal surgery

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    Maria Elaine Trevisan

    2010-12-01

    Full Text Available A cirurgia abdominal alta está associada a um risco elevado de complicações pulmonares que podem ser reduzidas pelo uso criterioso de manobras terapêuticas visando a expansão pulmonar. O objetivo foi comparar duas técnicas de incentivo respiratório na recuperação da dinâmica toracoabdominal em pacientes submetidos à cirurgia abdominal alta. O grupo de estudo experimental foi constituído por 16 pacientes internados na Clínica Cirúrgica do Hospital Universitário de Santa Maria distribuídos aleatoriamente em dois grupos: o grupo 1 foi constituído por dez pacientes que usaram o dispositivo Voldyne e o grupo 2, por seis pacientes submetidos ao padrão ventilatório com inspiração fracionada em três tempos. A expansibilidade toracoabdominal foi avaliada por cirtometria antes da cirurgia e no 1º, 3º¸ e 5º dias do pós-operatório (PO. Observou-se redução significativa dos valores de cirtometria no 1º PO que, gradualmente, foram sendo recuperados, não mais havendo diferença significativa no 5o PO em relação aos valores pré-operatórios em ambos os grupos. O grupo 1 obteve significativamente melhores índices de recuperação da mobilidade toracoabdominal do que o grupo 2. Também o tempo de recuperação do grupo 1 atingiu médias mais elevadas durante todo o período de PO investigado. Embora ambas as técnicas utilizadas fossem efetivas, o incentivo inspiratório por meio do Voldyne mostrou melhores resultados na recuperação da expansibilidade pulmonar após cirurgia abdominal alta.Upper abdominal surgery is associated to increased risk of pulmonary complications, which may be lessened by judicious use of therapeutic maneuvers aimed at lung expansion. The purpose here was to compare two respiratory incentive techniques on recovery of thoracic-abdominal dynamics in patients having undergone upper abdominal surgery. Sixteen patients in such condition were randomly divided into group 1 (n=10, who did respiratory training

  12. PREEMPTIVE PREGABLIN: EFFICACY ON POSTOPERATIVE PAIN RELIEF AND OPIOID SPARING IN LOWER ABDOMINAL SURGERIES

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    Mohamed

    2015-01-01

    Full Text Available OBJECTIVES : We aimed to evaluate the preemptive analgesic properties of pregabalin, an anticonvulsant drug used in clinical practice for the treatment of neuropathic pain. METHOD S : This study was performed on 40 patients from ASA I - II risk group aged 18 - 60 years which underwent lower abdominal surgeries. Group I received 300 mg pregabalin and Group II was given a placebo in oral capsule form. Visual analog scale (VAS scores, morphine consumption and side effects of all patients were recorded at 1, 4, 8, 12 and 24 hour s postoperatively. When Aldrette recovery score reached 9, morphine 0.75mcg/kg was given as rescue analgesia. RESULTS : There was no difference observed in the first analgesic requirement time values between the two groups (p>0.05. A statistically signific ant decrease was observed in the VAS scores of the pregabalin group at 1, 4, 12 and 24 hours after surgery (p0.05. CONCLUSION : Our study demonstrated that a 300 mg pregabalin administered preoperatively is an ef ficient and safe agent for preemptive analgesia. Premedication with pregabalin reduces postoperative pain scores and total analgesic consumption without increasing sedation or other side effects in the postoperative period.

  13. Prosthetic abdominal wall hernia repair in emergency surgery: from polypropylene to biological meshes

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    Campanelli G

    2008-12-01

    Full Text Available Abstract The use of nonabsorbable prosthetic materials such as polypropylene, polyester, and ePTFE, have expanded and are now widely used in reparative surgery for abdominal wall hernias. There are still difficulties to find correct indication for prosthetic implant in emergency hernia surgery: as a matter of fact there is still a great debate if to use non-absorbable prostheses in potentially or truly infected operating fields [e.g. after intestinal resections]. All these problems can be avoided with the use of absorbable prosthetic materials such as those composed of lactic acid polymers or lactic and glycolic acid copolymers: however, the use of these absorbable prosthesis exposes the patient to a rapid and inevitable hernia recurrence. It is important to remember that prosthetic repair has been proven to have a significant less risk of recurrence than repair with direct sutures. Recently, new "biologic" prosthetic materials have been developed and proposed for the clinical use in infected fields. These materials can be called "remodeling" for the way by which they are replaced after their placement within the patient. The "remodeling" process is made possible through a process of incorporation, where a reproduction of a site-specific tissue similar to the original host tissue is created.

  14. Prevention of abdominal wound infection (PROUD trial, DRKS00000390: study protocol for a randomized controlled trial

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    Heger Ulrike

    2011-11-01

    Full Text Available Abstract Background Wound infection affects a considerable portion of patients after abdominal operations, increasing health care costs and postoperative morbidity and affecting quality of life. Antibacterial coating has been suggested as an effective measure to decrease postoperative wound infections after laparotomies. The INLINE metaanalysis has recently shown the superiority of a slowly absorbable continuous suture for abdominal closure; with PDS plus® such a suture has now been made available with triclosan antibacterial coating. Methods/Design The PROUD trial is designed as a randomised, controlled, observer, surgeon and patient blinded multicenter superiority trial with two parallel groups and a primary endpoint of wound infection during 30 days after surgery. The intervention group will receive triclosan coated polydioxanone sutures, whereas the control group will receive the standard polydioxanone sutures; abdominal closure will otherwise be standardized in both groups. Statistical analysis is based on intention-to-treat population via binary logistic regression analysis, the total sample size of n = 750 is sufficient to ensure alpha = 5% and power = 80%, an interim analysis will be carried out after data of 375 patients are available. Discussion The PROUD trial will yield robust data to determine the effectiveness of antibacterial coating in one of the standard sutures for abdominal closure and potentially lead to amendment of current guidelines. The exploration of clinically objective parameters as well as quality of life holds immediate relevance for clinical management and the pragmatic trial design ensures high external validity. Trial Registration The trial protocol has been registered with the German Clinical Trials Register (DRKS00000390.

  15. Relationships betveen pain intensity and heart rate variability in patients after abdominal surgery: a pilot study

    Institute of Scientific and Technical Information of China (English)

    CHANG Ling-hua; MA Tso-chiang; TSAY Shiow-luan; JONG Gwo-ping

    2012-01-01

    Background A link between postoperative pain intensity and heart rate variability (HRV) had not been well established.This study aimed to investigate the correlation between post-operative pain intensity and HRV.Methods The subjects in this cross-sectional correlation study comprised of patients who had undergone abdominal surgery in a regional teaching hospital in central Taiwan during the period July 2009-November 2009.The visual analogue scale (VAS) and the short-form McGill pain questionnaire (SF-MPQ) were used to measure post-operative pain.HRV was measured as the standard deviation of normal RR interval,and by power spectral analysis that included high frequency (HF),low frequency (LF),very low frequency power,and LF/HF ratio.Results Atotal of 34 subjects were included in this study.We found that the day after the surgery,the mean VAS score was 47.50±20.98 and the mean SF-MPQ score was 18.06±8.90,indicating a moderate degree of pain.Moderate to severe degrees of tenderness were reported by 70.6% of the patients,moderate to severe degrees of gnawing pain were experienced by 67.7% of the patients,moderate to severe degrees of tiring-exhaustion pain were reported by 64.7% of the patients,and 41.2% of the patients who experienced moderate to severe pain believed that the pain was punishing-cruel.The standard deviation of normal RR interval and high frequency values obtained from male patients or married patients were higher than female patients or unmarried (P <0.05).The correlation of the standard deviation of normal RR interval,high frequency,very low frequency value and patient's age were negative (p <0.05).The total SF-MPQ pain scores positively correlated with the LF/HF ratio (P <0.05).Conclusions The multidimensional pain assessment tool (SF-MPQ) reflects better the patients' post-operative pain than the single-dimensional assessment tool (VAS).HRV positively correlated with SF-MPQ scores in patients after abdominal surgery.

  16. Diode laser surgery versus scalpel surgery in the treatment of fibrous hyperplasia: a randomized clinical trial.

    Science.gov (United States)

    Amaral, M B F; de Ávila, J M S; Abreu, M H G; Mesquita, R A

    2015-11-01

    Fibrous hyperplasia is treated by surgical incision using a scalpel, together with removal of the source of chronic trauma. However, scalpel techniques do not provide the haemostasis that is necessary when dealing with highly vascular tissues. Diode laser surgery can be used in the management of oral tissues due to its high absorption by water and haemoglobin, and has provided good results in both periodontal surgery and oral lesions. The aim of the present study was to compare the effects of diode laser surgery to those of the conventional technique in patients with fibrous hyperplasia. A randomized clinical trial was performed in which surgical and postoperative evaluations were analyzed. On comparison of the laser-treated (study group) patients to those treated with a scalpel (control group), significant differences were observed in the duration of surgery and the use of analgesic medications. Over a 3-week period, clinical healing of the postoperative wound was significantly faster in the control group as compared to the study group. In conclusion, diode laser surgery proved to be more effective and less invasive when compared to scalpel surgery in the management of fibrous hyperplasia. However, wound healing proved to be faster when using scalpel surgery.

  17. Emergent endovascular vs. open surgery repair for ruptured abdominal aortic aneurysms: a meta-analysis.

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    Chuan Qin

    Full Text Available OBJECTIVES: To systematically review studies comparing peri-operative mortality and length of hospital stay in patients with ruptured abdominal aortic aneurysms (rAAAs who underwent endovascular aneurysm repair (EVAR to patients who underwent open surgical repair (OSR. METHODS: The Medline, Cochrane, EMBASE, and Google Scholar databases were searched until Apr 30, 2013 using keywords such as abdominal aortic aneurysm, emergent, emergency, rupture, leaking, acute, endovascular, stent, graft, and endoscopic. The primary outcome was peri-operative mortality and the secondary outcome was length of hospital stay. RESULTS: A total of 18 studies (2 randomized controlled trials, 5 prospective studies, and 11 retrospective studies with a total of 135,734 rAAA patients were included. rAAA patients who underwent EVAR had significantly lower peri-operative mortality compared to those who underwent OSR (overall OR = 0.62, 95% CI = 0.58 to 0.67, P<0.001. rAAA patients with EVAR also had a significantly shorter mean length of hospital stay compared to those with OSR (difference in mean length of stay ranged from -2.00 to -19.10 days, with the overall estimate being -5.25 days (95% CI = -9.23 to -1.26, P = 0.010. There was no publication bias and sensitivity analysis showed good reliability. CONCLUSIONS: EVAR confers significant benefits in terms of peri-operative mortality and length of hospital stay. There is a need for more randomized controlled trials to compare outcomes of EVAR and OSR for rAAA.

  18. A multicenter,phase III trial of hemocoagulase Agkistrodon:hemostasis,coagulation,and safety in patients undergoing abdominal surgery

    Institute of Scientific and Technical Information of China (English)

    WEI Jun-min; LI Jie; XU Jing-yong; ZHENG Qing-shan; ZHU Ming-wei; ZHANG Zhong-tao; JIA Zhen-geng; HE Xiao-dong; WAN Yuan-lian; WANG Shan; XIU Dian-rong; TANG Yun

    2010-01-01

    Background Hemocoagulase Agkistrodon for injection is a single component thrombin which has passed phases I and II clinical trials. The purpose of this phase III clinical trial was to evaluate the effect of Hemocoagulase Agkistrodon on hemostasis and coagulation in abdominal skin and subcutaneous incisions and to assess the safety of this agent in surgical patients. Methods This is a phase III, prospective, randomized, double-blind, and controlled multicenter clinical trial including 432 consecutive patients randomized into either a study group (injected with hemocoagulase Agkistrodon at 2 U, n=324) or a control group (injected with hemocoagulase Atrox, n=108). The hemostatic time, hemorrhagic volume, hemorrhagic volume per unit area, blood coagulation, and adverse events were measured and compared between the two groups. Results The mean hemostatic time in the study group was (36.8±18.7) seconds; the hemorrhagic volume was (3.77±3.93) g; and the hemorrhagic volume per unit area was (0.091±0.125) g/cm~2. In the control group, the corresponding values were (38.1±19.7) seconds, (4.00±4.75) g, and (0.095±0.101) g/cm~2, respectively. No significant difference in values existed between the two groups (P >0.05). Blood coagulation results and hepatic and renal function were also similar between the two groups. Adverse events were reported in two cases, but were deemed non-drug-related. Conclusions Hemocoagulase Agkistrodon has good hemostatic and coagulative function and is safe for the use of arresting capillary hemorrhage that occurs while incising the abdomen during surgery.

  19. Melatonin reduces cardiac morbidity and markers of myocardial ischemia after elective abdominal aortic aneurism repair: a randomized, placebo-controlled, clinical trial.

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    Gögenur, Ismail; Kücükakin, Bülent; Panduro Jensen, Leif; Reiter, Russel J; Rosenberg, Jacob

    2014-08-01

    The aim was to examine the effect of perioperative melatonin treatment on clinical cardiac morbidity and markers of myocardial ischemia in patients undergoing elective surgery for abdominal aortic aneurism. Reperfusion injury results in increased cardiac morbidity in patients undergoing surgery for abdominal aortic aneurisms (AAA). A randomized, placebo-controlled, clinical trial including patients undergoing surgery for AAA was performed. The patients received by infusion over a 2-hr period either, 50 mg melatonin or placebo intra-operatively, and 10 mg melatonin or placebo orally, the first three nights after surgery. Postoperative cardiac morbidity was registered, and blood samples for analysis of troponin-I (TpI) were collected preoperatively, and at 5 min, 6, 24, 48, 72, and 96 hr after clamp removal/recirculation of the first leg. Continuous measurement of ST-segment depression was performed by Holter monitoring. A total of 26 patients received melatonin, while 24 received placebo. A significant reduction in cardiac morbidity was seen in the melatonin-treated patients compared with those given placebo [4% versus 29% (P = 0.02)]. Five patients (19%) who received melatonin had increased TpI levels in the postoperative period compared with 12 patients (50%) who were given placebo (P = 0.036). The median number of ST-segment deviations was less in the melatonin-treated patients compared with the placebo group [median 1 (range 0-4) versus 6 (range 0-13) (P = 0.01)], but no differences were found in the duration of ST-segment deviations. Melatonin treatment in the perioperative period decreased clinical cardiac morbidity as well as the occurrence of myocardial ischemia after abdominal aortic aneurism repair. PMID:24708480

  20. Benefits of immediate jejunostomy feeding after major abdominal trauma--a prospective, randomized study.

    Science.gov (United States)

    Moore, E E; Jones, T N

    1986-10-01

    Benefits of immediate postinjury nutritional support remain ill defined. Seventy-five consecutive patients undergoing emergent celiotomy with an abdominal trauma index (A.T.I.) greater than 15 were randomized prospectively to a control group (no supplemental nutrition during first 5 days) or enteral-fed group. The enteral patients had a needle catheter jejunostomy (N.C.J.) placed at laparotomy with the constant infusion of an elemental diet (Vivonex HN) begun at 18 hours and advanced to 3,000 ml/day (3,000 kcal, 20 gm N2) within 72 hours. Control and enteral-fed groups were comparable with respect to demographic features, trauma mechanism, shock, colon injury, splenectomy, A.T.I., and initial nutritional assessment. Twenty (63%) of the enteral patients were maintained on the elemental diet greater than 5 days; four (12%) needed total parenteral nutrition (T.P.N.). Nine (29%) of the control patients required T.P.N. Nitrogen balance was markedly improved (p less than 0.001) in the enteral-fed group. Although visceral protein markers and overall complication rate were not significantly different, septic morbidity was greater (p less than 0.025) in the control group (abdominal infection in seven and pneumonia in two) compared to the enteral-fed patients (abdominal abscess in three). Analysis of patients with A.T.I. 15-40 disclosed sepsis in seven (26%) of the control versus one (4%) of the enteral-fed group (p less than 0.01). Our clinical experience demonstrates the feasibility of immediate postoperative enteral feeding via N.C.J. after major abdominal trauma, and suggests this early nutrition reduces septic complications in critically injured patients. PMID:3095557

  1. Pharmacokinetics and pharmacodynamics of propofol in patients undergoing abdominal aortic surgery.

    Science.gov (United States)

    Wiczling, Paweł; Bienert, Agnieszka; Sobczyński, Paweł; Hartmann-Sobczyńska, Roma; Bieda, Krzysztof; Marcinkowska, Aleksandra; Malatyńska, Maria; Kaliszan, Roman; Grześkowiak, Edmund

    2012-01-01

    Available propofol pharmacokinetic protocols for target-controlled infusion (TCI) were obtained from healthy individuals. However, the disposition as well as the response to a given drug may be altered in clinical conditions. The aim of the study was to examine population pharmacokinetics (PK) and pharmacodynamics (PD) of propofol during total intravenous anesthesia (propofol/fentanyl) monitored by bispectral index (BIS) in patients scheduled for abdominal aortic surgery. Population nonlinear mixed-effect modeling was done with Nonmem. Data were obtained from ten male patients. The TCI system (Diprifusor) was used to administer propofol. The BIS index served to monitor the depth of anesthesia. The propofol dosing was adjusted to keep BIS level between 40 and 60. A two-compartment model was used to describe propofol PK. The typical values of the central and peripheral volume of distribution, and the metabolic and inter-compartmental clearance were V(C) = 24.7 l, V(T) = 112 l, Cl = 2.64 l/min and Q = 0.989 l/min. Delay of the anesthetic effect, with respect to plasma concentrations, was described by the effect compartment with the rate constant for the distribution to the effector compartment equal to 0.240 min(-1). The BIS index was linked to the effect site concentrations through a sigmoidal E(max) model with EC(50) = 2.19 mg/l. The body weight, age, blood pressure and gender were not identified as statistically significant covariates for all PK/PD parameters. The population PK/PD model was successfully developed to describe the time course and variability of propofol concentration and BIS index in patients undergoing surgery.

  2. ANALYSIS OF CLINICAL OUTCOME OF EFFECT OF CHEWING GUM ON BOWEL MOTILITY IN POST - OPERATIVE PATIENTS FOLLOWING ABDOMINAL SURGERY

    Directory of Open Access Journals (Sweden)

    Vicky

    2015-04-01

    Full Text Available INTRODUCTION : One very important complication of abdominal surgeries is postoperative ileus which results in severe patient discomfort, prolonged hospitalization, and enhanced treatment cost. This study was conducted with an aim to analyze the clinical outcome of effe ct of chewing gum mainly to avoid post - operative paralytic ileus in post - operative patients of abdominal surgeries . MATERIAL AND METHODS : In this study total 200 patients were included, 100 were cases and remaining were controls. The cases were given chewing gum to chew after the surgery while the controls were allowed to heal without chewing gums in conventional style and both were observed hourly for clinical outcome. RESULTS : Among cases the mean duration of first sound heard was 26.3 hours while am ong controls this was 38.8 hours [p<0.001], the mean duration of first flatus passed among cases was 50.7 hours while that among controls was 68.5 hours, the mean duration of first Bowel passed among cases was 92.4 hours while that among controls was 128.3 hours [p<0.001]. On comparing cases of routine with emergency surgeries, gastric with small bowel surgeries, and traumatic with pathological bowel surgeries it was observed that the first bowel sound, first flatus and first bowel passed appears significan tly earlier in routine surgeries, gastric surgeries and traumatic surgeries respectively. CONCLUSIONS: It was observed that chewing gum has significant effect over bowel motility as bowel sounds appeared significantly earlier in cases than control and tim e for first flatus passed and first bowel passed were also noted significantly earlier in cases than controls. Hospital stay of cases were found significantly lesser than control hence simple intervention like chewing can decrease the burden of disease of paralytic ileus from community.

  3. [Anomalies of the subrenal inferior vena cava in the surgery of non-specific and inflammatory abdominal aortic aneurysms].

    Science.gov (United States)

    Gargiulo, M; Stella, A; Caputo, M; Brusori, S; Pedrini, L; Tarantini, S; Curti, T

    1993-01-01

    The sub-renal abnormalities of the lower vena cava (LVC) (left LVC, double LVC) are determined by a deterioration of the alteration process of supra-cardinal veins. Though they are rare, it is necessary to look for them during surgery of abdominal aorta in order to lower the risk of iatrogenic venous injuries. You will find below the description of six cases of sub-renal lower vena cava abnormality (3 double LVC, 3 left LVC) associated with an abdominal aorta aneurism (4 non specific aneurisms, 2 inflammations ones) as well as the diagnostic aspects and the technical issues they cause during the reconstruction of a non specific and inflammation aneurism of the abdominal aorta. PMID:8248315

  4. The use of methylene blue in abdominal aortic surgery: a case report.

    Science.gov (United States)

    Piraccini, E; Agnoletti, V; Corso, R; Maitan, S; Gambale, G

    2010-01-01

    The open abdominal aortic surgery includes a well-known phase in which arterial blood flow is stopped by occluding clamps, resulting in peculiar physiologic changes usually superimposed on advanced pathologic conditions. An anesthetic plan should aim at providing hemodynamic stability and preserving organ function. Clamp removal leads to an acute fall in blood pressure following a decrease in systemic vascular resistance, caused by reactive hyperemia due to opening of the previously minimally perfused vascular beds. Several different mediators, including the nitrous oxide (NO) pathway, have been thought to be responsible for this hemodynamic effect. The massive production of NO by the inducible isoform of NO synthase could be partially responsible for the profound vasodilatation and myocardial dysfunction. The dye methylene blue (MB) has been used as to prevent vasodilatation in other clinical situations like sepsis, cardiopulmonary bypass and liver transplantation. We describe its use in a patient with poor hemodynamic status, who was submitted to aortic aneurism repair with infrarenal cross clamp. The intervention was also associated with a severe bleeding. In this case MB allowed us to control hypotension with relatively low doses of vasopressors. PMID:23440623

  5. El papel de la laparoscopia en la cirugía abdominal urgente The role of laparoscopy in emergency abdominal surgery

    Directory of Open Access Journals (Sweden)

    E. Balén

    2005-01-01

    Full Text Available La urgencia abdominal también puede ser intervenida mediante abordaje laparoscópico: el planteamiento puede ser de laparoscopia diagnóstica, cirugía asistida por laparoscopia o laparotomía dirigida según los hallazgos de la laparoscopia. Las contraindicaciones generales se refieren sobre todo al estado de inestabilidad hemodinámica del paciente y a pacientes graves (ASA IV. En ausencia de contraindicación específica para el procedimiento laparoscópico concreto a realizar, muchas enfermedades abdominales que requieren cirugía urgente pueden realizarse con abordaje laparoscópico. Las indicaciones más frecuentes son la apendicitis, la colecistitis aguda, la perforación gastroduodenal, la oclusión de intestino delgado, y algunos traumas abdominales. Con una correcta selección de pacientes y la oportuna experiencia del cirujano, los resultados son excelentes, y mejoran la cirugía abierta (menos infección de herida, complicaciones, estancia hospitalaria y dolor postoperatorio. Se explican con detalle los aspectos básicos de la técnica quirúrgica en los procedimientos más frecuentes de laparoscopia de urgencia.Abdominal emergencies can also be operated on through the laparoscopic approach: the approach can be diagnostic laparoscopy, surgery assisted by laparoscopy or laparotomy directed according to the findings of the laparoscopy. The general contraindications refer above all to the state of haemodynamic instability of the patient and to seriously ill patients (ASA IV. In the absence of any specific counter-indications for the specific laparoscopic procedure to be carried out, many abdominal diseases requiring emergency surgery can be performed with the laparoscopic approach. The most frequent indications are appendicitis, acute colecistitis, gastroduodenal perforation, occlusion of the small intestine, and some abdominal traumas. With a correct selection of patients and the appropriate experience of the surgeon, the results are

  6. Perioperative lung-protective ventilation strategy reduces postoperative pulmonary complications in patients undergoing thoracic and major abdominal surgery

    OpenAIRE

    Park, Sang-Heon

    2016-01-01

    The occurrence of postoperative pulmonary complications is strongly associated with increased hospital mortality and prolonged postoperative hospital stays. Although protective lung ventilation is commonly used in the intensive care unit, low tidal volume ventilation in the operating room is not a routine strategy. Low tidal volume ventilation, moderate positive end-expiratory pressure, and repeated recruitment maneuvers, particularly for high-risk patients undergoing major abdominal surgery,...

  7. Changes in total plasma and serum N-glycome composition and patient-controlled analgesia after major abdominal surgery

    Science.gov (United States)

    Gudelj, Ivan; Baciarello, Marco; Ugrina, Ivo; De Gregori, Manuela; Napolioni, Valerio; Ingelmo, Pablo M.; Bugada, Dario; De Gregori, Simona; Đerek, Lovorka; Pučić-Baković, Maja; Novokmet, Mislav; Gornik, Olga; Saccani Jotti, Gloria; Meschi, Tiziana; Lauc, Gordan; Allegri, Massimo

    2016-01-01

    Systemic inflammation participates to the complex healing process occurring after major surgery, thus directly affecting the surgical outcome and patient recovery. Total plasma N-glycome might be an indicator of inflammation after major surgery, as well as an anti-inflammatory therapy response marker, since protein glycosylation plays an essential role in the inflammatory cascade. Therefore, we assessed the effects of surgery on the total plasma N-glycome and the association with self-administration of postoperative morphine in two cohorts of patients that underwent major abdominal surgery. We found that plasma N-glycome undergoes significant changes one day after surgery and intensifies one day later, thus indicating a systemic physiological response. In particular, we observed the increase of bisialylated biantennary glycan, A2G2S[3,6]2, 12 hours after surgery, which progressively increased until 48 postoperative hours. Most changes occurred 24 hours after surgery with the decrease of most core-fucosylated biantennary structures, as well as the increase in sialylated tetraantennary and FA3G3S[3,3,3]3 structures. Moreover, we observed a progressive increase of sialylated triantennary and tetraantennary structures two days after surgery, with a concomitant decrease of the structures containing bisecting N-acetylglucosamine along with bi- and trisialylated triantennary glycans. We did not find any statistically significant association between morphine consumption and plasma N-glycome. PMID:27501865

  8. Glove failure in elective thyroid surgery: A prospective randomized study

    Directory of Open Access Journals (Sweden)

    Dariusz Timler

    2015-06-01

    Full Text Available Objectives: To analyze perforation rate in sterile gloves used by surgeons in the operating theatre of the Department of Endocrinological and General Surgery of Medical University of Lodz. Material and Methods: Randomized and controlled trial. This study analyses the incidents of tears in sterile surgical gloves used by surgeons during operations on 3 types of thyroid diseases according to the 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10 codes. Nine hundred seventy-two pairs (sets of gloves were collected from 321 surgical procedures. All gloves were tested immediately following surgery using the water leak test (EN455-1 to detect leakage. Results: Glove perforation was detected in 89 of 972 glove sets (9.2%. Statistically relevant more often glove tears occurred in operator than the 1st assistant (p < 0.001. The sites of perforation were localized mostly on the middle finger of the non-dominant hand (22.5%, and the non-dominant ring finger (17.9%. Conclusions: This study has proved that the role performed by the surgeon during the procedure (operator, 1st assistant has significant influence on the risk of glove perforations. Nearly 90% of glove perforations are unnoticed during surgery.

  9. Evaluation of guided imagery as treatment for recurrent abdominal pain in children: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Shapiro Daniel E

    2006-11-01

    Full Text Available Abstract Background Because of the paucity of effective evidence-based therapies for children with recurrent abdominal pain, we evaluated the therapeutic effect of guided imagery, a well-studied self-regulation technique. Methods 22 children, aged 5 – 18 years, were randomized to learn either breathing exercises alone or guided imagery with progressive muscle relaxation. Both groups had 4-weekly sessions with a therapist. Children reported the numbers of days with pain, the pain intensity, and missed activities due to abdominal pain using a daily pain diary collected at baseline and during the intervention. Monthly phone calls to the children reported the number of days with pain and the number of days of missed activities experienced during the month of and month following the intervention. Children with ≤ 4 days of pain/month and no missed activities due to pain were defined as being healed. Depression, anxiety, and somatization were measured in both children and parents at baseline. Results At baseline the children who received guided imagery had more days of pain during the preceding month (23 vs. 14 days, P = 0.04. There were no differences in the intensity of painful episodes or any baseline psychological factors between the two groups. Children who learned guided imagery with progressive muscle relaxation had significantly greater decrease in the number of days with pain than those learning breathing exercises alone after one (67% vs. 21%, P = 0.05, and two (82% vs. 45%, P Conclusion The therapeutic efficacy of guided imagery with progressive muscle relaxation found in this study is consistent with our present understanding of the pathophysiology of recurrent abdominal pain in children. Although unfamiliar to many pediatricians, guided imagery is a simple, noninvasive therapy with potential benefit for treating children with RAP.

  10. Nutritional Risk Screening 2002 as a Predictor of Postoperative Outcomes in Patients Undergoing Abdominal Surgery: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

    OpenAIRE

    Zhen Sun; Xin-Juan Kong; Xue Jing; Run-Jun Deng; Zi-Bin Tian

    2015-01-01

    Background The nutritional risk screening (NRS 2002) has been applied increasingly in patients who underwent abdominal surgery for nutritional risk assessment. However, the usefulness of the NRS 2002 for predicting is controversial. This meta-analysis was to examine whether a preoperative evaluation of nutritional risk by NRS 2002 provided prediction of postoperative outcomes in patients undergoing abdominal surgery. Methods A systematic literature search for published papers was conducted us...

  11. [Abdominal compartment syndrome in video laparoscopic surgery. Etiopathogenetic aspects, physiopathology and personal experience].

    Science.gov (United States)

    Alberti, A; Giannetto, G; Littori, F; Di Marco, D; Dattola, P; Dattola, A; Basile, M

    1998-01-01

    The abdominal compartment syndrome (ACS) is a very seven pathology, consequence oh abdominal injuries and traumatism, acute pancreatitis, aortic aneurism rupture, acute peritonitis. The etiopatogenesis is the increase of intra-abdominal pressure with systemic consequences for cardiorespiratory and renal failure. The authors after careful physiopathologic consideration, describe, a case report of ACS in the laparoscopic cholecystectomy for acute cholecystitis. To conclusion, we report very important the accurate intraoperative monitoring of vital parameters (PCO2, PO2, Pa, Fc, PVC, Ph, Diuresis) and immediate decision at laparotomic conversion for abdominal decompression. PMID:11762082

  12. Clinical evaluation of sivelestat for acute lung injury/acute respiratory distress syndrome following surgery for abdominal sepsis

    Directory of Open Access Journals (Sweden)

    Tsuboko Y

    2012-10-01

    Full Text Available Yoshiaki Tsuboko,1 Shinhiro Takeda,1,2 Seiji Mii,1 Keiko Nakazato,1 Keiji Tanaka,2 Eiji Uchida,3 Atsuhiro Sakamoto11Department of Anesthesiology, Nippon Medical School, 2Intensive Care Unit and Cardiac Care Unit, Nippon Medical School Hospital, 3Department of Surgery, Nippon Medical School, Tokyo, JapanBackground: The efficacy of sivelestat in the treatment of acute lung injury/acute respiratory distress syndrome (ALI/ARDS has not been established. In part, this is due to the wide variety of factors involved in the etiology of ALI/ARDS. In this study, we examined the efficacy of sivelestat in patients with ALI/ARDS associated with abdominal sepsis.Methods: The subjects were 49 patients with ALI/ARDS after surgery for abdominal sepsis. The efficacy of sivelestat was retrospectively assessed in two treatment groups, ie, a sivelestat group (n = 34 and a non-sivelestat group (n = 15.Results: The sivelestat group showed significant improvements in oxygenation, thrombocytopenia, and multiple organ dysfunction score. The number of ventilator days (6.6 ± 6.1 versus 11.1 ± 8.4 days; P = 0.034 and length of stay in the intensive care unit (8.5 ± 6.2 versus 13.3 ± 9.5 days; P = 0.036 were significantly lower in the sivelestat group. The hospital mortality rate decreased by half in the sivelestat group, but was not significantly different between the two groups.Conclusion: Administration of sivelestat to patients with ALI/ARDS following surgery for abdominal sepsis resulted in early improvements of oxygenation and multiple organ dysfunction score, early ventilator weaning, and early discharge from the intensive care unit.Keywords: sivelestat, acute lung injury, acute respiratory distress syndrome, abdominal sepsis

  13. Vecuronium and fentanyl requirement in abdominal surgery under combined epidural-general anaesthesia and general anaesthesia alone.

    Science.gov (United States)

    Hossain, M; Hoq, M F; Rahman, M S; Yeasmeen, S; Ahmed, A; Huda, M R; Rahman, M M

    2012-01-01

    Individual effect of epidural block and general anaesthesia is well established in the field of anaesthesiology. But adequate literature is yet not available to give decisive answer regarding the requirement of muscle relaxants and opioid analgesic when the two methods are combined together. In the present study, sixty patients, aged 18-50 years of both sexes with ASA (American Society of Anesthesiologists) grading I and II scheduled to undergo for major abdominal surgery were assigned randomly into two groups (30 in each group), where Group A received general anesthesia and Group B received combined epidural-general anesthesia. The patients with combined technique, epidural catheter tip were placed between T9-10. Ten ml of 0.125% bupivacaine was administered through the epidural catheter. Peripheral nerve stimulator was used to monitor neuromuscular transmission and subsequently to administer incremental dose of neuromuscular blocking drugs. All the patients were pre-medicated with fentanyl (2μg/kg) to reduce intubation reflex. Then the patients of both groups were pre-oxygenated for 3 minute and anaesthesia was induced with thiopental sodium 3-5 mg/kg body weight. Endotrachial intubation was facilitated by vecuronium 0.1mg/kg body weight. Anaesthesia was maintained with 60% N2O in O2 and halothane (0.4 to 0.8%). Fentanyl was given in incremental dose of 0.5 μg/kg to maintain an adequate analgesia. The vecuronium was given at the dose of 0.02 mg/kg, when TOF return to 25% of the base line. The mean±SD requirement of vecuronium in general anaesthesia group was 0.0016±0.00013 mg/kg/min and whereas in combined epidural-general anaesthesia, it was 0.0011±0.00014 mg/kg/min. The requirement of fentanyl was 0.71μg/kg/hr in general anaesthetic group whereas in combined group it was 0.31μg/kg/hr. These findings prompt us to place optimal dosing guidelines so as to avoid overdosing and thus delay recovery and help to get the excellent outcome of the surgery.

  14. A comparative study of intrathecal ropivacaine with fentanyl and L-bupivacaine with fentanyl in lower abdominal and lower limb surgeries

    Directory of Open Access Journals (Sweden)

    Prem Swarup Vampugalla

    2015-12-01

    Conclusion: This study revealed that the intrathecal ropivacaine with fentanyl provided adequate anesthesia for lower abdominal and lower limb surgeries. Ropivacaine achieved a shorter duration of sensory and motor blockade, and a lesser degree of motor blockade when compared to L-bupivacaine. Thus, ropivacaine was justified for short duration ambulatory surgeries of lower abdominal and lower limb surgeries. Furthermore, fentanyl as an adjuvant to both ropivacaine and L-bupivacaine enhanced the duration of the sensory block. Hence, ropivacaine with fentanyl in spinal anesthesia for lower abdominal and lower limb surgeries is a better alternative compared to L-bupivacaine with fentanyl favoring day care ambulatory surgeries. [Int J Basic Clin Pharmacol 2015; 4(6.000: 1147-1155

  15. Abdominal sounds

    Science.gov (United States)

    ... during sleep. They also occur normally for a short time after the use of certain medicines and after abdominal surgery. Decreased or absent bowel sounds often indicate constipation. Increased ( hyperactive ) bowel sounds ...

  16. Germ cells may survive clipping and division of the spermatic vessels in surgery for intra-abdominal testes

    DEFF Research Database (Denmark)

    Thorup, J M; Cortes, D; Visfeldt, J

    1999-01-01

    of the biopsies taken at stage 2 was slightly lower (0.03) compared to the median number at stage 1 (0.06) of the operation but this difference was not significant (p = 0.2031). CONCLUSIONS: Our study shows that the spermatogonia may survive clipping and division of the spermatic vessels, although the number......PURPOSE: Laparoscopy is a well described modality that provides an accurate visual diagnosis upon which further management of intra-abdominal testes may be based. Laparoscopic ligation of spermatic vessels as stage 1 of the procedure is a natural extension of laparoscopy. A staged approach provides...... studied 17 nonpalpable testes in 10 patients 1 year and 7 months to 13(1/2) years old. Results of testicular biopsies of 13 intra-abdominal testes taken at stages 1 and 2 of surgery were available for histological comparison. RESULTS: Median number of spermatogonia per tubular cross section...

  17. Early oral feeding after elective abdominal surgery--what are the issues?

    DEFF Research Database (Denmark)

    Bisgaard, Thue; Kehlet, Henrik

    2002-01-01

    This review analyzes the literature and the historical concerns (restrictions, traditions, nasogastric tube) and pathophysiologic factors (postoperative ileus, risk of anastomotic dehiscence, nausea and vomiting, loss of appetite) invoked for not instituting early oral feeding after major abdominal...

  18. Does mechanical massage of the abdominal wall after colectomy reduce postoperative pain and shorten the duration of ileus? Results of a randomized study.

    Science.gov (United States)

    Le Blanc-Louvry, Isabelle; Costaglioli, Bruno; Boulon, Catherine; Leroi, Anne-Marie; Ducrotte, Philippe

    2002-01-01

    The aim of this study was to determine the effectiveness of mechanical abdominal massage on postoperative pain and ileus after colectomy. We hypothesized that parietal abdominal stimulation could counteract induced pain and postoperative ileus, through common spinal-sensitive pathways, with nociceptive visceral messages. After preoperative randomization, 25 patients (age 52 +/- 5 years) underwent active mechanical massage by intermittent negative pressure on the abdominal wall resulting in aspiration (Cellu M50 device, LPG, Valence, France), and 25 patients (age 60 +/- 6 years) did not receive active mechanical massage (placebo group). Massage sessions began the first day after colectomy and were performed daily until the seventh postoperative day. In the active-massage group, amplitude and frequency were used, which have been shown to be effective in reducing muscular pain, whereas in the placebo group, ineffective parameters were used. Visual analogue scale (VAS) pain scores, doses of analgesics (propacetamol), and delay between surgery and the time to first passage of flatus were assessed. Types and dosages of the anesthetic drugs and the duration of the surgical procedure did not differ between groups. From the second and third postoperative days, respectively, VAS pain scores (P < 0.001) and doses of analgesics (P < 0.05) were significantly lower in patients receiving active massage compared to the placebo group. Time to first passage of flatus was also significantly shorter in the active-massage group (1.8 +/- 0.3 days vs. 3.6 +/- 0.4 days, P < 0.01). No adverse effects were observed. These results suggest that mechanical massage of the abdominal wall may decrease postoperative pain and ileus after colectomy. PMID:11986017

  19. Multivariate analysis of perioperative risk factors associated with postoperative pulmonary complications in elder patients undergoing upper abdominal surgery

    Directory of Open Access Journals (Sweden)

    Wen-bing LI

    2011-06-01

    Full Text Available Objective To explore the correlation between the perioperative risk factors and postoperative pulmonary complications(POPC in elder patients undergoing upper abdominal surgery.Methods A retrospective survey of 169 elder patients(age over 60 years,received elective upper abdominal surgery under general anesthesia from Jan.1,2006 to Jan.1,2010 was conducted.The perioperative factors influencing respiratory function were evaluated,including clinical manifestations,chest X-ray,pulmonary function,arterial blood gas analysis,duration of anesthesia,incision type,duration of nasogastric tube and ambulation time.Meanwhile,the relationship between POPC and the factors mentioned above was analyzed.Results POPC were seen to occur in 77 of the 169 patients(45.6%,and the most common complication was pneumonia(20 cases,followed by atelectasis(18 cases,tracheobronchitis or acute exacerbations of chronic bronchitis(17 cases,bronchospasm(15 cases,acute respiratory failure(5 cases and pulmonary embolism(2 cases.Multivariate logistic analysis showed that the postoperative nasogastric intubation,preoperative respiratory symptoms,decreased forced expiratory volume in 1st second/forced vital capacity(FEV1/FVC and longer duration of anesthesia were the valuable risk factors for prediction of POPC.Conclusions It is recommend that a detailed preoperative pulmonary examination and pulmonary function test in elder patients who are going to have upper abdominal surgery should be done to identify the risk for POPC.Preoperative intervention therapy may be helpful to improve pulmonary function,decrease the incidence of POPC and lower mortality of the patients.

  20. Perioperative lung-protective ventilation strategy reduces postoperative pulmonary complications in patients undergoing thoracic and major abdominal surgery

    Science.gov (United States)

    2016-01-01

    The occurrence of postoperative pulmonary complications is strongly associated with increased hospital mortality and prolonged postoperative hospital stays. Although protective lung ventilation is commonly used in the intensive care unit, low tidal volume ventilation in the operating room is not a routine strategy. Low tidal volume ventilation, moderate positive end-expiratory pressure, and repeated recruitment maneuvers, particularly for high-risk patients undergoing major abdominal surgery, can reduce postoperative pulmonary complications. Facilitating perioperative bundle care by combining prophylactic and postoperative positive-pressure ventilation with intraoperative lung-protective ventilation may be helpful to reduce postoperative pulmonary complications. PMID:26885294

  1. Comparison of polydioxanone (PDS and polyamid (nylon sutures complications in abdominal midline repair (laparotomy surgery

    Directory of Open Access Journals (Sweden)

    F.Eshghi

    2006-01-01

    Full Text Available Background and purpose: Despite progresss in the techniques of surgery, there is still a lot of controversy about selection of the best technique and suture material. Many post operation complications such as infection, wound dehiscence, pain and sinus formation are related to the type of the suture used. In this study we compared the complications due to the absorbent suture (PDS with a non absorbent suture (nylon in laparotomy operation.Materials and Methods: This clinical trial was performed on 120 patients referring to Imam Khomeini hospital, Sari, 2003-2005 for laparotomy. They were randomly divided in tow groups of equal number. The incision was repaired with PDS sutures in case and with nylon suture in control group. All patients under study were followed up for one year. Data about chronic pain,wound dehiscence, infection, hernia and sinus formation were recorded and analyzed using SPSS software and Chi- square test.Results: In this study 120 patients (60 in case and 60 in control groups were enrolled. After laparotomy, the incidence of chronic pain and sinus formation in case group was significantly less than the control group. There were no significant differences between the rate of infection, hernia and wound dehiscence in the two groups.Conclusion: No significant differences in the rate of infection, hernia and wound dehiscence between two types of suture materials were observed. However, application of PDS leads to less pain and sinus formation. Therefore, it can be a better choice in surgical incisions.

  2. The Predictive Nursing Strategy and Result Analysis of Reducing Postoperative Abdominal Distension After Thoracolumbar Surgery%减少胸腰椎术后腹胀的预见性护理策略及其成效

    Institute of Scientific and Technical Information of China (English)

    王月红

    2016-01-01

    Based on the analysis of the causes of postoperative abdominal distention for patients with thoracolumbar fractures,a targeted nursing strategy is adopted to reduce the incidence of postoperative abdominal distension after thoracolumbar surgery.72 patients of thoracolumbar fractures are selected, and they are randomly divided into conventional nursing group and predictive nursing group.The con-ventional nursing group adopts orthopaedic conventional nursing methods,while the predictive nursing group uses targeted nursing methods to prevent postoperative abdominal distention.Comparing the inci-dence of abdominal distension in the two groups,we find out that predictive nursing methods can effec-tively reduce postoperative abdominal distension after thoracolumbar surgery and effectively improve the patients'quality of life after thoracolumbar surgery.%分析引起胸腰椎骨折患者术后腹胀的原因,采用有针对性的预见性护理策略,降低胸腰椎术后腹胀的发生率。选取胸腰椎骨折患者72例,随机分成常规护理组和预见性护理组。常规护理组采用骨科常规护理方法;预见性护理组采用预防术后腹胀针对性护理方法。通过对两组患者腹胀发生情况的比较发现,采用预见性护理措施对于减少胸腰椎术后腹胀的效果明显,可有效提高胸腰椎骨折患者术后的生活质量。

  3. Breathing exercises in upper abdominal surgery: a systematic review and meta-analysis Exercícios respiratórios em cirurgia abdominal alta: revisão sistemática e metanálise

    Directory of Open Access Journals (Sweden)

    Samantha T. Grams

    2012-10-01

    Full Text Available BACKGROUND: There is currently no consensus on the indication and benefits of breathing exercises for the prevention of postoperative pulmonary complications PPCs and for the recovery of pulmonary mechanics. OBJECTIVE: To undertake a systematic review of randomized and quasi-randomized studies that assessed the effects of breathing exercises on the recovery of pulmonary function and prevention of PCCs after upper abdominal surgery UAS. METHOD: Search Strategy: We searched the Physiotherapy Evidence Database PEDro, Scientific Electronic Library Online SciELO, MEDLINE, and Cochrane Central Register of Controlled Trials. Selection Criteria: We included randomized controlled trials and quasi-randomized controlled trials on pre- and postoperative UAS patients, in which the primary intervention was breathing exercises without the use of incentive inspirometers. Data Collection and Analysis: The methodological quality of the studies was rated according to the PEDro scale. Data on maximal respiratory pressures MIP and MEP, spirometry, diaphragm mobility, and postoperative complications were extracted and analyzed. Data were pooled in fixed-effect meta-analysis whenever possible. RESULTS: Six studies were used for analysis. Two meta-analyses including 66 participants each showed that, on the first day post-operative, the breathing exercises were likely to have induced MEP and MIP improvement treatment effects of 11.44 mmH2O (95%CI 0.88 to 22 and 11.78 mmH2O (95%CI 2.47 to 21.09, respectively. CONCLUSION: Breathing exercises are likely to have a beneficial effect on respiratory muscle strength in patients submitted to UAS, however the lack of good quality studies hinders a clear conclusion on the subject.

  4. Postoperative nutrition practices in abdominal surgery patients in a tertiary referral hospital Intensive Care Unit: A prospective analysis

    Directory of Open Access Journals (Sweden)

    Tejaswini Arunachala Murthy

    2016-01-01

    Full Text Available Background: Benefit of early enteral feeds in surgical patients admitted to Intensive Care Units (ICUs has been emphasized by several studies. Apprehensions about anastomotic leaks in gastrointestinal surgical patients prevent initiation of early enteral nutrition (EN. The impact of these practices on outcome in Indian scenario is less studied. Aims: This study compares the impact of early EN (within 48 h after surgery with late EN (48 h postsurgery on outcomes in abdominal surgical ICU patients. Settings and Design: Postabdominal surgery patients admitted to a tertiary referral hospital ICU over a 2-year period were analyzed. Methods: Only patients directly admitted to ICU after abdominal surgery were included in this study. ICU stay>3 days was considered as prolonged; with average ICU length of stay (LOS for this ICU being 3 days. The primary outcome was in-patient mortality. ICU LOS, hospital LOS, infection rates, and ventilator days were secondary outcome measures. Acute Physiology and Chronic Health Evaluation II scores were calculated. SPSS and Microsoft Excel were used for analysis. Results: Of 91 ICU patients included, 58 received early EN and 33 late EN. Hospital LOS and infection rates were less in early EN group. Use of parenteral nutrition (odds ratio [OR] 5.25, 95% confidence interval (CI; P = 0.003 and number of nil-per-oral days (OR 8.25, 95% CI; P ≤ 0.001 were other predictors of prolonged LOS. Conclusions: Early EN in postabdominal surgery ICU patients was associated with reduced hospital LOS and infection rates. ICU LOS, duration of mechanical ventilation and mortality rates did not vary.

  5. Hybrid procedure for a descending thoracic and subclavian artery aneurysm in a patient with previous abdominal aortic surgery: Case report

    Directory of Open Access Journals (Sweden)

    Radak Đorđe

    2015-01-01

    Full Text Available Introduction. Hybrid procedures represent staged or simultaneous endovascular and open surgical techniques in the treatment of complex pathologies of the thoracic and abdominal aorta. We are presenting a patient with previous abdominal aortic surgery in whom hybrid vascular procedure for descending aorta and left subclavian artery aneurysm was performed. Case Outline. A 63-year-old female patient was admitted for computed tomography angiography. Descending aorta aneurysm (7.6 cm as well as aneurysm of the left subclavian artery (LSA was noted. Eight years ago she underwent abdominal aortic aneurysm resection and aortoiliac bypass. Standard TEVAR (thoracic endovascular aortic repair procedure couldn’t be done due to small dimensions of previous “Y” graft (12.6 mm, so first we did LSA transposition and after three days hybrid procedure. After “Y” graft exposure, anastomosis between the corps of “Y” graft and tubular graft 10 mm was created and through this conduit thoracic stent-graft was placed followed by complete “Y” graft replacement. After 6 months angiography showed regular postoperative findings. Conclusion. Combined surgical and endovascular procedures in thoracic aorta pathology treatment could be useful solutions with favorable outcome. [Projekat Ministarstva nauke Republike Srbije, br. 41002

  6. Computed tomography prospective study of pleural-pulmonary changes after abdominal surgery : assessment of associated risk factors; Estudo prospectivo por tomografia computadorizada das alteracoes pleuro-pulmonares apos cirurgia abdominal: avaliacao dos fatores de risco associados

    Energy Technology Data Exchange (ETDEWEB)

    Rossi, Luis Antonio [Pontificia Univ. Catolica de Sao Paulo, SP (Brazil). Centro de Ciencias Medicas e Biologicas]. E-mail: luizrossimd@uol.com.br; Bromberg, Sansom Henrique [Instituto de Assistencia Medica ao Servidor Publico Estadual de Sao Paulo (IAMSPE), Sao Paulo, SP (Brazil). Curso de Pos-graduacao em Gastroenterologia Cirurgica

    2005-07-01

    Postoperative pleural-pulmonary changes (PPC) are very common following elective abdominal surgery, resolving without clinical manifestations in most patients. The incidence and risk factors associated are unknown. Objective: to determine the incidence of PPC and possible association with risk factors using computerized tomography (CT). Material and method: thirty seven patients submitted to elective abdominal surgery were prospectively analyzed using CT performed in the preoperative period and 48 hours after surgery. The PPC was scored from 0 to III. The risk factors evaluated were: age, sex, obesity, smoking history, alcoholism, comorbid conditions, cancer, ASA classification, duration of surgery, surgical incision type and number of days of hospitalization. Results: Pleura effusion was detected by CT in 70.3% (26/37) of the patients and pulmonary atelectasis in 75.5% (28/37). Grade I and II PPC was found in 59.5% (22/37) of the patients and grade III in 21.6% (8/37). Two (5.4%) of these patients developed serious pulmonary complications whereas one patient died. Surgery due to cancer, class ASA >2, longitudinal incision and > 15 cm showed statistical significance and were associated with pleural effusion. The hospitalization was over 2.4 longer for patients with PPC. Conclusion: PPC is frequently seen in patients submitted to abdominal surgery. The use of the CT for the detection of pulmonary atelectasis and pleural effusion proved to be effective. Most cases of PPC are self-limited, resolving without symptoms. (author)

  7. A randomized study of combining maze surgery for atrial fibrillation with mitral valve surgery

    NARCIS (Netherlands)

    Jessurun, ER; Van Hemel, NM; Defauw, JJ; De La Riviere, AB; Stofmeel, MAM; Kingma, JH; Ernst, JMPG

    2003-01-01

    Aim Mitral valve surgery seldom suppresses atrial fibrillation (AF), present prior to surgery. Maze III surgery eliminates AF in >80% of cases, the reason why combining this procedure with mitral valve surgery in patients with AF seems worthwhile. We prospectively studied the outcome of combining th

  8. Perioperative glutamine supplementation restores disturbed renal arginine synthesis after open aortic surgery: a randomized controlled clinical trial.

    Science.gov (United States)

    Brinkmann, Saskia J H; Buijs, Nikki; Vermeulen, Mechteld A R; Oosterink, Efraim; Schierbeek, Henk; Beishuizen, Albertus; de Vries, Jean-Paul P M; Wisselink, Willem; van Leeuwen, Paul A M

    2016-09-01

    Postoperative renal failure is a common complication after open repair of an abdominal aortic aneurysm. The amino acid arginine is formed in the kidneys from its precursor citrulline, and citrulline is formed from glutamine in the intestines. Arginine enhances the function of the immune and cardiovascular systems, which is important for recovery after surgery. We hypothesized that renal arginine production is diminished after ischemia-reperfusion injury caused by clamping of the aorta during open abdominal aortic surgery and that parenteral glutamine supplementation might compensate for this impaired arginine synthesis. This open-label clinical trial randomized patients who underwent clamping of the aorta during open abdominal aortic surgery to receive a perioperative supplement of intravenous alanyl-glutamine (0.5 g·kg(-1)·day(-1); group A, n = 5) or no supplement (group B, n = 5). One day after surgery, stable isotopes and tracer methods were used to analyze the metabolism and conversion of glutamine, citrulline, and arginine. Whole body plasma flux of glutamine, citrulline, and arginine was significantly higher in group A than in group B (glutamine: 391 ± 34 vs. 258 ± 19 μmol·kg(-1)·h(-1), citrulline: 5.7 ± 0.4 vs. 2.8 ± 0.4 μmol·kg(-1)·h(-1), and arginine: 50 ± 4 vs. 26 ± 2 μmol·kg(-1)·h(-1), P glutamine (4.8 ± 0.7 vs. 1.6 ± 0.3 μmol·kg(-1)·h(-1)), citrulline from arginine (2.3 ± 0.3 vs. 0.96 ± 0.1 μmol·kg(-1)·h(-1)), and arginine from glutamine (7.7 ± 0.4 vs. 2.8 ± 0.2 μmol·kg(-1)·h(-1)), respectively (P arginine is severely reduced after clamping during aortic surgery. This study shows that an intravenous supplement of glutamine increases the production of citrulline and arginine and compensates for the inhibitory effect of ischemia-reperfusion injury.

  9. Obesity and the Risk for Surgical Site Infection in Abdominal Surgery.

    Science.gov (United States)

    Winfield, Robert D; Reese, Stacey; Bochicchio, Kelly; Mazuski, John E; Bochicchio, Grant V

    2016-04-01

    Obesity is a risk factor for surgical site infection (SSI) after abdominal procedures; however, data characterizing the risk of SSI in obese patients during abdominal procedures are lacking. We hypothesized that obesity is an independent risk factor for SSI across wound classes. We analyzed American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data for 2011. We calculated body mass index (BMI), classifying patients according to National Institute of Health (NIH) BMI groups. We excluded records in which height/weight was not recorded and patients with BMI less than 18.5. We examined patients undergoing open abdominal procedures, performing univariate and multivariate analyses to assess the relative contribution of obesity to SSI. Study criteria were met by 89,148 patients. Obese and morbidly obese patients had significantly greater SSI rates in clean and clean-contaminated cases but not contaminated or dirty/infected cases. Logistic regression confirmed obesity and morbid obesity as being independently associated with the overall SSI development, specifically in clean [Obesity odds ratio (OR) = 1.757, morbid obesity OR = 2.544, P obesity OR = 1.239, morbid obesity OR = 1.287, P Obesity is associated with increased risk of SSI overall, specifically in clean and clean-contaminated abdominal procedures; this is independent of diabetes mellitus. Novel techniques are needed to reduce SSI in this high-risk patient population.

  10. The Effect of Aromatherapy Abdominal Massage on Alleviating Menstrual Pain in Nursing Students: A Prospective Randomized Cross-Over Study

    OpenAIRE

    Marzouk, Tyseer M. F.; El-Nemer, Amina M. R.; Baraka, Hany N.

    2013-01-01

    Dysmenorrhea is a common cause of sickness absenteeism from both classes and work. This study investigated the effect of aromatherapy massage on a group of nursing students who are suffering of primary dysmenorrhea. A randomized blind clinical trial of crossover design was used. In the first treatment phase, group 1 (n = 48) received aromatherapy abdominal massage once daily for seven days prior to menstruation using the essential oils (cinnamon, clove, rose, and lavender in a base of almond ...

  11. Phytotherapy of chronic abdominal pain following pancreatic carcinoma surgery: a single case observation

    OpenAIRE

    Wiebelitz KR; Beer AM

    2012-01-01

    Karl Rüdiger Wiebelitz, André-Michael BeerDepartment of True Naturopathy, Blankenstein Hospital, Hattingen, GermanyAbstract: A patient with pancreatic carcinoma diagnosed in 2005 suffered from chronic abdominal pain 6 years later that did not respond to conventional pain treatment according to guidelines. Furthermore, several complementary medical approaches remained ineffective. In the long run, only an Iberis amara drug combination relieved pain sufficiently. The drug is...

  12. Perioperatory antibiotic prophylaxis in Pediatric Surgery (Part II: non-abdominal surgery. Profilaxis antibiótica perioperatoria en Cirugía Pediátrica (Parte II: cirugía no abdominal.

    Directory of Open Access Journals (Sweden)

    Guillermo Cortiza Orbe

    Full Text Available The surgical wound infection is the biggest cause of infectious morbility in surgical patients. It is an important cause of morbility that causes lincreased hospital demurrages, increased cost of medical attention and serious inconveniences to the patients and their familiies. 25% of all nosocomial infections are surgical wound infection. One of the big advances of the surgery in the last three decades is an introduction of antibiotic prophylaxis in the surgical practice. Is considered that it has saved more lives than any other novel procedure in surgery in the last 20 years. We presented the Good Clinical Practices Guideline for Antibiotic prophylaxis in no-abdominal surgery, approved by consensus in the 1st National Good Clinical Practices Workshop in Pediatric Surgery (Cienfuegos, Cuba, March 7 – 9, 2002.

    La infección posoperatoria de la herida quirúrgica es la mayor causa de morbilidad infecciosa en el paciente quirúrgico. Ocasiona prolongadas estadías hospitalarias, incremento de los costos de la atención médica y serios inconvenientes a los pacientes y sus familiares. El 25 % de todas las infecciones nosocomiales son infecciones de la herida quirúrgica. Uno de los grandes avances que ha experimentado la cirugía en las tres últimas décadas, es la introducción de la profilaxis antibiótica perioperatoria en la práctica quirúrgica. Se considera que en los últimos 20 años ha salvado más vidas que cualquier otro procedimiento novedoso en cirugía. Se presenta la Guía de Buenas Prácticas Clínicas para profilaxis antibiótica perioperatoria en cirugía abdominal, aprobada por consenso en el 1er Taller Nacional de Buenas Prácticas Clínicas en Cirugía Pediátrica (Cienfuegos, 7 al 9 de marzo del 2002.

  13. Perioperatory antibiotic prophylaxis in Pediatric Surgery (Part I: abdominal surgery Profilaxis antibiótica perioperatoria en Cirugía Pediátrica (Parte I: cirugía abdominal.

    Directory of Open Access Journals (Sweden)

    Berta Fonseca Romero

    2005-12-01

    Full Text Available The surgical wound infection is the biggest cause of infectious morbility in surgical patients. It is an important cause of morbility that causes lincreased hospital demurrages, increased cost of medical attention and serious inconveniences to the patients and their familiies. 25% of all nosocomial infections are surgical wound infection. One of the big advances of the surgery in the last three decades is an introduction of antibiotic prophylaxis in the surgical practice. Is considered that it has saved more lives than any other novel procedure in surgery in the last 20 years. We presented the Good Clinical Practices Guideline for Antibiotic prophylaxis in abdominal surgery, approved by consensus in the 1st National Good Clinical Practices Workshop in Pediatric Surgery (Cienfuegos, Cuba, March 7 – 9, 2002.

    La infección posoperatoria de la herida quirúrgica es la mayor causa de morbilidad infecciosa en el paciente quirúrgico. Ocasiona prolongadas estadías hospitalarias, incremento de los costos de la atención médica y serios inconvenientes a los pacientes y sus familiares. El 25 % de todas las infecciones nosocomiales son infecciones de la herida quirúrgica. Uno de los grandes avances que ha experimentado la cirugía en las tres últimas décadas, es la introducción de la profilaxis antibiótica perioperatoria en la práctica quirúrgica. Se considera que en los últimos 20 años ha salvado más vidas que cualquier otro procedimiento novedoso en cirugía. Se presenta la Guía de Buenas Prácticas Clínicas para profilaxis antibiótica perioperatoria en cirugía abdominal, aprobada por consenso en el 1er Taller Nacional de Buenas Prácticas Clínicas en Cirugía Pediátrica (Cienfuegos, 7 al 9 de marzo del 2002.

  14. COMPARISON OF 0.5% ROPIVACAINE WITH DEXMEDETOMIDINE AND 0.5% BUPIVACAINE WITH DEXMEDETOMIDINE FOR EPIDURAL ANAESTHESIA IN LOWER ABDOMINAL AND LOWER LIMB SURGERIES

    Directory of Open Access Journals (Sweden)

    Ch. Srinivas

    2016-02-01

    Full Text Available BACKGROUND In view of the wider application of regional anaesthetic procedures in modern anaesthesia practice, there is a need for local anaesthetic with desirable properties like long duration of sensory blockade and lesser duration of motor paralysis; α-2 adrenergic agonists have both analgesic and sedative properties when used as an adjuvant in regional anaesthesia.1-6 Dexmedetomidine is a highly selective α-2 adrenergic agonist with an affinity eight times greater than that of clonidine. AIM To evaluate the clinical efficacy of 0.5% ropivacaine with dexmedetomidine by epidural route compared to 0.5% bupivacaine with dexmedetomidine by epidural route in patients undergoing lower abdominal and lower limb surgeries. MATERIALS AND METHODS In this study, 60 patients aged between 18-60 yrs. of either sex, belonging to ASA-I and II undergoing elective lower abdominal and lower limb surgeries were randomly divided into two groups. Group RD comprises of patients in whom 20mL of 0.5% ropivacaine with 30mcg. Dexmedetomidine was administered single shot epidurally. Group BD comprises of patients in whom 20mL of 0.5% bupivacaine with 30mcg. Dexmedetomidine was administered single shot epidurally. RESULTS Addition of dexmedetomidine as an adjuvant to both the groups has shortened the mean time of onset of both sensory and motor blockade. The time for two segmental regression in ropivacaine dexmedetomidine (RD group is less than that of bupivacaine dexmedetomidine (BD group, which is statistically significant. The mean time of onset of motor blockade is longer in group RD than that of the group BD, which is statistically highly significant. Duration of motor blockade in group BD is longer than that of group RD, which is statistically significant. CONCLUSION Bupivacaine with dexmedetomidine group had early onset of motor and sensory blockade with longer duration of motor blockade than that of ropivacaine with dexmedetomidine group. Group ropivacaine with

  15. Comparison of Diaphragmatic Breathing Exercise, Volume and Flow Incentive Spirometry, on Diaphragm Excursion and Pulmonary Function in Patients Undergoing Laparoscopic Surgery: A Randomized Controlled Trial.

    Science.gov (United States)

    Alaparthi, Gopala Krishna; Augustine, Alfred Joseph; Anand, R; Mahale, Ajith

    2016-01-01

    Objective. To evaluate the effects of diaphragmatic breathing exercises and flow and volume-oriented incentive spirometry on pulmonary function and diaphragm excursion in patients undergoing laparoscopic abdominal surgery. Methodology. We selected 260 patients posted for laparoscopic abdominal surgery and they were block randomization as follows: 65 patients performed diaphragmatic breathing exercises, 65 patients performed flow incentive spirometry, 65 patients performed volume incentive spirometry, and 65 patients participated as a control group. All of them underwent evaluation of pulmonary function with measurement of Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), Peak Expiratory Flow Rate (PEFR), and diaphragm excursion measurement by ultrasonography before the operation and on the first and second postoperative days. With the level of significance set at p breathing exercise group than in the flow incentive spirometry group and the control group. Pulmonary function (Forced Vital Capacity) and diaphragm excursion showed statistically significant differences between volume incentive spirometry and diaphragmatic breathing exercise group (p breathing exercise can be recommended as an intervention for all patients pre- and postoperatively, over flow-oriented incentive spirometry for the generation and sustenance of pulmonary function and diaphragm excursion in the management of laparoscopic abdominal surgery. PMID:27525116

  16. 缩唇腹式呼吸预防骨科术后并发症的效果观察%Lip reduction of abdominal breathing effect observation on prevention of complications after surgery

    Institute of Scientific and Technical Information of China (English)

    李金果; 沈红英; 王燕

    2012-01-01

    目的:探讨缩唇腹式呼吸对骨科术后病人并发症的预防效果.方法:选择骨科手术病人202例,随机分为观察组102例和对照组100例,观察组术前实施缩唇腹式呼吸训练,术后每天坚持缩唇腹式呼吸锻炼;对照组实施常规护理.结果:观察组肺部感染、便秘的发生率均明显低于对照组.结论:缩唇腹式呼吸锻炼可有效预防骨科术后病人并发症的发生.%Objective:To explore lip reduction of abdominal breathing on prevention of complications of patients after orthopedic surgery. Methods: Selected 202 cases of patients with orthopaedic surgery, randomly divided into observation group(102 cases) and control group (100 cases) .observation group was implemented with lip reduction of abdominal breathing every day,control group was treated with routine nursing. Results:The pulmonary infection,the incidence of constipation in observation group were significantly lower than the control group. Conclusion: lip abdominal respiration exercises can prevent complications of postoperative patients.

  17. Characteristics of abdominal cavity drainage fluid in Chinese patients without postoperative complications after surgery for gastrointestinal or retroperitoneal tumors

    OpenAIRE

    Zhou J; Pi H; Zheng Y

    2015-01-01

    Jing Zhou,1 Hongying Pi,2 Yingying Zheng1 1General Surgery, 2Nursing Department, Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of China Background: Abdominal cavity drainage fluid can be used as an early diagnostic tool of postoperative complications, and observing its characteristics can help us to judge and handle postoperative complications. There is no accurate standard reference range on its characteristics after surgeries for gastrointestina...

  18. Abdominal trauma

    International Nuclear Information System (INIS)

    Abdominal injury is an important cause of morbidity and mortality in childhood. Ten percent of trauma-related deaths are due to abdominal injury. Thousands of children are involved in auto accidents annually; many suffer severe internal injury. Child abuse is a second less frequent but equally serious cause of internal abdominal injury. The descriptions of McCort and Eisenstein and their associates in the 1960s first brought to attention the frequency and severity of visceral injury as important manifestations of the child abuse syndrome. Blunt abdominal trauma often causes multiple injuries; in the past, many children have been subjected to exploratory surgery to evaluate the extent of possible hidden injury. Since the advent of noninvasive radiologic imaging techniques including radionuclide scans and ultrasound and, especially, computed tomography (CT), the radiologist has been better able to assess (accurately) the extent of abdominal injury and thus allow conservative therapy in many cases. Penetrating abdominal trauma occurs following gunshot wounds, stabbing, and other similar injury. This is fortunately, a relatively uncommon occurrence in most pediatric centers and will not be discussed specifically here, although many principles of blunt trauma diagnosis are valid for evaluation of penetrating abdominal trauma. If there is any question that a wound has extended intraperitonelly, a sinogram with water-soluble contrast material allows quick, accurate diagnosis. The presence of large amounts of free intraperitoneal gas suggests penetrating injury to the colon or other gas-containing viscus and is generally considered an indication for surgery

  19. Predictive performance of ‘Diprifusor’ TCI system in patients during upper abdominal surgery under propofol/fentanyl anesthesia

    Institute of Scientific and Technical Information of China (English)

    LI Yu-hong; XU Jian-hong; YANG Jian-jun; TIAN Jie; XU Jian-guo

    2005-01-01

    Objective: To evaluate the predictive performance of'Diprifusor' TCI (target-controlled infusion) system for its better application in clinical anesthesia. Methods: The predictive performance of a ‘Diprifusor’ TCI system was investigated in 27Chinese patients (16 males and 11 females) during upper abdominal surgery under total intravenous anesthesia (TIVA) with propofol/fentanyl. Measured arterial propofol concentrations were compared with the values predicted by the TCI infusion system.Performance was determined by the median performance error (MDPE), the median absolute performance error (MDAPE), the divergence (the percentage change of the absolute PE with time), and the wobble (the median absolute deviation of each PE from the MDPE). Results: The median (range) values of 14.9% (-21.6%~42.9%) for MDPE, 23.3% (6.9%~62.5%) for MDAPE, -1.9%h-1 (-32.7%~23.0% h-1) for divergence, and 18.9% (4.2%~59.6%) for wobble were obtained from 227 samples from all patients.For the studied population, the PE did not increase with time but with increasing target propofol concentration, particularly following induction. Conclusions: The control of depth of anaesthesia was good in all patients undergoing upper abdominal surgical operation and the predictive performance of the ‘Diprifusor’ target controlled infusion system was considered acceptable for clinical purposes. But the relatively bigger wobble showed that the pharmacokinetic model is not so suitable and requires improvement.

  20. A role of 18F-fluorodeoxyglucose positron emission/computed tomography in a strategy for abdominal wall metastasis of colorectal mucinous adenocarcinoma developed after laparoscopic surgery

    Directory of Open Access Journals (Sweden)

    Kaneko Hironori

    2011-02-01

    Full Text Available Abstract Metastasis to the abdominal wall including port sites after laparoscopic surgery for colorectal cancer is rare. Resection of metastatic lesions may lead to greater survival benefit if the abdominal wall metastasis is the only manifestation of recurrent disease. A 57-year-old man, who underwent laparoscopic surgery for advanced mucinous adenocarcinoma of the cecum 6 years prior, developed a nodule in the surgical wound at the lower right abdomen. Although tumor markers were within normal limits, the metastasis to the abdominal wall and abdominal cavity from the previous cecal cancer was suspected. An abdominal computed tomography scan did not provide detective evidence of metastasis. 18F-fluorodeoxyglucose positron emission/computed tomography (18F-FDG PET/CT was therefore performed, which demonstrated increased 18F-fluorodeoxyglucose uptake (maximum standardized uptake value: 3.1 in the small abdominal wall nodule alone. Histopathological examination of the resected nodule confirmed the diagnosis of metastatic mucinous adenocarcinoma. Prognosis of intestinal mucinous adenocarcinoma is reported to be poorer than that of non-mucinous adenocarcinoma. In conclusion, this case suggests an important role of 18F-FDG PET/CT in early diagnosis and decision-making regarding therapy for recurrent disease in cases where a firm diagnosis of recurrent colorectal cancer is difficult to make.

  1. Cyanoacrylate Skin Microsealant for Preventing Surgical Site Infection after Vascular Surgery : A Discontinued Randomized Clinical Trial

    NARCIS (Netherlands)

    Vierhout, Bastiaan P.; Ott, Alewijn; Reijnen, Michel M. P. J.; Oskam, Jacques; Ott, Alewijn; van den Dungen, Jan J. A. M.; Zeebregts, Clark J.

    2014-01-01

    Background: Surgical site infections (SSI) after vascular surgery are related to substantial morbidity. Restriction of bacterial access to the site of surgery with a cyanoacrylate sealant is a new concept. We performed a randomized clinical trial to assess the effect of the sealing of skin with a cy

  2. The efficacy and safety of enoxaparin versus unfractionated heparin for prevention of deep vein thrombosis in elective cancer surgery. A double blind randomized multicentre trail with venographic assesment

    DEFF Research Database (Denmark)

    Bergkvist, A; Eldor, A; Thorlacius-Ussing, O.

    1997-01-01

    BACKGROUND: Surgery for malignant disease carries a high risk of deep vein thrombosis. The aim of this study was to evaluate the prophylactic effect of a low molecular weight heparin, enoxaparin, 40 mg once daily, beginning 2 h before surgery, compared with that of unfractionated low-dose heparin...... was venous thromboembolism as detected by mandatory bilateral venography or pulmonary scintigraphy. Follow-up was at 3 months. RESULTS: Some 1115 patients were randomized into the study but venograms were inadequate in 460 (41.3 per cent). Of 631 evaluable patients, a total of 104 (16.5 per cent) developed...... severe thrombocytopenia. There were no differences in mortality at either 30 days or 3 months. CONCLUSION: Enoxaparin, 40 mg once daily, is as safe and effective as unfractionated heparin three times daily in preventing venous thromboembolism in patients undergoing major elective surgery for abdominal...

  3. Does chewing gum improve recovery after an abdominal surgery? –First update

    Directory of Open Access Journals (Sweden)

    Gabriel Rada

    2015-06-01

    Full Text Available Este resumen Epistemonikos (Living FRISBEE: Living FRIendly Summary of the Body of Evidence using Epistemonikos es una actualización del resumen publicado en Noviembre de 2014, basado en 4 nuevas revisiones sistemáticas aparecidas con posterioridad. El íleo postoperatorio es una condición común que retrasa la recuperación luego de una cirugía abdominal. El uso precoz de goma de mascar, como método de alimentación fingida, estimularía la peristalsis permitiendo una alimentación más precoz. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos 18 revisiones sistemáticas que en conjunto incluyen 81 estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que la goma de mascar probablemente disminuye el tiempo de hospitalización luego de una cirugía abdominal.

  4. COMPARISON OF SURGICAL STRESS RESPONSE UNDER GENERAL ANAESTHESIA IN OPEN LAPAROTOMY VS LAPAROSCOPIC ABDOMINAL SURGERIES

    Directory of Open Access Journals (Sweden)

    Gopal Reddy

    2015-10-01

    Full Text Available The stress response is the name given to the hormonal and metabolic changes which follow injury or trauma. The systemic reactions to surgical injury encompass a wide range of endocrinological, immunological and haematological effects. The ability of anaesthetic agents modifies the endocrine and metabolic responses have been studied enthusiastically. This research describes the endocrine and metabolic changes which occur during different types of surgical techniques, effects of anaesthetic and analgesic regimens to modify their responses. OBJECTIVES: The present study aimed to evaluate the effects of stress response on blood glucose levels and hemodynamics in patients undergoing open Laparotomy surgeries v/s laparoscopic surgeries. METHODS: Sixty surgical patients were enrolled in this clinical trial. The pulse, BP records were taken and blood sugar levels were tested peri-operatively. RESULTS: The results were analyzed and found that raise pulse rate, blood pressure and blood sugar levels due to stress in proportionate to surgical trauma, and duration of surgery under anaesthesia. Blood sugar levels gradually increased 90.5±4.88 to 115±7.18 and at post op119.4±6.93 in laparotomy group when compared to 91.07±4.93 to 118.33±5.06 and at post-op120.1±4.51 in laparoscopy group. CONCLUSION: Lap surgery causes minimum tissue injury and less stress response more so during postoperative period.

  5. Benefits and harms of adhesion barriers for abdominal surgery : a systematic review and meta-analysis

    NARCIS (Netherlands)

    ten Broek, Richard P. G.; Stommel, Martijn W. J.; Strik, Chema; van Laarhoven, Cornelis J. H. M.; Keus, Frederik; van Goor, Harry

    2014-01-01

    Background Formation of adhesions after peritoneal surgery results in high morbidity. Barriers to prevent adhesion are seldom applied, despite their ability to reduce the severity of adhesion formation. We evaluated the benefits and harms of four adhesion barriers that have been approved for clinica

  6. COMPARATIVE STUDY BETWEEN EPIDURAL BUPIVACAINE WITH BUPRENORPHINE AND EPIDURAL BUPIVACAINE FOR POST - OPERATIVE ANALGESIA IN ABDOMINAL AND LOWER LIMB SURGERY

    Directory of Open Access Journals (Sweden)

    Nagesh

    2015-02-01

    Full Text Available Epidural administration of various analgesics gained increasing popularity following the discovery of opioid receptors in the spinal cord capable of producing potent analgesia. This effect seems to be greatest when epidural anaesthesia in continued in the post - operative period as epidural analgesia . It is now clear that epidural administration of opioids. Ours was a comparative study between epidural bupivacaine with buprenorphine and epidural bupivacaine for post - operative analgesia in abdominal and lower limb surgery. METHODS: 60 patients undergoing lower abdominal and lower limb surgeries of either sex with ASA grade 1 and 2 a ged between 20 and 60 years for divided into two groups. After completion of the surgery and when the effect of local anaesthetic wears of and the patients complains of pain the intended study drugs were given when visual analogue pain score touched 5 cm m ark. Group – A: Patients received 8ml of 0.25% bupivacaine + 0.15mg of buprenorphine. Group – B: patients received 0.25% of bupivacaine alone. In the post - operative period the following parameters were studied , 1. Onset of analgesia , 2. Duration of analges ia , 3. Vital parameters such as heart beat , blood pressure , respiratory rate , sedation score and visual analogue score were recorded , 4. Side effects like nausea , vomiting , hypotension , respiratory depression , and pruritus allergic reaction were looked for . RESULTS: It is observed that onset of analgesia in Group A (0.25% bupivacaine + 0.15mg buprenorphine was 7.35 min. When compared to Group B which 15.5 min , which is statically significant (P<0.05. Duration of analgesia in Group A is 17.23 hrs compared to Group B , which is 5.2 hrs , this is statically significant (P<0.05. Visual analogue scale was reduced in Group A compared to Group B CONCLUSIONS: Addition of buprenorphine to bupivacaine by epidural injection for post - operative analgesia improves the on set , The duration and the

  7. Somatoform abdominal pain in surgery: is SD worthy of surgical attention? Case reports and literature review.

    LENUS (Irish Health Repository)

    Abd Elwahab, Sami Medani

    2012-08-01

    Somatoform disorders (SD) or medically unexplained physical symptoms (MUPS) are a group of disorders that represent a group of symptoms that cannot be explained by an organic or physical pathology. These disorders are widely prevalent, and, if unrecognised, SD may lead medical professionals to embark on tests or procedures which may inflict unnecessary iatrogenic complications. Despite the high prevalence, they are only poorly included in medical training curricula, at both undergraduate and postgraduate levels. In this article, we review the literature and present two cases. The first one presented with a recurrent acute abdomen had an unnecessary CT abdomen. The second case had laparoscopy for acute right-sided abdominal pain which turned out to be normal, and was readmitted again after a short period with acute urine retention which resolved spontaneously following discussion with the patient and family. Both cases were referred for psychiatric assessment and their family doctors were informed.

  8. Randomized clinical trial comparing blunt tapered and standard needles in closing abdominal fascia.

    NARCIS (Netherlands)

    Nordkam, R.A.; Bluyssen, S.J.; Goor, H. van

    2005-01-01

    Glove perforation frequently occurs during the course of surgical procedures, introducing risks for both surgeons and patients. The aim of this study was to compare the use of blunt tapered and "sharp" needles during abdominal wall closure with respect to the incidence of glove perforation and the c

  9. Abdominal CT predictors of fibrosis in patients with chronic pancreatitis undergoing surgery

    Energy Technology Data Exchange (ETDEWEB)

    Sinha, Amitasha; Afghani, Elham [Johns Hopkins Medical Institutions, Division of Gastroenterology, Baltimore, MD (United States); Singh, Vikesh K. [Johns Hopkins Medical Institutions, Division of Gastroenterology, Baltimore, MD (United States); Johns Hopkins Medical Institutions, Pancreatitis Center, Baltimore, MD (United States); Cruise, Michael; Matsukuma, Karen [Johns Hopkins Medical Institutions, Department of Pathology, Baltimore, MD (United States); Ali, Sumera; Raman, Siva P.; Fishman, Elliot K. [Johns Hopkins Medical Institutions, The Russel H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Andersen, Dana K. [National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (United States); Makary, Martin A. [Johns Hopkins Medical Institutions, Department of Surgery, Baltimore, MD (United States); Johns Hopkins Medical Institutions, Pancreatitis Center, Baltimore, MD (United States); Zaheer, Atif [Johns Hopkins Medical Institutions, The Russel H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Johns Hopkins Medical Institutions, Pancreatitis Center, Baltimore, MD (United States); Johns Hopkins Medical Institutions, Baltimore, MD (United States)

    2015-05-01

    To determine which abdominal CT findings predict severe fibrosis and post-operative pain relief in chronic pancreatitis (CP). Pre-operative abdominal CTs of 66 patients (mean age 52 ± 12 years, 53 % males) with painful CP who underwent the Whipple procedure (n = 32), Frey procedure (n = 32) or pancreatic head biopsy (n = 2), between 1/2003-3/2014, were evaluated. CT was evaluated for parenchymal calcifications, intraductal calculi, main pancreatic duct dilation (>5 mm), main pancreatic duct stricture, and abnormal side branch(es). The surgical histopathology was graded for fibrosis. CT findings were evaluated as predictors of severe fibrosis and post-operative pain relief using regression and area under receiver operating curve (AUC) analysis. Thirty-eight (58 %) patients had severe fibrosis. Parenchymal calcification(s) were an independent predictor of severe fibrosis (p = 0.03), and post-operative pain relief over a mean follow-up of 1-year (p = 0.04). Presence of >10 parenchymal calcifications had higher predictive accuracy for severe fibrosis than 1-10 parenchymal calcification(s) (AUC 0.88 vs. 0.59, p = 0.003). The predictive accuracy of >10 versus 1-10 parenchymal calcifications increased after adjusting for all other CT findings (AUC 0.89 vs. 0.63, p = 0.01). Parenchymal calcification(s) independently predict severe fibrosis and are significantly associated with post-operative pain relief in CP. The presence of >10 parenchymal calcifications is a better predictor of severe fibrosis than 1-10 parenchymal calcification(s). (orig.)

  10. The effect of ranitidine on postoperative infectious complications following emergency colorectal surgery: a randomized, placebo-controlled, double-blind trial

    DEFF Research Database (Denmark)

    Moesgaard, F; Jensen, L S; Christiansen, P M;

    1998-01-01

    OBJECTIVE AND DESIGN: To study the potential effect of ranitidine on postoperative infectious complications following emergency colorectal surgery. A randomized, placebo-controlled, double-blind trial was carried out in three university clinics and two county hospitals in Denmark. PATIENTS...... patients were withdrawn from the study (for reasons such as other diagnosis, refused to continue, medication not given as prescribed). MAIN OUTCOME MEASURES: Patients were observed for signs of infectious complications; such as wound infection, intra-abdominal abscess, septicemia, and pneumonia. RESULTS...

  11. NSAID Use after Bariatric Surgery : a Randomized Controlled Intervention Study

    NARCIS (Netherlands)

    Yska, Jan Peter; Gertsen, Sanneke; Flapper, Gerbrich; Emous, Marloes; Wilffert, Bob; van Roon, Eric N

    2016-01-01

    BACKGROUND: Use of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in bariatric surgery patients. If use of an NSAID is inevitable, a proton pump inhibitor (PPI) should also be used. AIM: To determine the effect of an, compared to care-as-usual, additional intervention to reduce NSAI

  12. Effectiveness of ultrasonography and plain abdominal graphy in the follow-up of patients after retrograde intrarenal surgery

    Directory of Open Access Journals (Sweden)

    Mustafa Reşorlu

    2012-09-01

    Full Text Available Objectives: It was aimed to evaluate the effectivenessof combined use of ultrasonography (US and plain radiography(PR in the postoperative follow-up of patientsundergoing retrograde intrarenal surgery (RIRS.Materials and methods: The charts of 207 patients whounderwent RIRS for renal stones in a 3-years-periodwere retrospectively reviewed. Fifty-eight patients wereincluded to study who were evaluated with combinationof urinary US, PR and computed tomography (CT at 1month after surgery.Results: Of 58 procedures with perioperative completestone fragmentation, 49 were completely stone-free(84.4%, while fragments (≥ 3 mm were observed in 9patients and hydronephrosis was detected in 5 patients(8.6% on the CT. Of the 9 residual stones and 5 hydronephrosis,the radiologists truly diagnosed 6 stones (66.6%and 5 hydronephrosis (100% by using the combination ofUS and PR. The sensitivity, specificity, positive and negativepredictive values of US and PR for detecting presenceof residual stone and hydronephrosis were 66.6%and 100%, 98% and 98%, 85.7% and 83.3%, 94.2% and100%, respectively.Conclusions: A combination of urinary US and plain filmhas clear advantages about lack of radiation exposureover CT scan and it is a highly specific and sensitive testfor detecting hydronephrosis. However this procedurehas limited accuracy for detecting small residual stones,so we believe that CT scan is only necessary when patienthas persistent pain or sonographic evidence of hydronephrosisis present.Key words: Renal stone, plain abdominal film, retrogradeintrarenal surgery, ultrasonography

  13. TO STUDY THE EFFECT OF ADDITION OF NALBUPHINE TO INTRATHECAL BUPIVACAINE USED FOR ELDERLY PATIENT IN LOWER ABDOMINAL SURGERIES UNDER SPINAL ANAESTHESIA: A RANDOMISED DOUBLE BLINDED CONTROL STUDY

    Directory of Open Access Journals (Sweden)

    Rashmi

    2014-12-01

    Full Text Available : BACKGROUND AND OBJECTIVES: The purpose of this study was: 1. To asses, evaluate and compare the analgesic effect of intrathecal nalbuphine when added to hyperbaric intrathecal bupivacaine and bupivacaine alone. 2. To evaluate the onset, quality and duration of sensory and motor blockade achieved with hyperbaric bupivacaine and nalbuphine combination when administered intrathecally for spinal anesthesia in lower abdominal surgery. 3. To study the effect of intrathecal nalbuphine on vital parameters. 4. To study any side effects and complication. METHODOLOGY: 40 ASA I and II patients of age group 50-70 years, scheduled for below umbilicus surgeries were chosen for this study. Patients were randomized in two equal groups of 20 each by lottery method. Group I (Study Group received 3 ml of hyperbaric bupivacaine 0.5 % + 0.5 ml inj. nalbuphine (0.5 mg intrathecally. Group II (Control Group received 3 ml of hyperbaric bupivacaine 0.5 % + 0.5 ml of inj. normal saline intrathecally. Assessment of motor and sensory blockade was done by Bromage scale and pin prick method. Pulse rate, BP, respiratory rate and SpO2 were monitored throughout intraoperative period and 24hrs postoperative period. RESULTS: There is no significant difference between 2 groups for onset of motor and sensory blockade but mean time of postoperative analgesia in Study Group was highly significant than Control Group. No patient in our study developed any side effects. CONCLUSION: Nalbuphine provides better quality of block as compared to bupivacaine alone. It also prolongs postoperative analgesia when used as adjuvant to spinal bupivacaine in elderly patients.

  14. Expression of triggering receptor on myeloid cell 1 and histocompatibility complex molecules in sepsis and major abdominal surgery

    Institute of Scientific and Technical Information of China (English)

    Nestor González-Roldán; Constantino López-Macías; Armando Isibasi; Eduardo Ferat-Osorio; Rosalía Aduna-Vicente; Isabel Wong-Baeza; Noemí Esquivel-Callejas; Horacio Astudillo-de la Vega; Patricio Sánchez-Fernández; Lourdes Arriaga-Pizano; Miguel Angel Villasís Keever

    2005-01-01

    AIM: To evaluate the surface expression of triggering receptor on myeloid cell 1 (TREM-1), class Ⅱ major histocompatibility complex molecules (HLA-DR), andthe expression of the splicing variant (svTREM-1) ofTREM-1 in septic patients and those subjected to major abdominal surgery.METHODS: Using flow cytometry, we examined the surface expression of TREM-1 and HLA-DR in peripheral blood monocytes from 11 septic patients, 7 elective gastrointestinal surgical patients, and 10 healthy volunteers. svTREM-1 levels were analyzed by RT-PCR. RESULTS: Basal expression of TREM-1 and HLA-DR in healthy volunteers was 35.91±14.75 MFI and75.8±18.3%, respectively. In septic patients, TREM-1 expression was 59.9±23.9 MFI and HLA-DR expression was 44.39±20.25%, with a significant differencebetween healthy and septic groups (P<0.05) for bothmolecules. In the surgical patients, TREM-1 and HLA-DR expressions were 56.8±20.85 MFI and 71±13.8% before surgery and 72.65±29.92 MlFI and 72.82±22.55% after surgery. TREM-1 expression was significantly different(P = 0.0087) between the samples before and aftersurgery and svTREM-1 expression was 0.8590±0.1451 MF1, 0.8820±0.1460 MF1, and 2.210±0.7873MF1 in the healthy, surgical (after surgery) and septic groups, respectively. There was a significant difference (P = 0.048) in svTREM-1 expression between the healthy and surgical groups and the septic group.CONCLUSION: TREM-1 expression is increased during systemic inflammatory conditions such as sepsis and the postoperative phase. Simultaneous low expression of HLA-DR molecules correlates with the severity of illness and increases susceptibility to infection. Additionally, TREM-1 expression is distinctly different in surgical patients at different stages of the inflammatory response before and after surgery. Thus, surface TREM-1 appears to be an endogenous signal during the course of the inflammatory response. svTREM-1 expression is significantly increased during sepsis, appearing to be

  15. Intensity-Modulated Whole Abdominal Radiotherapy After Surgery and Carboplatin/Taxane Chemotherapy for Advanced Ovarian Cancer: Phase I Study

    International Nuclear Information System (INIS)

    Purpose: To assess the feasibility and toxicity of consolidative intensity-modulated whole abdominal radiotherapy (WAR) after surgery and chemotherapy in high-risk patients with advanced ovarian cancer. Methods and Materials: Ten patients with optimally debulked ovarian cancer International Federation of Gynecology and Obstetrics Stage IIIc were treated in a Phase I study with intensity-modulated WAR up to a total dose of 30 Gy in 1.5-Gy fractions as consolidation therapy after adjuvant carboplatin/taxane chemotherapy. Treatment was delivered using intensity-modulated radiotherapy in a step-and-shoot technique (n = 3) or a helical tomotherapy technique (n = 7). The planning target volume included the entire peritoneal cavity and the pelvic and para-aortal node regions. Organs at risk were kidneys, liver, heart, vertebral bodies, and pelvic bones. Results: Intensity-modulated WAR resulted in an excellent coverage of the planning target volume and an effective sparing of the organs at risk. The treatment was well tolerated, and no severe Grade 4 acute side effects occurred. Common Toxicity Criteria Grade III toxicities were as follows: diarrhea (n = 1), thrombocytopenia (n = 1), and leukopenia (n = 3). Radiotherapy could be completed by all the patients without any toxicity-related interruption. Median follow-up was 23 months, and 4 patients had tumor recurrence (intraperitoneal progression, n = 3; hepatic metastasis, n = 1). Small bowel obstruction caused by adhesions occurred in 3 patients. Conclusions: The results of this Phase I study showed for the first time, to our knowledge, the clinical feasibility of intensity-modulated whole abdominal radiotherapy, which could offer a new therapeutic option for consolidation treatment of advanced ovarian carcinoma after adjuvant chemotherapy in selected subgroups of patients. We initiated a Phase II study to further evaluate the toxicity of this intensive multimodal treatment.

  16. Effective observation on treating abdominal distension after gastrointestinal surgery by the acupoint pressure beans%穴位贴敷联合耳穴压豆治疗胃肠道术后腹胀的疗效观察

    Institute of Scientific and Technical Information of China (English)

    于福源; 王媛媛; 高峰; 王菲

    2015-01-01

    Objective: To observe the efficacy of acupoint ear pressure beans on abdominal distension after gastrointestinal surgery. Methods: 131 cases of abdominal distension after gastrointestinal surgery were randomly divided into the treatment group and the control group. The control group were treated with acupoint application plus ear pressure beans. The control group were treated with pure ear pressure beans. Efficacy in two group for 24 hours were compared. Results: Efficacy in the treatment group was more obvious than that in the control group, with statistical significance (P<0.05). Conclusion: Acupoint application plus ear pressure beans can effectively alleviate the symptoms of abdominal distension after gastrointestinal surgery.%目的:观察穴位贴敷联合耳穴压豆治疗胃肠道术后腹胀的疗效。方法:选择131例胃肠道手术术后出现腹胀的患者,随机分为治疗组和对照组,治疗组采用穴位贴敷联合耳穴压豆治疗,对照组单纯采用耳穴压豆治疗。比较24h内两组患者的治疗效果。结果:治疗组与对照组相比较治疗效果明显,差异有统计学意义(P<0.05)。结论:穴位贴敷配合耳穴压豆治疗能有效缓解胃肠道手术后出现的腹胀症状。

  17. Disturbances in the circadian pattern of activity and sleep after laparoscopic versus open abdominal surgery

    DEFF Research Database (Denmark)

    Gögenur, Ismail; Bisgaard, Thue; Burgdorf, Stefan;

    2008-01-01

    BACKGROUND: Studies on the circadian variation in bodily functions and sleep are important for understanding the pathophysiological processes in the postoperative period. We aimed to investigate changes in the circadian variation in activity after minimally invasive surgery (laparoscopic cholecys......BACKGROUND: Studies on the circadian variation in bodily functions and sleep are important for understanding the pathophysiological processes in the postoperative period. We aimed to investigate changes in the circadian variation in activity after minimally invasive surgery (laparoscopic...... scale (sleep quality, general well-being and pain) and fatigue was measured by a ten-point fatigue scale. The activity levels of the patients were monitored by actigraphy (a wrist-worn device measuring patient activity). Measures of circadian activity level [interday stability (IS), intraday variability...... to the circadian activity parameters (IS, IV and AMP). CONCLUSION: Severely disturbed circadian activity parameters was found after both LC and MAS with worse changes after MAS. Measures of circadian activity pattern analyses correlated significantly with postoperative subjective recovery parameters....

  18. Randomized clinical trial of mast cell inhibition in patients with a medium-sized abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Sillesen, H; Eldrup, N; Hultgren, R;

    2015-01-01

    BACKGROUND: Abdominal aortic aneurysm (AAA) is thought to develop as a result of inflammatory processes in the aortic wall. In particular, mast cells are believed to play a central role. The AORTA trial was undertaken to investigate whether the mast cell inhibitor, pemirolast, could retard...... the growth of medium-sized AAAs. In preclinical and clinical trials, pemirolast has been shown to inhibit antigen-induced allergic reactions. METHODS: Inclusion criteria for the trial were patients with an AAA of 39-49 mm in diameter on ultrasound imaging. Among exclusion criteria were previous aortic...... surgery, diabetes mellitus, and severe concomitant disease with a life expectancy of less than 2 years. Included patients were treated with 10, 25 or 40 mg pemirolast, or matching placebo for 52 weeks. The primary endpoint was change in aortic diameter as measured from leading edge adventitia...

  19. Effects of diaphragm stretching on posterior chain muscle kinematics and rib cage and abdominal excursion: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Francisco J. González-Álvarez

    2016-01-01

    Full Text Available ABSTRACT Background Few studies have explored the effects of stretching techniques on diaphragm and spine kinematics. Objective To determine whether the application of diaphragm stretching resulted in changes in posterior chain muscle kinematics and ribcage and abdominal excursion in healthy subjects. Method Eighty healthy adults were included in this randomized clinical trial. Participants were randomized into two groups: the experimental group, which received a diaphragmatic stretching technique, or the placebo group, which received a sham-ultrasound procedure. The duration of the technique, the position of participants, and the therapist who applied the technique were the same for both treatments. Participant assessment (cervical range of movement, lumbar flexibility, flexibility of the posterior chain, and rib cage and abdominal excursion was performed at baseline and immediately after the intervention by a blinded assessor. Results The mean between-group difference [95% CI] for the ribcage excursion after technique at xiphoid level was 2.48 [0.97 to 3.99], which shows significant differences in this outcome. The remaining between-group analysis showed significant differences in cervical extension, right and left flexion, flexibility of the posterior chain, and ribcage excursion at xiphoid level (p<0.05 in favor of the experimental group. Conclusion Diaphragm stretching generates a significant improvement in cervical extension, right and left cervical flexion, flexibility of the posterior chain, and ribcage excursion at xiphoid level compared to a placebo technique in healthy adults.

  20. Comparison of Ondansetron with Ondansetron and Dexamethasone in prevention of postoperative nausea vomiting in abdominal surgery

    OpenAIRE

    Ajani, Abbas ali; Singam, Amol Prakash; Chaudhari, Ashok; chandak, aruna vijay

    2013-01-01

    Purpose: To compare the efficacy of ondansetron-dexamethasone combination with ondansetron alone for prevention of postoperative nausea and vomiting (PONV). Methods: This  double blind, randomized, prospective, Placebo controlled study was carried out in 120 patients, aged 20-60 yr, ASA-I and II physical status posted for exploratory laparotomy for various clinical conditions under general anaesthesia The patients were divided into three groups of 40 each. Patients received one of the three r...

  1. A randomized pilot study on single-port versus conventional laparoscopic rectal surgery

    DEFF Research Database (Denmark)

    Bulut, O; Aslak, K K; Levic, K;

    2015-01-01

    BACKGROUND: Potential benefits of single-port laparoscopic surgery may include improved cosmetic results, less postoperative pain, surgical trauma and faster recovery. Results of randomized prospective studies with a focus on single-port rectal surgery have not yet been presented. The aim...... of the present study was to compare single-port and conventional laparoscopic surgery for rectal cancer in terms of short-term outcomes including postoperative pain and trauma-induced changes in certain bioactive substances. METHODS: Patients with non-metastasized rectal cancer were prospectively randomized...... to single-port (n = 20) or conventional laparoscopic rectal surgery (n = 20). Postoperative pain was assessed at rest, at coughing and during mobilization, with a numeric pain ranking score and was recorded at 6 h after the operation and subsequently every morning daily for 4 days. Levels of C...

  2. Randomized Controlled Trials: A Systematic Review of Laparoscopic Surgery and Simulation-Based Training

    OpenAIRE

    2014-01-01

    Introduction This systematic review was conducted to analyze the impact and describe simulation-based training and the acquisition of laparoscopic surgery skills during medical school and residency programs. Methods This systematic review focused on the published literature that used randomized controlled trials to examine the effectiveness of simulation-based training to develop laparoscopic surgery skills. Searching PubMed from the inception of the databases to May 1, 2014 and specific hand...

  3. A COMPARATIVE STUDY OF EPIDURAL BUTORPHANOL AND EPIDURAL FENTANYL FOR THE RELIEF OF POST-OPERATIVE PAIN IN LOWER ABDOMINAL AND LOWER LIMB SURGERIES

    Directory of Open Access Journals (Sweden)

    Ashwini

    2014-11-01

    Full Text Available BACKGROUND: Epidural anaesthesia is used extensively for both intra-operative and post-operative analgesia. This prospective randomized study was conducted using opioids epidurally for post-operative analgesia. Fentanyl is a pure opioid agonist. Butorphanol tartarate which is an agonist antagonist opioid is considered safer than pure opioid agonist. Hence, we compared epidural 4mg butorphanol and epidural 100 µg fentanyl for the relief of post-operative pain. AIMS AND OBJECTIVES: To compare the onset, duration, quality of analgesia, hemodynamic effects and side effects between the 2 study drugs. MATERIALS AND METHODS: 60 patients of either sex posted for elective lower abdominal and lower limb surgeries were randomly divided into 2 groups of 30 each. Group A received butorphanol 4mg epidurally. Group B received fentanyl 100 µg epidurally. All surgeries were done under lumbar epidural anaesthesia with catheter in situ. Post-operatively when patients complained of pain, intensity of pain was assessed using visual analogue scale [VAS]. When the VAS score was > 5, Group A received butorphanol 4mg diluted to 10 ml with NS or Group B received 100 µg fentanyl epidurally diluted to 10 ml with NS. Onset, duration, quality of analgesia, hemodynamic effects and incidence of side effects were compared between the two groups and treated accordingly. RESULTS: Demographic profile was comparable in both groups. Mean time of onset of analgesia was rapid (3.22 ±0.9 (S.D min in group B compared to group A (6.38± 1.26 (S.D min. Duration of analgesia was longer in group A (344.00 ±63.39 min compared to group B (227±38.12 min. Quality of analgesia was better with group A compared to group B. There was no significant difference in hemodynamic parameters in both groups. Sedation was the main side effect in group A. Incidence of pruritis, vomiting, hypotension and respiratory depression was more in group B. CONCLUSION: Epidural Butorphanol though has a delayed

  4. [General infection prevention in abdominal surgery with special reference to intestinal decontamination].

    Science.gov (United States)

    Schardey, H M

    1999-01-01

    In surgery prophylaxis for infection is necessary, because patients are immunocompromised due to the underlying disease and the operation while at the same time being increasingly exposed to potentially pathogenic germs. Prophylaxis is based on the control of endogenous and exogenous microorganisms. For this purpose either systemic or locally active topical agents may be employed. Systemically active substances are applied with the aim to kill and eliminate invasive microorganisms in deep tissue levels, either by their own biological activity or by stimulating specific or unspecific host immune reactions. Local topical measures in contrast are to prevent the primary contact between microorganisms and host. The central pillar of systemic measures is the perioperative systemic antibiotic prophylaxis, immunonutrition is beginning to gain importance, and in the future possibly substances such as G-CSF, which directly stimulate the immune system, may be employed. Standard topical measures are sterilization and desinfection while decontamination of the digestive tract has until now not found a wide spread acceptance. For certain indications especially high risk surgical resections with anastomoses at the level of the oesophagus or the lower rectum it is possible to eliminate endogenous intestinal microorganisms effectively using topical decontamination in combination with systemic antibiotics and improve the surgical results, especially anastomotic healing.

  5. Non-invasive continuous arterial pressure and pulse pressure variation measured with Nexfin(®) in patients following major upper abdominal surgery: a comparative study.

    Science.gov (United States)

    de Wilde, R B P; de Wit, F; Geerts, B F; van Vliet, A L; Aarts, L P H J; Vuyk, J; Jansen, J R C

    2016-07-01

    We compared the accuracy and precision of the non-invasive Nexfin(®) device for determining systolic, diastolic, mean arterial pressure and pulse pressure variation, with arterial blood pressure values measured from a radial artery catheter in 19 patients following upper abdominal surgery. Measurements were taken at baseline and following fluid loading. Pooled data results of the arterial blood pressures showed no difference between the two measurement modalities. Bland-Altman analysis of pulse pressure variation showed significant differences between values obtained from the radial artery catheter and Nexfin finger cuff technology (mean (SD) 1.49 (2.09)%, p agreement -2.71% to 5.69%). The effect of volume expansion on pulse pressure variation was identical between methods (concordance correlation coefficient 0.848). We consider the Nexfin monitor system to be acceptable for use in patients after major upper abdominal surgery without major cardiovascular compromise or haemodynamic support. PMID:27291598

  6. Ketamina epidural en cirugía de hemiabdomen inferior Epidural ketamine in low abdominal surgery

    Directory of Open Access Journals (Sweden)

    S. F. González-Pérez

    2006-04-01

    the spinal level in the same way as opioids (2 and non-competitive N-methyl-D-aspar-tate NMDA receptor antagonist (3. Purpose: To evaluate the efficacy of epidural ketamine for postoperative pain relief in lower abdominal procedures. Materials and Methods: 50 patients undergoing inguinal herniotomy were studied in a comparative propective trial. They were divided into two groups to receive epidural ketamine 50 mg or epidural morphine 2 mg. Results: Epidural ketamine in doses to 50 mg provide adequate analgesia during 6 hours. Morphine administered epidurally obtained analgesia more than 18 hours. Conclusion: Epidurally administered ketamine is less effective than epidural morphine for postoperative analgesia, but it playes an important role in morphine-induced analgesia and during the combination with local anaesthetic.

  7. The LIPPSMAck POP (Lung Infection Prevention Post Surgery - Major Abdominal - with Pre-Operative Physiotherapy) trial: study protocol for a multi-centre randomised controlled trial

    OpenAIRE

    Boden, Ianthe; Browning, Laura; Skinner, Elizabeth H.; Reeve, Julie; El-Ansary, Doa; Robertson, Iain K; Denehy, Linda

    2015-01-01

    Background Post-operative pulmonary complications are a significant problem following open upper abdominal surgery. Preliminary evidence suggests that a single pre-operative physiotherapy education and preparatory lung expansion training session alone may prevent respiratory complications more effectively than supervised post-operative breathing and coughing exercises. However, the evidence is inconclusive due to methodological limitations. No well-designed, adequately powered, randomised con...

  8. Value of a step-up diagnosis plan: CRP and CT-scan to diagnose and manage postoperative complications after major abdominal surgery

    Directory of Open Access Journals (Sweden)

    Jennifer Straatman

    2014-12-01

    Full Text Available Postoperative complications frequently follow major abdominal surgery and are associated with increased morbidity and mortality. Early diagnosis and treatment of complications is associated with improved patient outcome. In this study we assessed the value of a step-up diagnosis plan by C-reactive protein and CT-scan (computed tomography-scan imaging for detection of postoperative complications following major abdominal surgery. An observational cohort study was conducted of 399 consecutive patients undergoing major abdominal surgery between January 2009 and January 2011. Indication for operation, type of surgery, postoperative morbidity, complications according to the Clavien-Dindo classification and mortality were recorded. Clinical parameters were recorded until 14 days postoperatively or until discharge. Regular C-reactive protein (CPR measurements in peripheral blood and on indication -enhanced CT-scans were performed. Eighty-three out of 399 (20.6 % patients developed a major complication in the postoperative course after a median of seven days (IQR 4-9 days. One hundred and thirty two patients received additional examination consisting of enhanced CT-scan imaging, and treatment by surgical reintervention or intensive care observation. CRP levels were significantly higher in patients with postoperative complications. On the second postoperative day CRP levels were on average 197.4 mg/L in the uncomplicated group, 220.9 mg/L in patients with a minor complication and 280.1 mg/L in patients with major complications (p < 0,001. CT-scan imaging showed a sensitivity of 91.7 % and specificity of 100 % in diagnosis of major complications. Based on clinical deterioration and the increase of CRP, an additional enhanced CT-scan offered clear discrimination between patients with major abdominal complications and uncomplicated patients. Adequate treatment could then be accomplished.

  9. Exchange of best practices within the European Union: surgery standardization of abdominal organ retrieval.

    Science.gov (United States)

    de Graauw, J A; Mihály, S; Deme, O; Hofker, H S; Baranski, A G; Gobée, O P; Krikke, C; Fehérvari, I; Langer, R M; Ploeg, R J; Marazuela, R; Domínguez-Gil, B; Haase-Kromwijk, B J J M; Font-Sala, C

    2014-01-01

    Considering the growing organ demand worldwide, it is crucial to optimize organ retrieval and training of surgeons to reduce the risk of injury during the procedure and increase the quality of organs to be transplanted. In the Netherlands, a national complete trajectory from training of surgeons in procurement surgery to the quality assessment of the procured organs was implemented in 2010. This mandatory trajectory comprises training and certification modules: E-learning, training on the job, and a practical session. Thanks to the ACCORD (Achieving Comprehensive Coordination in Organ Donation) Joint Action coordinated by Spain and co-funded under the European Commission Health Programme, 3 twinning activities (led by France) were set to exchange best practices between countries. The Dutch trajectory is being adapted and implemented in Hungary as one of these twinning activities. The E-learning platform was modified, tested by a panel of Hungarian and UK surgeons, and was awarded in July 2013 by the European Accreditation Council for Continuing Medical Education of the European Union of Medical Specialists. As a pilot phase for future national training, 6 Hungarian surgeons from Semmelweis University are being trained; E-learning platform was fulfilled, and practical sessions, training-on-the-job activities, and evaluations of technical skills are ongoing. The first national practical session was recently organized in Budapest, and the new series of nationwide selected candidates completed the E-learning platform before the practical. There is great potential for sharing best practices and for direct transfer of expertise at the European level, and especially to export this standardized training in organ retrieval to other European countries and even broader. The final goal was to not only provide a national training to all countries lacking such a program but also to improve the quality and safety criteria of organs to be transplanted. PMID:25131109

  10. Management of Postoperative Hypoxaemia in Patients Following Upper Abdominal Laparoscopic Surgery. - A Comparative Study

    Directory of Open Access Journals (Sweden)

    Sampa Datta Gupta

    2008-01-01

    Full Text Available Noninvasive ventilation has been shown to reduce acute postoperative hypoxaemia, with significant reduction in the incidence of re-intubation, complications and a trend towards lower mortality. The aim of the study was to determine the effectiveness of CPAP vs venturi therapy in early achievement of oxygenation goals and in prevention of re-intubation for management of postoperative hypoxaemia following laparoscopic cholecystectomy. Forty adult patients of ASA physical status I& II, scheduled for elective laparoscopic cholecystectomy, those were unable to maintain SpO2 > 95% breathing room air after extubation, were recruited for a prospective, randomized comparative study. Patients with PaO2 / FiO2 between 250 and 300 were included in the study and were randomly allocated to one of the two groups to receive oxygen therapy either using a CPAP of 10 cm of water and a FiO2 of 0.5 (Group A or using a venturi mask of FiO2 of 0.5 (Group B . All patients were observed postoperatively upto 18 h and were screened by ABG analyses at 6, 12 and 18 h of treatment. SpO2, ECG, heart rate, respiratory rate, temperature and NIBP were monitored throughout the study period. Patients in Group A showed significant improvement in early achievement of adequate oxygenation than those in Group B, although, due to intolerance to CPAP therapy two patients in Group A needed reintubation to maintain adequate oxygenation. To conclude, oxygenation using continuous positive airway pressure is a safe and effective means in improving gas exchange to treat acute postoperative hypoxaemia in conscious and cooperative patients.

  11. Treating 100 cases of abdominal distension following surgery by acupuncture%温针灸治疗术后腹胀100例

    Institute of Scientific and Technical Information of China (English)

    王美英; 卢智; 王润云

    2015-01-01

    Objective:To explore clinical efficacy of acupuncture on abdominal distension following surgery. Methods:100 cases of abdominal distension following surgery were given acupuncture treatment. After treatment , the efficacy was determined according to the Chinese disease diagnosis and efficacy standards published by SDA. Results:After treatment, in 100 cases, 62 cases were cured, effective 35 cases, improvement 3 cases;the total efficiency was 100%. Conclusion:Acupuncture on abdominal distension following surgery shows an obvious efficacy.%目的:探讨应用温针灸治疗术后腹胀的临床疗效。方法:所选100例均为术后胀气患者,均给予温针灸治疗。治疗后根据中医药管理局颁发的《中医病症诊断疗效标准》判定疗效。结果:100例患者治疗后,治愈62例,显效35例,好转3例,有效率为100%。结论:温针灸治疗术后腹胀疗效显著。

  12. 大黄加芒硝外敷腹部配合综合护理治疗腹部手术患者腹胀临床观察%Clinical observation of Rhubarb and mirabilite with comprehensive nursing in treatment of abdominal surgery in patients with abdominal distension

    Institute of Scientific and Technical Information of China (English)

    周小飞; 陈巧英

    2015-01-01

    目的:分析大黄加芒硝外敷腹部配合综合治疗腹部手术患者腹胀临床效果。方法本研究选取2014年6月~2015年9月收治的90例妇科腹部手术后腹胀患者,根据随机原则分成常规组和综合组。其中45例常规组患者实施常规妇科术后护理,45例综合组患者以大黄加芒硝外敷腹部配合综合治疗。对2组患者腹胀持续时间、肛门排气时间、肠鸣音恢复时间、首次排便时间、患者治疗效果、干预前后患者焦虑、抑郁情绪和生活质量变化进行比较。结果与常规组相比较,综合组腹胀持续时间、肛门排气时间、肠鸣音恢复时间、首次排便时间更短( P<0.05)。与常规组相比较,干预后综合组焦虑、抑郁情绪和生活质量更优( P<0.05)。结论大黄加芒硝外敷腹部配合综合治疗腹部手术患者腹胀临床效果确切,有助于改善患者负性情绪和腹胀症状,提升患者生活质量。%Objective To study the clinical effect of complex treatment combined with external application of Rhubarb and Mirabilite on abdomen of patients with abdominal distension after abdominal surgery .Methods 90 patients with abdominal distension after gynecological abdominal surgery from June 2014 to September 2015 were randomly divided into conventional group(45 patients) and comprehensive group(45 patients).Patients in the conventional group were given routine gynecological postoperative care, and patients in the comprehensive group were given complex treatment combined with external application of Rhubarb and Mirabilite on abdomen.The abdominal distension duration, anal exhaust time, time of resuming peristaltic sound, first defecation time, treatment effect, depression and anxiety emotions, changes of life quality of the two groups before and after intervention were compared.Results The comprehensive group had higher treatment effect than the comprehensive group ( P<0.05 ) .The abdominal

  13. Standards of Reporting of Randomized Controlled Trials in General Surgery

    Science.gov (United States)

    Balasubramanian, Sabapathy P.; Wiener, Martin; Alshameeri, Zeiad; Tiruvoipati, Ravindranath; Elbourne, Diana; Reed, Malcolm W.

    2006-01-01

    Objective: To evaluate the quality of reporting of surgical randomized controlled trials published in surgical and general medical journals using Jadad score, allocation concealment, and adherence to CONSORT guidelines and to identify factors associated with good quality. Summary Background Data: Randomized controlled trials (RCTs) provide the best evidence about the relative effectiveness of different interventions. Improper methodology and reporting of RCTs can lead to erroneous conclusions about treatment effects, which may mislead decision-making in health care at all levels. Methods: Information was obtained on RCTs published in 6 general surgical and 4 general medical journals in the year 2003. The quality of reporting of RCTs was assessed under masked conditions using allocation concealment, Jadad score, and a CONSORT checklist devised for the purpose. Results: Of the 69 RCTs analyzed, only 37.7% had a Jadad score of ≥3, and only 13% of the trials clearly explained allocation concealment. The modified CONSORT score of surgical trials reported in medical journals was significantly higher than those reported in surgical journals (Mann-Whitney U test, P < 0.001). Overall, the modified CONSORT score was higher in studies with higher author numbers (P = 0.03), multicenter studies (P = 0.002), and studies with a declared funding source (P = 0.022). Conclusion: The overall quality of reporting of surgical RCTs was suboptimal. There is a need for improving awareness of the CONSORT statement among authors, reviewers, and editors of surgical journals and better quality control measures for trial reporting and methodology. PMID:17060756

  14. Cisatracurium in different doses versus atracurium during general anesthesia for abdominal surgery

    Directory of Open Access Journals (Sweden)

    El-Kasaby A

    2010-01-01

    Full Text Available Background: Cisatracurium in clinical practice is devoid of histamine-induced cardiovascular effects. On the other hand, 2 ED 95 doses of cisatracurium (100 μg/kg do not create satisfactory intubating conditions such as those seen with equipotent doses of atracurium. The recommended intubating dose of cisatracurium is 3 ED 95 . To understand this discrepancy better, we evaluated the potency and onset of atracurium and cisatracurium. Materials and Methods: The study designed as randomized controlled clinical trial to compare between atracurium (2ΧED 95 and different doses of cisatracurium (2ΧED 95 , 4ΧED 95 , 6ΧED 95 regarding onset time, duration of action, condition of intubation, hemodynamic effects, and sings of histamine release clinically. Sixty four patients were randomly assigned to one of four groups, the first group (group 1 received 2ΧED 95 dose of atracurium, group 2 received 2ΧED 95 dose of cisatracurium , group 3 received 4ΧED 95 dose of cisatracurium, while group 4 received 6ΧED 95 dose of cisatracurium. The Datex relaxograph (Type NMT-100-23-01, S/N: 37541 for neuromuscular monitoring was used. Results : HR, MABP was statistically significant increased post-intubation with administration of 2ΧED 95 dose of atracurium in group 1 and the same dose of cisatracurium in group 2 but 5-20 min later was not statistically significant with administration of 4ΧED 95 and 6ΧED 95 doses of cisatracurium in groups 3 and 4, respectively. Onset time was found to be significantly lower with 2ΧED 95 dose of atracurium than with the same dose of cisatracurium. At the same time, higher doses of cisatracurium (4ΧED 95 and 6ΧED 95 showed onset time and longer duration of action that was significantly lower than with atracurium and with lower dose of cisatracurium (2ΧED 95 . Only 6ΧED 95 dose of cisatracurium showed statistically significant difference versus the atracurium dose with higher percentages of patients with excellent

  15. Comparison of Diaphragmatic Breathing Exercise, Volume and Flow Incentive Spirometry, on Diaphragm Excursion and Pulmonary Function in Patients Undergoing Laparoscopic Surgery: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Gopala Krishna Alaparthi

    2016-01-01

    Full Text Available Objective. To evaluate the effects of diaphragmatic breathing exercises and flow and volume-oriented incentive spirometry on pulmonary function and diaphragm excursion in patients undergoing laparoscopic abdominal surgery. Methodology. We selected 260 patients posted for laparoscopic abdominal surgery and they were block randomization as follows: 65 patients performed diaphragmatic breathing exercises, 65 patients performed flow incentive spirometry, 65 patients performed volume incentive spirometry, and 65 patients participated as a control group. All of them underwent evaluation of pulmonary function with measurement of Forced Vital Capacity (FVC, Forced Expiratory Volume in the first second (FEV1, Peak Expiratory Flow Rate (PEFR, and diaphragm excursion measurement by ultrasonography before the operation and on the first and second postoperative days. With the level of significance set at p<0.05. Results. Pulmonary function and diaphragm excursion showed a significant decrease on the first postoperative day in all four groups (p<0.001 but was evident more in the control group than in the experimental groups. On the second postoperative day pulmonary function (Forced Vital Capacity and diaphragm excursion were found to be better preserved in volume incentive spirometry and diaphragmatic breathing exercise group than in the flow incentive spirometry group and the control group. Pulmonary function (Forced Vital Capacity and diaphragm excursion showed statistically significant differences between volume incentive spirometry and diaphragmatic breathing exercise group (p<0.05 as compared to that flow incentive spirometry group and the control group. Conclusion. Volume incentive spirometry and diaphragmatic breathing exercise can be recommended as an intervention for all patients pre- and postoperatively, over flow-oriented incentive spirometry for the generation and sustenance of pulmonary function and diaphragm excursion in the management of

  16. RANDOMIZED CONTROLLED TRIALS OF MATERNAL-FETAL SURGERY : A CHALLENGE TO CLINICAL EQUIPOISE

    NARCIS (Netherlands)

    Rodrigues, H. C. M. L.; van den Berg, P. P.

    2014-01-01

    This article focuses on maternal-fetal surgery (MFS) and on the concept of clinical equipoise that is a widely accepted requirement for conducting randomized controlled trials (RCT). There are at least three reasons why equipoise is unsuitable for MFS. First, the concept is based on a misconception

  17. Ultrasonic root-end preparation in apical surgery : a prospective randomized study

    NARCIS (Netherlands)

    de Lange, Jan; Putters, Thomas; Baas, Erik M.; van Ingen, Johan M.

    2007-01-01

    Objective. The purpose of this study was to evaluate the potential benefit of an ultrasonic device in apical surgery on the outcome of treatment. Study design. A randomized prospective design was used in a standardized treatment protocol. Patients were allocated to treatment with an ultrasonic devic

  18. Comparison of clinical curative effect between open surgery and endovascular repair of abdominal aortic aneurysm in China

    Institute of Scientific and Technical Information of China (English)

    WANG Si-wen; LIN Ying; YAO Chen; LIN Pei-liang; WANG Shen-ming

    2012-01-01

    Objective To compare clinical curative effects of open surgery (OS) or endovascular repair (EVAR) for patients with abdominal aortic aneurysm (AAA) in China.Data sources We performed a comprehensive search of both English and Chinese literatures involving case studies on retrograde OS or EVAR of AAA in China from January 1976 to December 2010.Study selection According to the inclusion criteria,76 articles were finally analyzed to compare patient characteristics,clinical success,complications,and prognosis.Results We analyzed a total of 2862 patients with 1757 undergoing OS (OS group) and 1105 undergoing EVAR (EVAR group).There was no significant difference in the success rate of the procedures.Operative time,length of ICU stay,fasting time,duration of total postoperative stay,blood loss,and blood transfusion requirements during the procedure were significantly lower in the EVAR group.A 30-day follow up revealed more cardiac,renal,pulmonary,and visceral complications in the OS group (P<0.01).Low-limb ischemia,however,was more common in the EVAR group (P<0.05).The 30-day mortality rate,including aorta-related and non-aorta related mortality,was significantly lower in the EVAR group (P<0.01).In the follow-up period,there were more patients with occlusions of artificial vessel and late endoleak in the EVAR group (P<0.01).The overall late mortality rate was higher in the OS group (P <0.01),especially non-aorta-related late mortality and mortality during the fourth to the sixth year (P<0.01).Conclusions EVAR was safer and less invasive for AAA patients.Patients suffered fewer complications and recovered sooner.However,complications such as artificial vessel occlusion,low-limb ischemia,and endoleak were common in EVAR.Clinicians should carry out further research to solve these complications and improve the efficacy of EVAR.

  19. Effect of intermediate care on mortality following emergency abdominal surgery. The InCare trial: study protocol, rationale and feasibility of a randomised multicentre trial

    Directory of Open Access Journals (Sweden)

    Vester-Andersen Morten

    2013-02-01

    Full Text Available Abstract Background Emergency abdominal surgery carries a 15% to 20% short-term mortality rate. Postoperative medical complications are strongly associated with increased mortality. Recent research suggests that timely recognition and effective management of complications may reduce mortality. 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 potentially influence the survival of many high-risk surgical patients. As a pioneer trial in the area, it will provide important data on the feasibility of future large-scale randomised clinical trials evaluating different levels of postoperative care. Trial registration Clinicaltrials.gov identifier: NCT01209663

  20. Surgery of infrarenal inflammatory aneurysm of abdominal aorta infected with methicillin resistant Staphylococcus aureus in a patient undergoing haemodialysis

    Directory of Open Access Journals (Sweden)

    Babić Srđan

    2008-01-01

    Full Text Available INTRODUCTION Inflammatory abdominal aortic aneurysm accounts for 5% to 10% of all cases of abdominal aortic aneurysm and differs from typical atherosclerotic abdominal aortic aneurysm in many important ways. Although both inflammatory and atherosclerotic abdominal aortic aneurysms most commonly affect the infrarenal portion of the abdominal aorta, patients with the inflammatory variant are younger and usually symptomatic, chiefly from back or abdominal pain. Unlike patients with atherosclerotic abdominal aortic aneurysm, most with the inflammatory variant have an elevated erythrocyte sedimentation rate or abnormalities of other serum inflammatory markers. Computed tomography and magnetic resonance imaging are both sensitive for demonstrating the cuff of soft tissue inflammation surrounding the aneurysm that is characteristic of inflammatory abdominal aortic aneurysm. Inflammatory abdominal aortic aneurysm can be primarily infected by degenaration of an infected artery (in less than 1% of cases, or can become secondary infected in the already existing aneurysm. Secondary infection of the pre-existing aneurysm has big influence on treatment choice, but is also rare. Clinically non-symptomatic infection, also known as bacterial collonisation, can be very frequent, regarding a greatly increased number of positive intraoperative findings (10-15%. Prolonged intravascular catheterization, vascular grafting, repeated punctures with large bore needles, and decreased immune defense mechanism make uraemic patients undergoing hemodialysis more likely to develop Staphylococcus aureus bacteraemia and its complications. CASE OUTLINE The case shows a gigantic inflammatory aneurysm of the abdominal aorta, localized infrarenally, which was solved successfully by resection of the aneurysm of the abdominal aorta, and interposition of Dacron tubular graft 22 mm. Bacterial examination of the aneurysmal sac was positive: methicillin-resistent Staphylococcus aureus was

  1. 七氟醚联合骶管麻醉在患儿下腹部手术中的应用%Sevoflurane Combined with Caudal Anesthesia in Pediatric Abdominal Surgery

    Institute of Scientific and Technical Information of China (English)

    赵会奇

    2015-01-01

    目的:探讨七氟醚联合骶管麻醉在患儿下腹部手术中的应用。方法收集2012年4月至2014年4月于本院行下腹部手术的患儿88例资料,将患儿按照随机数字表法分为两组,对照组患者应用七氟醚麻醉,观察组患者行七氟醚联合骶管麻醉,观察比较两组患者各时点平均动脉压(MAP)、心率(HR),诱导时间及苏醒时间比较情况。结果麻醉后观察组各时点MAP、HR均低于对照组,差异均有统计学意义(均P<0.05)。结论小儿下腹部手术应用七氟醚联合骶管麻醉,获得明显效果。%Objective To investigate the sevoflurane combined caudal anesthesia in pediatric abdominal surgery applications.Methods Data selected at random from April 2012 to April 2014 to 88 cases in children under hospital abdominal surgery,according to a random number table is divided into two groups,the application of the patients in the control group sevoflurane anesthesia,patients in the observation group of seven desflurane combined caudal anesthesia,two groups were compared at each time point were observed in mean arterial pressure(MAP),heart rate (HR),the induction time and wake time comparison situation.Results Observation group at al time points after anesthesia MAP,HR values were lower than the control group,the difference was statisticaly significant(P<0.05). Conclusion Pediatric abdominal surgery under sevoflurane combined caudal anesthesia,achieve significant results.

  2. 罗库溴铵不同给药方式对腹部手术术后拔管的影响%The impact of extubation after abdominal surgery for administration of rocuronium in different ways

    Institute of Scientific and Technical Information of China (English)

    颜娅; 闫红

    2012-01-01

    Objective To compare the impact of postoperative extubation of Abdominal surgery compared rocuronium administration of different ways. Methods From January 2010 to June 2011, patients selectd under general anesthesia undergoing elective surgery 110 patients were randomly divided into intermittent administration of rocuronium group (control group) and the continuous infusion group (observation group), neuromuscular blockade were recorded time and the maximum block onset time, the recovery process, and record rocuronium dosage. Results In the treatment onset time, muscle Songwei holding time, the dosage, the average pumping rate, the difference between the two groups were statistically significant (P < 0.05); Observed after discontinuation of neuromuscular recovery group was significantly faster than the control group (P < 0.01). Conclusion Continuous infusion of muscle relaxants rocuronium surgery for abdominal muscle relaxant to provide satisfactory conditions, and neuromuscular recovery after treatment is significantly shorter abdominal surgery "fast track" the ideal anesthetic drug approach.%目的 比较腹部手术中罗库溴铵不同给药方式对术后拔管的影响.方法 2010年1月~2011年6月,选取我院全麻下行开腹手术的患者共110例,随机分成罗库溴铵间断给药组(对照组)和持续泵注组(观察组),分别记录神经肌肉阻滞的最大阻滞时间及起效时间、恢复过程,并记录罗库溴铵的用药量.结果 在用药后起效时间、肌松维持时间、用药量、平均泵注速率上,两组患者差异有统计学意义(P < 0.05);停药后观察组的肌松恢复过程明显快于对照组(P < 0.01).结论 持续泵注肌松药罗库溴铵可为腹部手术提供满意的肌松条件,且停药后肌松恢复过程明显缩短是腹部手术"快通道"麻醉的理想用药方式.

  3. Electroacupuncture Reduces Postoperative Pain and Analgesic Consumption in Patients Undergoing Thoracic Surgery: A Randomized Study

    Science.gov (United States)

    Chen, Tongyu; Xu, Jianjun; Ma, Wen; Zhou, Jia

    2016-01-01

    The aim of this study was to evaluate the effect of electroacupuncture (EA) on postoperative pain management in patients undergoing thoracic surgery. A randomized study was conducted. Ninety-two thoracic surgical patients were randomly divided into an EA group and a sham group. Postoperative intravenous analgesia was applied with a half dose of the conventional drug concentration in both groups. In the EA group, EA treatment was administered for three consecutive days after the surgery with 6 sessions of 30 min each. Compared with the sham group, patients in the EA group had a lower visual analogue scale (VAS) score at 2, 24, 48, and 72 hours and consumed less analgesic after surgery. The incidence of opioid-related adverse effects of nausea was lower in the EA group. The time to first flatus and defecation was also shorter in the EA group. Furthermore, the plasma β-endorphin (β-EP) level was higher by radioimmunoassay and the plasma 5-hydroxytryptamine (5-HT) level was lower in the EA group by enzyme-linked immunosorbent assay during the first 72 hr after thoracic surgery. Therefore, EA is suitable as an adjunct treatment for postoperative pain management after thoracic surgery. PMID:27073400

  4. Thin's abdominal acupuncture for treatment 0f failed back surgery syndrome in 20 cases of clinical observation%薄氏腹针治疗腰椎手术失败综合征20例临床观察

    Institute of Scientific and Technical Information of China (English)

    黄海涛; 郑盛惠; 冯军; 王曙辉; 任蓉; 姜健; 杨丽霞

    2012-01-01

    目的:观察薄氏腹针治疗腰椎手术失败综合征的临床疗效及对血清前列腺素E2(PGE2)、白介素-1β(IL-1β)的影响.方法:将40例本病患者随机分为腹针组与常规针刺组各20例,另设正常组20例.腹针组采用腹针疗法,常规针刺组采用常规针刺疗法.观察两组的临床疗效并测定两组患者治疗前、后血清PGE2、IL-1β水平.结果:两组患者治疗后VAS评分均明显降低,腹针组优于常规针刺组,差异有统计学意义(P<0.05,P<0.01);腹针组总有效率为95.0%,常规针刺组为80.0%,两组比较,差异有统计学意义(P<0.05).两组患者治疗前血清PGE:、IL-1β水平较正常组升高,经治疗后均明显降低,以腹针组更加明显,差异有统计学意义(P<0.05,P<0.01).结论:腹针疗法治疗腰椎手术失败综合征疗效确切,能有效降低VAS评分及血清PCE2、IL-1β含量,可能为其作用机制之一.%Objective: To observe the clinical efficacy of abdominal acupuncture for treatment of thin's failed back surgery syndrome and serum prostaglandin E2 (PGE2), white interleukin-1 β (IL-1β). Methods: 40 cases the patients were randomly divided into 20 cases of abdominal acupuncture group and the routine acupuncture group, separate group of 20 cases. Abdominal acupuncture group were treated with abdominal acupuncture, routine acupuncture group with routine acupuncture. The clinical efficacy of the two groups were observed and measured the two groups of patients, serum PGE2, IL-1β levels. Results: After treatment, VAS scores were significantly lower abdominal acupuncture group was better than the routine acupuncture group, the difference was statistically significant(PP<0.05, <0.01); abdominal acupuncture group, the total effective rate was 95.0%, the conventional needle The acupuncture group was 80.0%, respectively, the difference was statistically significantP< 0.05). The two groups before treatment serum PGE2, IL-1β levels than the normal group increased

  5. Standard abdominal wound edge protection with surgical dressings vs coverage with a sterile circular polyethylene drape for prevention of surgical site infections (BaFO: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Mihaljevic André L

    2012-05-01

    Full Text Available Abstract Background Postoperative surgical site infections cause substantial morbidity, prolonged hospitalization, costs and even mortality and remain one of the most frequent surgical complications. Approximately 14% to 30% of all patients undergoing elective open abdominal surgery are affected and methods to reduce surgical site infection rates warrant further investigation and evaluation in randomized controlled trials. Methods/design To investigate whether the application of a circular plastic wound protector reduces the rate of surgical site infections in general and visceral surgical patients that undergo midline or transverse laparotomy by 50%. BaFO is a randomized, controlled, patient-blinded and observer-blinded multicenter clinical trial with two parallel surgical groups. The primary outcome measure will be the rate of surgical site infections within 45 days postoperative assessed according to the definition of the Center for Disease Control. Statistical analysis of the primary endpoint will be based on the intention-to-treat population. The global level of significance is set at 5% (2 sided and sample size (n = 258 per group is determined to assure a power of 80% with a planned interim analysis for the primary endpoint after the inclusion of 340 patients. Discussion The BaFO trial will explore if the rate of surgical site infections can be reduced by a single, simple, inexpensive intervention in patients undergoing open elective abdominal surgery. Its pragmatic design guarantees high external validity and clinical relevance. Trial registration http://www.clinicaltrials.gov NCT01181206. Date of registration: 11 August 2010; date of first patient randomized: 8 September 2010

  6. The Effect of Honey Gel on Abdominal Wound Healing in Cesarean Section: A Triple Blind Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Maryam Nikpour

    2014-07-01

    Full Text Available Objective: To assess whether honey can accelerate the wound healing in women undergoing cesarean section. Methods: This was a triple blinded randomized prospective clinical trial. Women with cesarean section were randomly designated as drug (37 cases and placebo (38 cases groups. The drug group received local honey gel 25% while the placebo group received similar free-honey gel on abdominal cesarean incision twice a day for 14 days. REEDA scale (Redness, Edema, Ecchymosis, Discharge and Approximation of wound edges was used to assess wound healing. Results: The mean REEDA was 2.27 ± 2.46 and 3.91 ± 2.74 (p=0.008 on the 7th day and 0.47 ± 0.84 and 1.59± 1.95 (p=0.002 on the 14th day for the drug and placebo groups, respectively. Redness, edema and hematoma in the drug group were significantly lower on the 7th and 14th days. Conclusion: Honey was effective in healing the cesarean section incision. Using topical honey is suggested as a natural product with rare side effects in order to reduce the complications of cesarean wounds.

  7. The Anxiolytic Effect of Aromatherapy on Patients Awaiting Ambulatory Surgery: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Cheng-Hua Ni

    2013-01-01

    Full Text Available The aim of this study was to determine if aromatherapy could reduce preoperative anxiety in ambulatory surgery patients. A total of 109 preoperative patients were randomly assigned to experimental (bergamot essential oil and control (water vapor conditions and their responses to the State Trait Anxiety Inventory and vital signs were monitored. Patients were stratified by previous surgical experience, but that did not influence the results. All those exposed to bergamot essential oil aromatherapy showed a greater reduction in preoperative anxiety than those in the control groups. Aromatherapy may be a useful part of a holistic approach to reducing preoperative anxiety before ambulatory surgery.

  8. Core muscle size assessed by perioperative abdominal CT scan is related to mortality, postoperative complications, and hospitalization after major abdominal surgery

    DEFF Research Database (Denmark)

    Hasselager, Rune; Gögenur, Ismail

    2014-01-01

    PURPOSE: Risk stratification of patients prior to surgery is important for reduction of postoperative morbidity and mortality. The frailty concept has been put forward as a good predictor of surgical outcomes. Sarcopenia (depletion of muscle mass) can be used to measure frailty. We aimed to syste......PURPOSE: Risk stratification of patients prior to surgery is important for reduction of postoperative morbidity and mortality. The frailty concept has been put forward as a good predictor of surgical outcomes. Sarcopenia (depletion of muscle mass) can be used to measure frailty. We aimed...

  9. Screening Models for Cardiac Risk Evaluation in Emergency Abdominal Surgery. I. Evaluation of the Intraoperative Period Risk based on Data from the Preoperative Period

    Directory of Open Access Journals (Sweden)

    Mikhail Matveev

    2008-04-01

    Full Text Available A classification of intraoperative cardio-vascular complications (CVC was performed, based on data from 466 patients subjected to emergency surgery, due to severe abdominal surgical diseases or traumas, in accordance with the severe criteria of ACC/AHA for CVC in noncardiac surgery. There were 370 intraoperative CVC registered, distributed as follows: groups with low risk (148, moderate risk (200, and high risk (22. Patient groups were formed, according to the CVC risk level, during the intraoperative period, for which the determinant factor for the group distribution of patients was the complication with the highest risk. Individual data was collected for each patient, based on 65 indices: age, physical status, diseases, surgical interventions, anaesthesiological information, intra and postoperative cardio-vascular complications, disease outcome, causes of death, cardiovascular disease anamnesis, anamnesis of all other nonsurgical diseases present, laboratory results, results from all imaging and instrumental examinations, etc. On the basis of these indices, a new distribution of the risk factors was implemented, into groups with different levels of risk of CVC during intraoperative period. This result is a solid argument, substantiating the proposal to introduce these adjustments for determining the severity of CVC in the specific conditions of emergency abdominal surgery.

  10. TRANSVERSUS ABDOMINIS PLANE BLOCK : A COMPLEMENTARY TECHNIQUE FOR POST OPERATIVE ANALGESIA IN LOWER ABDOMINAL GYNECOLOGICAL CANCER SURGERIES

    Directory of Open Access Journals (Sweden)

    Arathi

    2015-06-01

    Full Text Available BACKGROUND : Gynecological cancer surgeries differ from non - cancer surgeries as the former involves extensive dissection , and tissue handling , which contributes to increased nociception perioperatively. Radical hysterectomy with pelvic lymph node dissection is one of the most commonly performed surgeries in gynecological oncological set up. Transversus abdominis plane (TAP block is one of the new promising regional anesthesia technique complementing multi modal analgesic regimen. This is a prospective randomized controlled trial. We evaluated the role of the TAP block in Radical hysterectomy with pelvic lymph node dissection for periope rative analgesia and reducing the requirement of opioid consumption . METHODS : 100 patients of ASA grade 1 and 2 undergoing radical hysterectomy and pelvic lymph node dissection with below umbilical incision were randomized as block group to undergo TAP blo ck with bupivacaine 0.25% 20ml on each side (n=50 , versus non - block group (n=50. All patients received general anesthethesia. Block was performed before surgical incision bilaterally by using blind double pop technique in patients who were randomized to the block group. Intra operative analgesic regimen was with inj fentanyl 1.5 mic/k.g , repeated with 0.5mic/k.g depending on the requirement as assessed by the anaesthe - siologist based on haemodynamic parameters and post operatively by pain scores on numeri c visual analogue scale with inj . paracetamol 1gm followed by tramadol 2mg/kg and fentany 0.5mic/kg . Each patient was assessed post operatively at 0 , 2 , 4 , 6 , 8 , 12 , 16 , 20 , 24 hours for pain , nausea , vomiting and sedation . The data recorded . Descriptive a nd inferential sta ti stical analysis has been carried out using student t test , chi square/ fisher exact test in the present study. RESULTS : We studied 100 patients , 50 patients in block group and 50 patients in non - block group. The block group had significantly less pain

  11. EVALUATION OF THE ANALGESIC EFFICACY AND SAFETY OF INTRAVENOUS PARACETAMOL IN COMPARISION TO INTRAVENOUS TRAMADOL FOR POST - OPERATIVE ANALGEISA IN PATIENTS UNDERGOING LOWER ABDOMINAL SURGERY

    Directory of Open Access Journals (Sweden)

    Rupankar

    2015-01-01

    Full Text Available Aims: To compare the efficacy of IV Paracetamol versus IV Tramadol for post - operative pain relief in cases undergoing lower abdominal surgery. METHODS AND MATERIAL: The study included 150 patients aged between 18 - 50 years of ASA I and ASA II physical statu s who underwent elective lower abdominal surgery. The patients were divided into two groups of seventy five patients each. Group P received IV Paracetamol 15mg/kg and Group T received IV Tramadol 2mg/Kg. Parameters recorded in our study were pain score, se dation score, pulse rate, mean arterial pressure, SpO 2 duration of analgesia, total number of rescue analgesics, and complications like Nausea and vomiting, hypotension, bradycardia and respiratory depression. The magnitude of change occurring in the diffe rent groups at each interval was also compared. STATISTICAL ANALYSIS USED: Student T test, Mann whitney test, Chi square test, analysis of variance . RESULTS: The demographic profiles were comparable among the two groups. The mean duration of post - operative analgesia was 372.40 ±60.46 minutes in Group P and 369.86 ±64.39 minutes in Group T( P >0.05. The visual analogue scale (VAS scores were comparable in both the groups. The number of doses of rescue analgesia required in postoperative period was similar. S edation score was assessed in both group and it was found that tramadol group subjects were more sedated compared to the paracetamol group. Complications like nausea and vomiting were found more in tramadol group than paracetamol group. CONCLUSIONS: Intrav enous paracetamol is a safer and effective non - opioid analgesic for the treatment of postoperative pain in patient undergoing lower abdominal surgery.

  12. The Anxiolytic Effect of Aromatherapy on Patients Awaiting Ambulatory Surgery: A Randomized Controlled Trial

    OpenAIRE

    Cheng-Hua Ni; Wen-Hsuan Hou; Ching-Chiu Kao; Ming-Li Chang; Lee-Fen Yu; Chia-Che Wu; Chiehfeng Chen

    2013-01-01

    The aim of this study was to determine if aromatherapy could reduce preoperative anxiety in ambulatory surgery patients. A total of 109 preoperative patients were randomly assigned to experimental (bergamot essential oil) and control (water vapor) conditions and their responses to the State Trait Anxiety Inventory and vital signs were monitored. Patients were stratified by previous surgical experience, but that did not influence the results. All those exposed to bergamot essential oil aromath...

  13. The Effect of Aromatherapy Abdominal Massage on Alleviating Menstrual Pain in Nursing Students: A Prospective Randomized Cross-Over Study

    Directory of Open Access Journals (Sweden)

    Tyseer M. F. Marzouk

    2013-01-01

    Full Text Available Dysmenorrhea is a common cause of sickness absenteeism from both classes and work. This study investigated the effect of aromatherapy massage on a group of nursing students who are suffering of primary dysmenorrhea. A randomized blind clinical trial of crossover design was used. In the first treatment phase, group 1 ( received aromatherapy abdominal massage once daily for seven days prior to menstruation using the essential oils (cinnamon, clove, rose, and lavender in a base of almond oil. Group 2 ( received the same intervention but with placebo oil (almond oil. In the second treatment phase, the two groups switched to alternate regimen. Level and duration of pain and the amount of menstrual bleeding were evaluated at the baseline and after each treatment phase. During both treatment phases, the level and duration of menstrual pain and the amount of menstrual bleeding were significantly lower in the aromatherapy group than in the placebo group. These results suggests that aromatherapy is effective in alleviating menstrual pain, its duration and excessive menstrual bleeding. Aromatherapy can be provided as a nonpharmacological pain relief measure and as a part of nursing care given to girls suffering of dysmenorrhea, or excessive menstrual bleeding.

  14. A Randomized Controlled Trial of Lorazepam to Reduce Liver Motion in Patients Receiving Upper Abdominal Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Tsang, Derek S.; Voncken, Francine E.M.; Tse, Regina V. [Princess Margaret Cancer Centre, University Health Network, Department of Radiation Oncology, University of Toronto, Toronto (Canada); Sykes, Jenna [Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto (Canada); Wong, Rebecca K.S.; Dinniwell, Rob E.; Kim, John; Ringash, Jolie; Brierley, James D.; Cummings, Bernard J.; Brade, Anthony [Princess Margaret Cancer Centre, University Health Network, Department of Radiation Oncology, University of Toronto, Toronto (Canada); Dawson, Laura A., E-mail: laura.dawson@rmp.uhn.on.ca [Princess Margaret Cancer Centre, University Health Network, Department of Radiation Oncology, University of Toronto, Toronto (Canada)

    2013-12-01

    Purpose: Reduction of respiratory motion is desirable to reduce the volume of normal tissues irradiated, to improve concordance of planned and delivered doses, and to improve image guided radiation therapy (IGRT). We hypothesized that pretreatment lorazepam would lead to a measurable reduction of liver motion. Methods and Materials: Thirty-three patients receiving upper abdominal IGRT were recruited to a double-blinded randomized controlled crossover trial. Patients were randomized to 1 of 2 study arms: arm 1 received lorazepam 2 mg by mouth on day 1, followed by placebo 4 to 8 days later; arm 2 received placebo on day 1, followed by lorazepam 4 to 8 days later. After tablet ingestion and daily radiation therapy, amplitude of liver motion was measured on both study days. The primary outcomes were reduction in craniocaudal (CC) liver motion using 4-dimensional kV cone beam computed tomography (CBCT) and the proportion of patients with liver motion ≤5 mm. Secondary endpoints included motion measured with cine magnetic resonance imaging and kV fluoroscopy. Results: Mean relative and absolute reduction in CC amplitude with lorazepam was 21% and 2.5 mm respectively (95% confidence interval [CI] 1.1-3.9, P=.001), as assessed with CBCT. Reduction in CC amplitude to ≤5 mm residual liver motion was seen in 13% (95% CI 1%-25%) of patients receiving lorazepam (vs 10% receiving placebo, P=NS); 65% (95% CI 48%-81%) had reduction in residual CC liver motion to ≤10 mm (vs 52% with placebo, P=NS). Patients with large respiratory movement and patients who took lorazepam ≥60 minutes before imaging had greater reductions in liver CC motion. Mean reductions in liver CC amplitude on magnetic resonance imaging and fluoroscopy were nonsignificant. Conclusions: Lorazepam reduces liver motion in the CC direction; however, average magnitude of reduction is small, and most patients have residual motion >5 mm.

  15. ONDANSETRON FOR THE PREVENT OF POSTOPERATIVE NAUSEA AND VOMITING FOLLOWING UPPER ABDOMINAL SURGERY ONDANSETRON FOR THE PREVENT OF POSTOPERATIVE NAUSEA AND VOMITING FOLLOWING UPPER ABDOMINAL SURGERY%恩丹西酮预防全麻上腹部 手术后恶心呕吐的临床研究

    Institute of Scientific and Technical Information of China (English)

    赵双平; 郭曲练; 杨浩汉; 熊云川

    2001-01-01

    探讨静脉注射恩丹西酮的时机和剂量对吸静复合全麻上腹部手术 患者术后恶心呕吐的预防效果。方法:150例ASAⅠ~Ⅲ级成人患者随机分成五组。A组:麻 醉诱导前静脉注射恩丹西酮4mg,B组:麻醉诱导前静脉注射恩丹西酮8mg,C组:术毕静脉 注射恩丹 西酮4mg,D组:术毕静脉注射恩丹西酮8mg,E组不用恩丹西酮。结果:A、B、C、D、E组患 者 术后恶心呕吐发生率分别为50.0%,40.0%,53.3%,16.7%,56.7%(P<0.01)。结论 :术毕静脉注射恩丹西酮8mg更能有效预防全麻上腹部术后恶心呕吐。%To evaluate the prophylactic effect of ondansetrom (OND) on postoperative nausea and vomiting (PONV).Methods: One hundred and fifty patients,scheduled for upper abdominal surgery und e r general anesthesia,were randomly allocated into five groups.Group A OND 4mg iv before anesthesia induction,Group B OND 8mg iv before anesthesia induction,Grou p C OND 4mg iv after operation,Group D OND 8mg iv after operation,and Group E without OND. Results:The incidences of nausea and vomiting in gr oup A,B,C,D,E were 50.0%,40.0%,53.3%,167%,56.7% respectively (P<0.01).C onc lusions:Ondansetron 8mg iv after operation can be used effectively to pr event PONV in upper abdominal surgical patients.

  16. Ipsilateral transversus abdominis plane block provides effective analgesia after appendectomy in children: a randomized controlled trial.

    LENUS (Irish Health Repository)

    Carney, John

    2010-10-01

    The transversus abdominis plane (TAP) block provides effective postoperative analgesia in adults undergoing major abdominal surgery. Its efficacy in children remains unclear, with no randomized clinical trials in this population. In this study, we evaluated its analgesic efficacy over the first 48 postoperative hours after appendectomy performed through an open abdominal incision, in a randomized, controlled, double-blind clinical trial.

  17. Application of a hyaluronic acid gel after intrauterine surgery may improve spontaneous fertility: a randomized controlled trial in New Zealand White rabbits.

    Directory of Open Access Journals (Sweden)

    Stephanie Huberlant

    Full Text Available Intrauterine adhesions (IUAs are the most common complication after hysteroscopy in patients of reproductive age. Intra-abdominal anti-adhesion gel reduces the incidence of adhesions, but effects on fertility after uterine surgery are not known. The objective of our work was to evaluate the effect of intrauterine anti-adhesion gel on spontaneous fertility after repeated intrauterine surgery with induced experimental synechiae in the rabbit model.Twenty New Zealand White rabbits underwent a double uterine curettage 10 days apart and were randomized into two groups. Each rabbit served as its own control: one uterine tube was the treatment group (A, the second uterine tube was the control group (B to avoid bias through other causes of infertility. Group A received a post curettage intrauterine instillation of anti-adhesion gel whereas group B, the control group, underwent curettage without instillation of the gel. After a recovery period, the rabbits were mated. An abdominal ultrasound performed 21 days after mating allowed us to diagnose pregnancy and quantify the number of viable fetuses.There was a significant difference in total fetuses in favor of group A, with an average of 3.7 (range, 0-9 total fetuses per tube against 2.1 (0-7 in group B (p = .04. The number of viable fetuses shows a trend in favor of group A, with an average of 3.4 (0-7 viable fetuses per tube against 1.9 (0-6 viable fetuses per tube in group B (p = .05.The use of immediate postoperative anti-adhesion gel improved fertility in an animal model after intrauterine surgery likely to cause uterine synechiae. This experimental model will permit comparison of different anti-adhesion solutions, including assessment of their tolerance and potential mucosal toxicity on embryonic development.

  18. Long-term benefit and cost-effectiveness analysis of screening for abdominal aortic aneurysms from a randomized controlled trial

    DEFF Research Database (Denmark)

    Lindholt, Jes S.; Sørensen, J; Søgaard, R;

    2010-01-01

    The aim was to estimate long-term mortality benefits and cost-effectiveness of screening for abdominal aortic aneurysm (AAA) in men aged 64-73 years.......The aim was to estimate long-term mortality benefits and cost-effectiveness of screening for abdominal aortic aneurysm (AAA) in men aged 64-73 years....

  19. Morbidade respiratória nos pacientes com e sem síndrome pulmonar obstrutiva submetidos a cirurgia abdominal alta Respiratory morbidity in patients with and without pulmonary obstrutive syndrome after upper abdominal surgery

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    E.D.B. Pereira

    2000-03-01

    Full Text Available OBJETIVO: Estudar a morbidade respiratória nos pacientes com síndrome pulmonar obstrutiva submetidos a cirurgia abdominal alta. CASUÍSTICA E MÉTODO: Durante o pré-operatório, 196 pacientes candidatos à cirurgia abdominal alta eletiva responderam a um questionário padronizado e logo em seguida realizaram espirometria. Houve acompanhamento no pós-operatório até a alta hospitalar ou óbito. Os pacientes foram divididos em quatro grupos: 27 pacientes com DPOC (diagnóstico de bronquite crônica ou enfisema e VEF1/CVFBACKGROUND: We wanted to determine the postoperative pulmonary complicatiosn after upper abdominal surgery in patients with pulmonary obstrutive syndrome. METHODS: We have studied 196 patients prospectively analyzed in preoperative period with spirometry and followed for observation of PPC. The patients were divided in four groups: COPD - those with chronic bronchitis or emphysema and VEF1/CVF 70% (23 patients. NORMAL - patients without pulmonary disease and normal spirometry (102 patients. RESULTS: Postoperative pulmonary complication was recognized when the patient presented atelectasis with clinical or gasometric alterations; bronchospasm that needed bronchodilator therapy; respiratory failure; mechanical ventilation or orotracheal entubation more than 48 hours in postosurgery period; tracheobronchitis characterized by the presence of purulent sputum with normal x-ray; pneumonia. Patients with pulmonary obstruction had experienced higher rates of pulmonar complications (32% vs 6%,p<0,05. The presence of obstuctive lung disease was associated with an increased number of ventilator days, but was not associeted with longer intensive care unit or hospital stay. CONCLUSIONS: The incidence of postoperative pulmonary complications was strongly associated with the presence of pulmonary obstrutive syndrome.

  20. 肝胆外科术后腹腔感染的综合护理%Integrated nursing for abdominal infections after hepatobiliary surgery

    Institute of Scientific and Technical Information of China (English)

    程艳爽; 吕少诚; 徐明月; 高国强; 路辉; 张雯雯; 刘同友; 史宪杰

    2012-01-01

    OBJECTIVE To explore the integrated nursing of abdominal infection after hepatobiliary surgery. METHODS We retrospectively analyzed the clinical data of 51 patients with abdominal infections after hepatobiliary surgery between Jan 2009 and Dec 2011. All of the patients were treated by the method of the integrated nursing including unobstructed drainage, vacuum suction, and physiotherapy. RESULTS Of 51 patients with abdominal infections, were isolated, there were 35 case-times of single bacterial infectinos and 16 case-times of wixed infections and totally 61 strains of patnogens were isolated, among which the top three pathogens causing infections were 22 (32. 8%) strains of Enterococcus faecalis , 16 (23. 9%) strains of Escherichia coli, and 12 (17. 9%) strains of Enterococcus faecium ; After the integrated nursing for all the patients, forty-seven patients were cured with the effective rate of 92. 2 %, 4 cases were dead. CONCLUSION To adopt the integrated nursing for abdominal infections after hepatobiliary surgery can contribute to the control and treatment of the infections and decrease the mortality of the patients.%目的 探讨肝胆外科术后腹腔感染的综合护理方法.方法 回顾性分析2009年1月-2011年12月51例肝胆外科术后出现腹腔感染患者的临床资料,所有患者术后采用通畅引流、负压吸引、理疗等综合护理方法.结果 51例腹腔感染患者中送检标本培养阳性67例次,其中单一菌感染35例次,混合感染16例次;共检出病原菌67株,位居前3位的病原菌分别为粪肠球菌22株占32.8%、大肠埃希菌16株占23.9%、屎肠球菌12株占17.9%;所有患者经积极综合护理治疗后,47例治愈,治愈率为92.2%,4例死亡.结论 对肝胆外科术后腹腔感染的患者采用综合护理措施,有助于控制和治疗感染,降低患者的死亡率.

  1. The use of a modified, oscillating positive expiratory pressure device reduced fever and length of hospital stay in patients after thoracic and upper abdominal surgery: a randomised trial

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    Xiang-yu Zhang

    2015-01-01

    Full Text Available Question: Does the use of an oscillating positive expiratory pressure (PEP device reduce postoperative pulmonary complications in thoracic and upper abdominal surgical patients? Design: A multi-centre, parallel-group, randomised controlled trial with intention-to-treat analysis, blinding of some outcomes, and concealed allocation. Participants: A total of 203 adults after thoracic or upper abdominal surgery with general anaesthesia. Intervention: Participants in the experimental group used an oscillating PEP device, thrice daily for 5 postoperative days. Both the experimental and control groups received standard medical postoperative management and early mobilisation. Outcome measures: Fever, days of antibiotic therapy, length of hospital stay, white blood cell count, and possible adverse events were recorded for 28 days or until hospital discharge. Results: The 99 participants in the experimental group and 104 in the control group were well matched at baseline and there was no loss to follow-up. Fever affected a significantly lower percentage of the experimental group (22% than the control group (42%, with a RR of 0.56 (95% CI 0.36 to 0.87, NNT 6. Similarly, length of hospital stay was significantly shorter in the experimental group, at 10.7 days (SD 8.1, than in the control group, at 13.3 days (SD 11.1; the mean difference was 2.6 days (95% CI 0.4 to 4.8. The groups did not differ significantly in the need for antibiotic therapy, white blood cell count or total expense of treatment. Conclusion: In adults undergoing thoracic and upper abdominal surgery, postoperative use of an oscillating PEP device resulted in fewer cases of fever and shorter hospital stay. However, antibiotic therapy and total hospital expenses were not significantly reduced by this intervention. Trial registration: NCT00816881. [Zhang X-y, Wang Q, Zhang S, Tan W, Wang Z, Li J (2015 The use of a modified, oscillating positive expiratory pressure device reduced fever and

  2. Early inflammatory response following elective abdominal aortic aneurysm repair: A comparison between endovascular procedure and conventional, open surgery

    Directory of Open Access Journals (Sweden)

    Marjanović Ivan

    2011-01-01

    Full Text Available Background/Aim. Abdominal aorta aneurysm (AAA represents a pathological enlargment of infrarenal portion of aorta for over 50% of its lumen. The only treatment of AAA is a surgical reconstruction of the affected segment. Until the late XX century, surgical reconstruction implied explicit, open repair (OR of AAA, which was accompanied by a significant morbidity and mortality of the treated patients. Development of endovascular repair of (EVAR AAA, especially in the last decade, offered another possibility of surgical reconstruction of AAA. The preliminary results of world studies show that complications of such a procedure, as well as morbidity and mortality of patients, are significantly lower than with OR of AAA. The aim of this paper was to present results of comparative clinical prospective study of early inflammatory response after reconstruction of AAA between endovascular and open, conventional surgical technique. Methods. A comparative clinical prospective study included 39 patients, electively operated on for AAA within the period of December 2008 - February 2010, divided into two groups. The group I counted 21 (54% of the patients, 58-87 years old (mean 74.3 years, who had been submited to EVAR by the use of excluder stent graft. The group II consisted of 18 (46% of the patients, 49-82 (mean 66.8 years, operated on using OR technique. All of the treated patients in both groups had AAA larager than 50 mm. The study did not include patients who have been treated as urgent cases, due to the rupture or with simptomatic AAA. Clinical, biochemical and inflamatory parameters in early postoperative period were analyzed, in direct postoperative course (number of leucocytes, thrombocytes, serum circulating levels of cytokine - interleukine (IL-2, IL-4, IL-6 and IL-10. Parameters were monitored on the zero, first, second, third and seventh postoperative days. The study was approved by the Ethics Commitee of the Military Medical Academy. Results

  3. ADJUVANT CHEMOTHERAPY FOLLOWING RADICAL SURGERY FOR NON-SMALL CELL LUNG CANCER:A RANDOMIZED STUDY

    Institute of Scientific and Technical Information of China (English)

    XU Guang-chuan; RONG Tie-hua; LIN Peng

    1999-01-01

    Objective: To evaluate the efficacy of adjuvant chemotherapy after radical surgery for non-small cell lung cancer (NSCLC). Methods: Seventy patients with NSCLC (stage Ⅰ-Ⅲ) undergone radical surgery were randomized into two groups: 35 patients received adjuvant chemotherapy with cyclophosphamide (CTX)300 mg/m2, vincristine (VCR) 1.4% mg/m2, adriamycin (ADM) 50 mg/m2, lomustine (CCNU) 50 mg/m2 d1,cisplatin (DDP) 20 mg/m2, d1-5, for 4 cycles, and followed by oral Ftorafur (FT-207) 600-900 mg/d for 1year (adjuvant chemotherapy group). The other 35patients received surgical treatment only (surgery group). Results: The overall 5-year survival rate was 48.6% in the adjuvant chemotherapy group, and 31.4%in the surgery group, respectively. The difference between the two groups was not statistically significant (P>0.05). The 5-year survival rate of patients in stage Ⅲwas 44.0% and 20.8% received surgery with and without adjuvant chemotherapy, respectively. The difference between the two groups was statistically significant (P<0.025). The 5-year survival rate of patients in stage Ⅰ-Ⅱ in the two groups was 60.0% and 54.5%, respectively (P>0.75). Conclusion: Postoperative adjuvant chemotherapy in NSCLC can improve survival, for those patients in stage Ⅲ, it suggests significantly 5-year survival rate in the adjuvant chemotherapy group was higher than that in the surgery alone group.

  4. Short-term intravenous antimicrobial prophylaxis for elective rectal cancer surgery: results of a prospective randomized non-inferiority trial

    OpenAIRE

    ISHIBASHI, KEIICHIRO; Ishida, Hideyuki; KUWABARA, KOUKI; OHSAWA, TOMONORI; OKADA, NORIMICHI; Yokoyama, Masaru; Kumamoto, Kensuke

    2013-01-01

    Purpose To investigate the non-inferiority of postoperative single-dose intravenous antimicrobial prophylaxis to multiple-dose intravenous antimicrobial prophylaxis in terms of the incidence of surgical site infections (SSIs) in patients undergoing elective rectal cancer surgery by a prospective randomized study. Methods Patients undergoing elective surgery for rectal cancer were randomized to receive a single intravenous injection of flomoxef (group 1) or five additional doses (group 2) of f...

  5. Germ cells may survive clipping and division of the spermatic vessels in surgery for intra-abdominal testes

    DEFF Research Database (Denmark)

    Thorup, J M; Cortes, Dina; Visfeldt, J

    1999-01-01

    Laparoscopy is a well described modality that provides an accurate visual diagnosis upon which further management of intra-abdominal testes may be based. Laparoscopic ligation of spermatic vessels as stage 1 of the procedure is a natural extension of laparoscopy. A staged approach provides adequa...

  6. Preinduction incentive spirometry versus deep breathing to improve apnea tolerance during induction of anesthesia in patients of abdominal sepsis: A randomized trial

    OpenAIRE

    Tripathi, M; A. Subedi; A Raimajhi; K Pokharel; Pandey, M.

    2013-01-01

    Background: Abdominal sepsis is associated with varied degree of hypoxemia and atelactasis in the lung and can enhance the onset of desaturation of arterial blood during apnea. Aims : This study looked at methods to improve safety margin of apnea during induction of anesthesia in these high-risk patients. Settings and Design: It was a randomized, single blind study on adult patients presenting for emergency laparotomy due to peritonitis in a university teaching hospital setting. Materials and...

  7. Estudo prospectivo do derrame pleural pós-cirurgia abdominal e dos fatores de risco associados: avalição por ultra-sonografia Pleural effusion following abdominal surgery and associated risk factors: ultrasound assessment

    Directory of Open Access Journals (Sweden)

    Luiz Antonio Rossi

    2005-04-01

    ós-operatório de cirurgia abdominal eletiva é muito freqüente. A maioria dos DPPO é autolimitada, evoluindo de modo assintomático. A ecografia na constatação do DPPO mostrou-se efetiva e sua utilização merece ser difundida.BACKGROUND: Pleural effusion is frequently seen on imaging examinations following elective abdominal surgery and has no clinical significance in most patients. This condition should be distinguished from pulmonary complications that require treatment. OBJECTIVE: To prospectively determine the incidence of pleural effusion in patients submitted to elective abdominal surgery using ultrasound (US, and to assess the possible association with risk factors related to the patients and anesthetic-surgical procedures. MATERIALS AND METHODS: Thirty-seven patients, 21 (56.8% female, and 16 (43.2% male aged 29 to 76 years submitted to elective abdominal surgery were evaluated. US was performed preoperatively and 48 hours after surgery in all patients. Associated risk factors were also assessed - age > 60 years, sex, obesity, smoking history, alcoholism and associated diseases -, and anesthetic-surgical procedure - cancer resection, class ASA > 2, duration of surgery, longitudinal incision and incision > 15 cm. Biliar lithiasis (43.2% and gastrointestinal cancer (43.2% were the main causes leading to surgery. RESULTS: The incidence of postoperative pleural effusion (PPE detected by US was 70.3% (26/37. Two of these patients (5.4% developed pulmonary complications, and one died. The risk factors age > 60 years, smoking history, alcoholism, obesity and associated diseases had no influence on the development of the PPE whereas cancer resection, class ASA > 2, longitudinal incision and incision > 15 cm were significantly statistically associated with the presence of PPE. PPE developed even during antibiotic therapy. The duration of hospitalization was more than 2.4 longer in the patients with PPE. CONCLUSION: PPE is a very frequent condition observed in patients

  8. Effect of adding dexamethasone to bupivacaine on transversus abdominis plane block for abdominal hysterectomy: A prospective randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Amany S Ammar

    2012-01-01

    Full Text Available Purpose: Different adjuvants have been used to improve the quality and increase the duration of local anesthetics during various nerve block techniques. The current study was aimed to evaluate the effect of adding dexamethasone to bupivacaine on the quality and duration of transversus abdominis plane (TAP block. Methods: Sixty adult patients undergoing elective open abdominal hysterectomy were randomly allocated to receive TAP block using 20 mL of bupivacaine hydrochloride 0.25% + 2 mL saline 0.9% (control group, n=30 or 20 mL of bupivacaine hydrochloride 0.25% + 2 mL dexamethasone "8 mg" (dexamethasone group, n=30. The primary outcome was postoperative pain, as evaluated by visual analog scale (VAS for pain scoring at 1, 2, 4, 12, 24 and 48 h postoperatively, whereas the secondary outcomes were time to first analgesia (TFA, morphine consumption and the occurrence of nausea, vomiting or somnolence. Results: The pain VAS score was significantly lower at the postoperative 2 h (4.9 vs. 28.1, P=0.01, 4 h (12.2 vs. 31.1, P=0.01 and 12 h (15.7 vs. 25.4, P=0.02. Furthermore, TFA was significantly longer in the dexamethasone group (459.8 vs. 325.4 min, P=0.002, with lesser morphine requirements in the postoperative 48 h (4.9 vs. 21.2 mg, P=0.003 and lower incidence of nausea and vomiting (6 vs. 14, P=0.03. No complications attributed to the block were recorded. Conclusion: Addition of dexamethasone to bupivacaine in TAP block prolonged the duration of the block and decreased the incidence of nausea and vomiting.

  9. Randomized clinical trial of surgery versus conservative therapy for carpal tunnel syndrome [ISRCTN84286481

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    Turner Judith A

    2005-01-01

    Full Text Available Abstract Background Conservative treatment remains the standard of care for treating mild to moderate carpal tunnel syndrome despite a small number of well-controlled studies and limited objective evidence to support current treatment options. There is an increasing interest in the usefulness of wrist magnetic resonance imaging could play in predicting who will benefit for various treatments. Method and design Two hundred patients with mild to moderate symptoms will be recruited over 3 1/2 years from neurological surgery, primary care, electrodiagnostic clinics. We will exclude patients with clinical or electrodiagnostic evidence of denervation or thenar muscle atrophy. We will randomly assign patients to either a well-defined conservative care protocol or surgery. The conservative care treatment will include visits with a hand therapist, exercises, a self-care booklet, work modification/ activity restriction, B6 therapy, ultrasound and possible steroid injections. The surgical care would be left up to the surgeon (endoscopic vs. open with usual and customary follow-up. All patients will receive a wrist MRI at baseline. Patients will be contacted at 3, 6, 9 and 12 months after randomization to complete the Carpal Tunnel Syndrome Assessment Questionnaire (CTSAQ. In addition, we will compare disability (activity and work days lost and general well being as measured by the SF-36 version II. We will control for demographics and use psychological measures (SCL-90 somatization and depression scales as well as EDS and MRI predictors of outcomes. Discussion We have designed a randomized controlled trial which will assess the effectiveness of surgery for patients with mild to moderate carpal tunnel syndrome. An important secondary goal is to study the ability of MRI to predict patient outcomes.

  10. Pregabalin and dexamethasone in combination with paracetamol for postoperative pain control after abdominal hysterectomy. A randomized clinical trial

    DEFF Research Database (Denmark)

    Rasmussen, M L; Dierking, G; Lech, K;

    2008-01-01

    BACKGROUND: Multimodal analgesia may be important for optimal postoperative pain treatment and facilitation of early mobilization and recovery. We investigated the analgesic effect of pregabalin and dexamethasone in combination with paracetamol after abdominal hysterectomy. METHODS: One hundred a...

  11. Prospective randomized trial of surgery combined with preoperative and postoperative radiotherapy for rectal carcinoma

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Objective To assess the effect of surgery combined with preoperative and postoperative radiotherapy(sandwich treatment)in rectal carcinoma.Methods From October 1990 to January 2002,260 patients with stage Ⅱ(117 patients)and stage Ⅲ(143 patients)rectal carcinoma were randomly divided into three groups:sandwich group(92 patients,group A),postoperative radiotherapy group(98 patients,Group B)and operation group(70 patients,Group C).The preoperative accelerated hyperfractionation(15Gy/6f/3d)was given for sandwic...

  12. Müllerian intra-abdominal carcinomatosis in hereditary breast ovarian cancer syndrome: implications for risk-reducing surgery.

    Science.gov (United States)

    Casey, Murray Joseph; Colanta, Agnes B

    2016-07-01

    More than 40 years ago Lynch et al. described several multigenerational breast cancer family pedigrees which demonstrated autosomal dominant inheritance of a trait(s) that increased risks for both breast and ovarian cancers. Mutation carriers in at least 90 % of these hereditary breast ovarian cancer (HBOC) syndrome families have been linked to cancer-associated mutations in the genes BRCA1 and BRCA2. This review focuses on the contributions of Lynch, colleagues and collaborators and pertinent literature, toward defining the HBOC syndrome, the cancer risks that the inherited adverse mutations convey, the gynecologic tissues and organs from which the malignancy may arise to disseminate throughout the pelvic and abdominal organs and peritoneum and how this information can be used to reduce the risk and morbidities of intra-abdominal carcinomatosis in effected individuals. PMID:26875157

  13. Gauze packing for uncontrolled bleeding of abdominal surgery%纱布填塞用于腹部手术难以控制的大出血

    Institute of Scientific and Technical Information of China (English)

    胡宁; 江艺; 张小进

    2011-01-01

    目的 探讨纱布填塞法用于腹部手术难以控制的大出血的价值.方法 对15例腹部手术中大出血病人采用纱布填塞法.其中腹膜后肿瘤1例,创伤性肝破裂2例,肝癌行肝右三叶切除肝创面渗血1例,门静脉高压症行断流术食管旁、脾窝渗血3例,急性肝功能衰竭行原位肝移植术中肾上腺区域、肝裸区腔静脉旁后腹膜创面广泛渗血8例.结果 15例术后腹腔引流量均逐日减少,填塞纱条术后5~10 d内拔出,2例因感染继发多器官衰竭死亡.结论 对于腹部手术难以控制的大出血,纱布填塞止血方法仍不失为一项重要的、简单有效的止血手段.%Objective To explore the value of gauze packing for uncontrolled bleeding of abdominal surgery. Methods Fifteen cases of massive haemorrhage during abdominal surgery were treated with gauze packing method. Among them, there was 1 case of retroperitoneal tumor, 2 cases of traumatic rupture of the liver, 1 case of liver wound oozing blood in hepatocellular carcinoma after resection of hepatic right 3 lobes,3 cases of paraesophageal,splenic fossa oozing blood in portal hypertension after devascularization,8 cases of retroperitoneal wound bleeding extensively in the adrenal region and the bare area of the liver next to inferior vena cava in acute liver failure after orthotopic liver transplantation. Results In 15 cases, postoperative peritoneal drainage volume was decreased daily. The packed gauze was pulled out 5-10 days after operation. There were 2 cases of multiple organ failure to death due to secondary infection. Conclusion For uncontrolled massive haemorrhage in abdominal surgery, gauze packing method was still a major means of simple and effective hemostasis.

  14. Neo-adjuvant chemotherapy plus surgery versus surgery alone for cervical cancer: Meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Peng, Yun-Hua; Wang, Xin-Xiu; Zhu, Jing-Song; Gao, Li

    2016-02-01

    The aim of this study was to evaluate the efficacy and safety of neo-adjuvant chemotherapy (NACT) versus radical surgery (RS) for patients with cervical cancer. A meta-analysis of randomized controlled trials (RCT) of NACT + RS versus RS alone for patients with cervical cancer was performed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The following electronic databases were searched from their inception to April 2015: PUBMED, EMBASE and Cochrane Library. Statistical analysis was done using REVIEW MANAGER 5.3. Five RCT involving 739 patients were studied. There were significant differences between the NACT + RS and the RS-alone groups for positive lymph nodes (OR, 0.45; 95%CI: 0.29-0.70) and parametrial infiltration (OR, 0.48; 95% CI: 0.25-0.92), while treatment efficacy did not differ significantly for 5-year overall survival rate (OR, 1.17; 95% CI: 0.85-1.61), 5-year disease-free survival rate (OR, 1.09; 95% CI: 0.77-1.56) or recurrence rate (OR, 1.17; 95% CI: 0.85-1.61). The results also indicated that chemotherapy-related toxicity was well tolerated. For patients with cervical cancer, NACT could significantly reduce the number of positive lymph nodes and the level of parametrial infiltration compared with RS alone, and be well tolerated. PMID:26807961

  15. A randomized controlled trial evaluating early versus traditional oral feeding after colorectal surgery

    Directory of Open Access Journals (Sweden)

    Ahmet Dag

    2011-01-01

    Full Text Available OBJECTIVE: This prospective randomized clinical study was conducted to evaluate the safety and tolerability of early oral feeding after colorectal operations. METHODS: A total of 199 patients underwent colorectal surgery and were randomly assigned to early feeding (n = 99 or a regular diet (n = 100. Patients’ characteristics, diagnoses, surgical procedures, comorbidity, bowel movements, defecation, nasogastric tube reinsertion, time of tolerance of solid diet, complications, and length of hospitalization were assessed. RESULTS: The two groups were similar in terms of gender, age, diagnosis, surgical procedures, and comorbidity. In the early feeding group, 85.9% of patients tolerated the early feeding schedule. Bowel movements (1.7±0.89 vs. 3.27±1.3, defecation (3.4±0.77 vs. 4.38±1.18 and time of tolerance of solid diet (2.48±0.85 vs. 4.77±1.81 were significantly earlier in the early feeding group. There was no change between the groups in terms of nasogastric tube reinsertion, overall complication or anastomotic leakage. Hospitalization (5.55±2.35 vs. 9.0±6.5 was shorter in the early feeding group. CONCLUSIONS: The present study indicated that early oral feeding after elective colorectal surgery was not only well tolerated by patients but also affected the postoperative outcomes positively. Early postoperative feeding is safe and leads to the early recovery of gastrointestinal functions.

  16. Fish oil and atrial fibrillation after cardiac surgery: a meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Wei Xin

    Full Text Available BACKGROUND: Influence of fish oil supplementation on postoperative atrial fibrillation (POAF was inconsistent according to published clinical trials. The aim of the meta-analysis was to evaluate the effects of perioperative fish oil supplementation on the incidence of POAF after cardiac surgery. METHODS: Pubmed, Embase and the Cochrane Library databases were searched. Randomized controlled trials (RCTs assessing perioperative fish oil supplementation for patients undergoing cardiac surgery were identified. Data concerning study design, patient characteristics, and outcomes were extracted. Risk ratio (RR and weighted mean differences (WMD were calculated using fixed or random effects models. RESULTS: Eight RCTs involving 2687 patients were included. Perioperative supplementation of fish oil did not significantly reduce the incidence of POAF (RR = 0.86, 95%CI 0.71 to 1.03, p = 0.11 or length of hospitalization after surgery (WMD = 0.10 days, 95% CI: 0.48 to 0.67 days, p = 0.75. Fish oil supplementation also did not affect the perioperative mortality, incidence of major bleeding or the length of stay in the intensive care unit. Meta-regression and subgroup analyses indicated mean DHA dose in the supplements may be a potential modifier for the effects of fish oil for POAF. For supplements with DHA >1 g/d, fish oil significantly reduced the incidence of POAF; while it did not for the supplements with a lower dose of DHA. CONCLUSIONS: Current evidence did not support a preventative role of fish oil for POAF. However, relative amounts of DHA and EPA in fish oil may be important for the prevention of POAF.

  17. 大黄素对腹部术后大鼠ghrelin表达的影响%Effect of Emodin on Ghrelin Expression from Rats after Abdominal Surgery

    Institute of Scientific and Technical Information of China (English)

    蒋军; 裘华森; 顾锡冬; 周济春; 张喜平; 张勤

    2012-01-01

    Objective To approach the mechanism of the action of emodin on the ghrelin secretion from rats after abdominal surger-y. Methods Totally 120 SD rats after abdominal operation were randomly divided into five groups: as sham -operated, model control, emodin with low dosage (EL) , medium dosage (EM) and high dosage (EH) groups. Each group was divided into four subgroups randomly, and rats were treated with emodin after postoperation. The gastric remainder rates of Blue Dextron (BD) 2000, intestinal emptying rate, level of serum ghrelin, the pathological changes in intestinal canal, somatostatin (ss) and expression of ghrelin from gastric fundus were measured post - operatively on 3 ,6,12,24h after administration with fasted. Results ①The mortality of rats in all groups were 0. ②The contents of serum ss (at 6, 12 and 24h in EH groups, at 12 and 24h in EM groups) , the gastric remainder rates of BD 2000 (at 24h in EH groups, at 3h in EL groups) were significantly lower than those in the model control group (P <0. 05). The contents of serum ghrelin (at 12, 24h in HE groups, at 24h in EL groups) , the expression of ghrelin from gastric fundus (at 3h in EH groups, at 24h in EM groups, at 3h in EL groups) , the intestinal emptying rate (at 12h in EH groups, at 6, 12h in EM groups, at 6, 24h in EL groups) were significantly higher than those in the model control group (P < 0. 05). The pathological severity scores in intestinal canal in the Sham - operated groups, at 3h in EH groups, at 24h in EM groups and at 3h in EL groups were also significantly lower than those in the model control group (P < 0. 05 ) . The contents of serum ghrelin at 12h and the expression of ghrelin from gastric fundus at 3 , 6h in the Sham - operated groups were significantly higher than those in the model control group ( P < 0. 05). ③The expression of ghrelin from gastric fundus at 3h in EH groups were significantly higher than those in the EM group (P < 0. 05). The expression of ghrelin from

  18. Testing the generalizability of national reimbursement rates with respect to local setting: the costs of abdominal aortic aneurysm surgery in Denmark

    Directory of Open Access Journals (Sweden)

    Søren Løvstad Christensen

    2010-09-01

    Full Text Available Søren Løvstad Christensen1, Mette Kjoelby1,2, Lars Ehlers31Health Technology Assessment and Health Services Research, Centre for Public Health, Central Denmark Region, Denmark; 2School of Public Health, Aarhus University, Denmark; 3Health Economics and Management, Aalborg University, DenmarkObjective: The purpose of this study is to investigate if the Danish national diagnosis-related group (DRG tariffs for surgery for abdominal aortic aneurysm (AAA were good estimates of the actual costs in two local hospitals in the Central Region of Denmark.Methods: We collected clinical data for 178 AAA patients operated at Skejby Hospital and Viborg Hospital in the period 2005–2006 from the Danish National Vascular Registry and economic data from the administrative systems in the hospitals. We used bootstrap methods to calculate 95% confidence intervals (CIs for the mean costs of surgery for ruptured AAA, nonruptured AAA and AAA where the patient died within 30 days by applying a cost-trimming rule that the Danish National Board of Health uses in calculating national DRG tariffs.Results: The national DRG tariff lies within the calculated Danish Krone (DKK CIs (CI ruptured AAA, 98,178–195,327 [€13,196–€26,254]; CI nonruptured AAA, 79,039–98,178 [€10,624–€13,196]; CI dead, 42,023–111,685 [€5,648–€15,011], and thus national DRG tariffs could be a good estimate for the actual costs in the local hospitals.Conclusion: The bootstrap method is useful for testing the generalizability of national DRG tariffs as estimates of local surgical costs.Keywords: bootstrap method, costs, DRG, abdominal aortic aneurysm

  19. Therapeutic efficacy and safety of intravenous flurbiprofen axetil for analgesia after upper abdominal surgery%氟比洛芬酯用于上腹部术后镇痛的疗效及安全性观察

    Institute of Scientific and Technical Information of China (English)

    张惠娟

    2012-01-01

    目的 观察上腹部术后患者PCIA中,氟比洛芬酯镇痛效果与不良反应,及对凝血功能的影响.方法 选择行上腹部手术患者90例均分为3组,A组术后镇痛给予舒芬太尼200 μg稀释到盐水100 mL;B组关腹前静脉注射氟比洛芬酯50mg,术后镇痛给予舒芬太尼200 μg稀释到盐水100 mL;C组关腹前静脉注射氟比洛芬酯50 mg,术后镇痛给予舒芬太尼200μg+氟比洛芬酯100 mg稀释到盐水100mL.3组PCIA泵的设置维持量1.2 mL/h,单次负荷剂量1.2 mL,锁定时间20 min.观察3组术后24 h、48 h的镇痛评分(VAS评分)和不良反应的发生情况.结果 3组镇痛效果均满意,而B组恶心,呕吐等药物不良反应发生率低于A、C组.B、C两组舒芬太尼用量及患者按压次数均低于A组.结论 氟比洛芬酯联合舒芬太尼用于上腹部术后的镇痛效果与单纯舒芬太尼相似,但不良反应降低.%Objective To observe and evaluate the analgestic efficacy of flurbiprofen axetil and its effect on coagulatioin function in patients with upper abdominal surgery. Methods Ninety patients suffered from upper abdominal surgery were divided equally and randomly into 3 groups. Group A was given sufentanyl 200 μg dissolved in 100 mL saline for PCIA after surgery. Group B was administrated with flurbiprofen axetil 50 mg before thorax closure, and sufentanyl 200 μg dissolved in 100 mL for PCIA after surgery. Group C was given flurbiprofen axetil 50 mg before thorax closure and flurbiprofen axetil 100 mg plus sufentanyl 200 μg dissolved in 100 mL saline for PCIA after surgery. The volume for PCIA was 1.2 mL/h, blous 1.2 mL, lock time 20 min.VAS scales and side effects were evaluated 24 h and 48 h after surgery. Results There was no significant difference in analgesia grade among three groups. The side effects were lower in group B than those in group A and group C. Conclusion Compared with sufentanyl alone, flurbiprofen axetil combined with sufentanyl can obtain similar

  20. Sutures versus staples for wound closure in orthopaedic surgery: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Shantz Jesse A

    2012-06-01

    Full Text Available Abstract Background A recently published meta-analysis comparing metallic staples to sutures in orthopaedic procedures revealed three fold increase in risk for infection in stapled wounds. The studies included in the meta-analysis are at risk of bias due to experimental design limitations. A large randomized controlled trial is proposed to direct orthopaedic surgeons in their choice of wound closure material. Methods/Design A parallel group randomized controlled trial with institutional review board approval will be conducted. Patients will be randomized intraoperatively to have skin wounds closed with sutures or staples. Dressings will be used to maintain blinding outcome assessors. The primary outcome measure will be a composite all-cause wound complication outcome measure composed of: infection, wound drainage, wound necrosis, blistering, dehiscence, suture abscess and material sensitivity reaction. An independent review board blinded to treatment assignment will adjudicate suspected complications based on clinical data. All deceased patients will also be reviewed. An interim analysis of complications will take place after half of the patients have been recruited. All data will be analyzed by a blinded statistician. Dichotomous primary and secondary outcome measures will be analyzed using the Chi-squared statistic. Continuous outcome measures will be analyzed using Student's t-test. Subgroup analysis will compare infection rates using sutures versus staples in each anatomic area (upper extremity, pelvis/acetabulum, hip/femur, knee, ankle. A further subgroup analysis will be conducted comparing trauma patients to elective surgery patients. Non-infected revision surgery will also be compared to primary surgery. Discussion Wound closure material is an afterthought for many orthopaedic surgeons. The combined results of several comparative trials suggests that the choice of wound closure materials may have an impact on the rate of surgical site

  1. Clonazepam for the Management of Anxiety Associated with Oral Surgery: A Randomized Double-blind Controlled Trial

    OpenAIRE

    Zamiri B.; Eftekharian HR.; Arasteh N.

    2012-01-01

    Statement of Problem: Anxiety is one of the most common challenges which affect both the patient and the surgeon throughout dental procedures. Thus, there has been growing interest in the application of sedatives in dentistry. Purpose: This study evaluated the efficacy of clonazepam in reducing anxiety prior to oral surgery. Materials and Method: The participants of this, randomized controlled trial, study included 60 patients who referred to the Department of Oral and Maxillof-acial Surgery,...

  2. The Effects of Perioperative Music Interventions in Pediatric Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

    OpenAIRE

    van der Heijden, Marianne J.E.; Sadaf Oliai Araghi; Monique van Dijk; Johannes Jeekel; M G Myriam Hunink

    2015-01-01

    Objective Music interventions are widely used, but have not yet gained a place in guidelines for pediatric surgery or pediatric anesthesia. In this systematic review and meta-analysis we examined the effects of music interventions on pain, anxiety and distress in children undergoing invasive surgery. Data Sources We searched 25 electronic databases from their first available date until October 2014. Study Selection Included were all randomized controlled trials with a parallel group, crossove...

  3. Preoperative steroid in abdominal wall reconstruction

    DEFF Research Database (Denmark)

    Jensen, Kristian Kiim; Brøndum, Tina Lee; Belhage, Bo;

    2016-01-01

    INTRODUCTION: Preoperative administration of high-dose glucocorticoid leads to improved recovery and decreased length of stay after abdominal surgery. Even so, studies on administration of glucocorticoids for patients undergoing abdominal wall reconstruction (AWR) for giant ventral hernia repair ...

  4. 腹部外科患者的营养风险筛查%Nutritional risk screening in patients undergoing abdominal surgery

    Institute of Scientific and Technical Information of China (English)

    胡惠惠; 任泽强; 张秀忠; 左传丽

    2011-01-01

    Objective To assess the prevalence of malnutrition and nutritional risks in patients undergoing abdominal surgery.Methods 124 patients undergoing abdominal surgery from two general surgery wards were consecutively evaluated according to the Nutritional Risk Screening (NRS) published by ESPEN in 2002.Then the incidences of malnutrition and nutritional risk were calculated.Results The incidence of malnutrition was 14.5% and the incidence of nutritional risk was 25.0% in the patients at admission; A higher prevalence of malnutrition occurred in cancer patients than in non - oncologic patients ( P < 0.05 ), with significant statistical difference.The incidences of nutritional risk in the senior patients (60 -90 years old) and the cancer patients were higher than those in the junior patients ( 18 -59 years old) and the non- oncologic patients (P <0.01 ).Conclusion Assessment of the nutritional status by NRS2002 is feasible for patients undergoing abdominal surgery.The clinical nutrition support should be rationally applied according to the NRS2002 results, especially for the elderly patients and the cancer patients who are more susceptible to malnutrition and nutritional risks.%目的 评估腹部外科患者营养不良、营养风险发生情况.方法 采用欧洲营养风险筛查(NRS 2002)方法,定点连续抽取徐州医学院附属医院2个普外科病区中的124例腹部外科患者进行营养风险筛查,统计营养不良、营养风险的发生率.结果 腹部外科患者入院时营养不良的发生率为14.5%,营养风险的发生率为25.0%;恶性肿瘤疾病患者营养不良的发生率高于良性疾病患者,差异有统计学意义(P<0.05);60~90岁年龄组患者、恶性肿瘤疾病患者营养风险的发生率分别高于18~59岁年龄组患者及良性疾病患者,差异有统计学意义(P<0.01).结论 NRS2002可用于腹部外科患者的营养风险筛查.应根据NRS2002评估结果指导临床营养支持的合理应用,尤

  5. [The effect of combination epidural anesthesia techniques in upper abdominal surgery on the stress reaction, pain control and respiratory mechanics].

    Science.gov (United States)

    Wiedemann, B; Leibe, S; Kätzel, R; Grube, U; Landgraf, R; Bierwolf, B

    1991-11-01

    Twenty-eight patients undergoing upper abdominal operations (mainly selective proximal vagotomy [SPV]) were referred for assessment of the hormonal metabolic reaction (adrenocorticotropic hormone [ACTH], arginine vasopressin [AVP], cortisol, and glucose), the postoperative pain reaction, and respiration according to the method of anesthesia (group 1: neuroleptanesthesia [NLA], group 2: NLA in combination with epidural opiate analgesia, group 3: NLA in combination with local anesthesia). To alleviate postoperative pain piritramide was systematically administered in group 1, whereas in groups 2 and 3 a thoracic epidural catheter was injected with morphine or bupivacaine. Postoperative analgesia was better in patients with epidural administration than in those with systemic application. On the 1st and 2nd postoperative days the vital capacity was statistically significantly higher by 10%-15% in groups 2 and 3 than in group 1. As expected, the neurohormonal and metabolic stress response was highest in all patients in the intraoperative and immediate postoperative phases: ACTH, AVP, and glucose levels were in most cases significantly higher compared with the initial values. However, cortisol levels decreased intraoperatively, probably as a result of the generally used induction agent etomidate. Comparison of the three methods of anesthesia revealed that all mean hormone levels analyzed in group 2 patients were lower both intraoperatively and 2 h postoperatively, which implies that epidurally administered morphine reduces the stress reaction, probably indirectly through additional selective alleviation of pain at the spinal cord level. The various differences in hormonal reactions of patients in groups 1 and 3 gave no clear evidence, however, of possible mitigation of the stress reaction by epidural local anesthetics in upper abdominal operations.

  6. Minimally invasive lumbar interbody fusion via MAST Quadrant retractor versus open surgery: a prospective randomized clinical trial

    Institute of Scientific and Technical Information of China (English)

    WANG Hong-li; L(U) Fei-zhou; JIANG Jian-yuan; MA Xin; XIA Xin-lei; WANG Li-xun

    2011-01-01

    Background In recent years,a variety of minimally invasive lumbar surgery techniques have achieved desirable efficacy,but some dispute remains regarding the advantages over open surgery.This study aimed to compare minimally invasive lumbar interbody fusion via MAST Quadrant retractor with open surgery in terms of perioperative factors,postoperative back muscle function,and 24-month postoperative follow-up results.Methods From September 2006 to June 2008,patients with single-level degenerative lumbar spine disease who were not responsive to conservative treatment were enrolled in this study.Patients were randomized to undergo either minimally invasive surgery (MIS,transforaminal lumbar interbody fusion via MAST Quadrant retractor,41 cases) or open surgery (improved transforaminal lumbar interbody fusion,38 cases).Results The MIS group had longer intraoperative fluoroscopy time than the open surgery group,and the open surgery group had significantly increased postoperative drainage volume and significantly prolonged postoperative recovery time compared with the MIS group (P <0.05 for all).MRI scanning showed that the T2 relaxation time in the multifidus muscle was significantly shorter in the MIS group than in the open surgery group at 3 months after surgery (P <0.01).Surface electromyography of the sacrospinalis muscle showed that the average discharge amplitude and frequency were significantly higher in the MIS group than in the open surgery group (P <0.01).The Oswestry disability index and visual analog scale scores were better at 3,6,12 and 24 months postoperatively than preoperatively in both groups.Both groups of patients met the imaging convergence criteria at the last follow-up.Conclusions MIS can effectively reduce sacrospinalis muscle injury compared with open surgery,which is conducive to early functional recovery.In the short term,MIS is superior to open surgery,but in the long term there is no significant difference between the two procedures.

  7. Perioperative hyperoxia - Long-term impact on cardiovascular complications after abdominal surgery, a post hoc analysis of the PROXI trial

    DEFF Research Database (Denmark)

    Fonnes, Siv; Gogenur, Ismail; Sondergaard, Edith Smed;

    2016-01-01

    BACKGROUND: Increased long-term mortality was found in patients exposed to perioperative hyperoxia in the PROXI trial, where patients undergoing laparotomy were randomised to 80% versus 30% oxygen during and after surgery. This post hoc follow-up study assessed the impact of perioperative hyperoxia...... on long-term risk of cardiovascular events. METHODS: A total of 1386 patients undergoing either elective or emergency laparotomy were randomised to 80% versus 30% oxygen during and two hours after surgery. At follow-up, the primary outcome of acute coronary syndrome was assessed. Secondary outcomes...... included myocardial infarction, other heart disease, and acute coronary syndrome or death. Data were analysed in the Cox proportional hazards model. RESULTS: The primary outcome, acute coronary syndrome, occurred in 2.5% versus 1.3% in the 80% versus 30% oxygen group; HR 2.15 (95% CI 0.96-4.84). Patients...

  8. Morphine versus Nalbuphine for Open Gynaecological Surgery: A Randomized Controlled Double Blinded Trial

    Directory of Open Access Journals (Sweden)

    Shiv Akshat

    2014-01-01

    Full Text Available Introduction. Pain is the commonest morbidity after open surgical procedures. The most effective treatment of postoperative pain is opioid therapy. Morphine, the commonly used opioid, is associated with many side effects including respiratory depression, sedation, postoperative nausea vomiting, and pruritus. Nalbuphine, on the other hand, is known to cause less respiratory depression. Thus this study was undertaken to compare the intraoperative and postoperative analgesic efficacy and side effect profile of the two drugs. Methodology. 60 patients undergoing open gynaecological surgery were randomized to receive either morphine (Group M or nalbuphine (Group N in the intraoperative and postoperative period. Intraoperative analgesic efficacy (measured by need for rescue analgesics, postoperative pain by visual analogue scale, and side effects like postoperative nausea, vomiting, sedation, respiratory depression, and pruritus were compared in both groups. Intraoperative and postoperative heart rate and blood pressure were also compared between the groups. Results. Need for intraoperative analgesia was significantly more in Group N (P=0.023. Postoperative VAS scores were significantly different between the groups at various time points; however, none of the patients required any rescue analgesia. The incidence of various side effects was not significantly different between the groups. The haemodynamic profile of patients was comparable between the groups in both intraoperative and postoperative period. Conclusion. Nalbuphine provides less effective intraoperative analgesia than morphine in patients undergoing open gynaecological surgery under general anaesthesia. Both drugs, however, provided similar postoperative analgesia and had similar haemodynamic and side effect profile.

  9. A cost/benefit analysis of randomized invasive monitoring for patients undergoing cardiac surgery.

    Science.gov (United States)

    Pearson, K S; Gomez, M N; Moyers, J R; Carter, J G; Tinker, J H

    1989-09-01

    The aim of this study was to determine the effect of choice of invasive monitoring on cost, morbidity, and mortality in cardiac surgery. Two hundred and twenty-six adults undergoing elective cardiac surgery were initially assigned at random to receive either a central venous pressure monitoring catheter (group I), a conventional pulmonary artery (PA) catheter (group II), or a mixed venous oxygen saturation (SvO2) measuring PA catheter (group III). If the attending anesthesiologist believed that the patient initially randomized to group I should have a PA catheter, that patient was then reassigned to receive either a conventional PA catheter (group IV) or SvO2 measuring PA catheter (group V). The total costs were defined as the total amount billed to the patient for the catheter used; the professional cost of its insertion; and the determinations of cardiac output, arterial blood gas tensions, hemoglobin level, and hematocrit. Mean total monitoring and laboratory costs in Group I ($591 +/- 67) were statistically significantly (P less than 0.05) less than costs in Group II ($856 +/- 231). Further, mean monitoring and laboratory costs in Group II were statistically significantly (P less than 0.05) less than those in Group III ($1128 +/- 759). Patients in group IV incurred mean total costs of $986 +/- 578, while those in group V had mean total costs of $1126 +/- 382 (NS). There were no significant differences between any of the groups with respect to length of stay in the intensive care unit, morbidity, or mortality.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2505641

  10. 低潮气量通气对老年腹部手术肺顺应性及氧合的影响%Effect of low tidal volumes on lung compliance and oxygenation in elder patients during abdominal surgery

    Institute of Scientific and Technical Information of China (English)

    朱蔚琳; 黄中华; 张学刚; 何并文; 黄爱兰; 李锋; 胡彦艳; 秦丹丹

    2011-01-01

    Objective To investigate the effect of low tidal volumes on lung compliance ( CL) and oxygenation in elder patients during abdominal surgery. Methods Forty ASA I or II elder patients, aged over 60 years, scheduled for selective abdominal operation under general anesthesia were divided randomly into 2 groups: group LV (VT 7 ml/kg PBW) and group C (VT 12 ml/kg PBW). HR, MAP, SpO2, PETCO2, Ppeak, Pplat, CL were monitored continuously and recorded at 5 min (T0 ) , 30 min (T1),1h(T2),3h(T3) after tracheal intubation. Arterial blood gas analysis was performed at the same point. Result Compared with the group C, mechanical ventilation with low tidal volumes had lower peak airway pressures (Pplat and Ppeak, respectively) , and higher CL and PaO2. Conclusions Mechanical ventilation with low tidal volumes can improve CL and PaO2 in elder patients with abdominal surgery, which alleviates their abdominal injury.%目的 研究低潮气量通气对老年人术中肺顺应性(CL)及氧合的影响.方法 40例60岁以上、ASA I或Ⅱ级老年患者,在气管插管全身麻醉下实施择期开腹手术.观察组潮气量(VT)为7 mL/kg预测体质量(PBW);对照组VT为12 ml/kg PBW.分别于插管后5 min(To)、30 min(T1)、1 h(T2)、3 h(T3)4个时点记录心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)、呼气末二氧化碳分压(PFTCO2)、气道峰压(Ppeak)、气道平台压(Pplat)、CL;并于各时点桡动脉处抽血测血气指标.结果 对照组在机械通气期间,Ppeak、Pplat明显高于观察组(P=0012,P=0.013);两组CL均随着时间延长呈下降趋势,对照组低于观察组(P =0.012);对照组T3时点PaO2低于观察组(P<0.05).结论 低潮气量通气改善了老年人术中的氧合及CL,能减轻机械通气造成的肺损伤.

  11. Analgesic effect of flurbiprofen on patients receiving open abdominal surgery%上腹部开放手术后氟比洛芬酯镇痛效果评价

    Institute of Scientific and Technical Information of China (English)

    何凯; 曲歌; 桑诺尔; 黄宇光

    2014-01-01

    Objective To evaluate the analgesic effect and side effects of flurbiproten on patients receiving open abdominal surgery.Methods Forty patients receiving open abdominal surgeries were randomized to different regimens of PCA .Study group PCA:60 mg morphine +200 mg flurbiproten/240 ml;control group PCA:60 mg morphine/240 ml.Background infusion rate:4 ml/h, bolus 4ml;lock time:15 mins.The VAS、drug doses consumption and side effects were evaluated .Results There were no differences between the VAS and side effects ,except the drug consumption at 4 hours after the operation; there were no differences between drug consumptions on the other time points .Conclusions Compared with the PCA with only morphine , PCA plus flurbiproten can not in-crease the analgesic effect , nor the morphine consumption .%目的:评价氟比洛芬酯用于上腹部开放手术患者的镇痛效果及不良反应。方法将40例上腹部手术患者随机分为实验组和对照组。实验组患者采用自控镇痛(patient controlled analgesia,PCA)方案:(60 mg吗啡+200 mg氟比洛芬酯)/240 ml;对照组采用PCA方案:60 mg吗啡/240 ml。背景输注4 ml/h,单次给药量4 ml,锁定时间15 min。术后观察不同时间的视觉模拟镇痛评分( VAS)、用药量及不良反应发生情况。结果两组患者不同时间点VAS评分、不良反应发生率之间差异无统计学意义,除4 h时药物使用量实验组小于对照组(P<0.05)以外,其他时点的药物使用量比较无统计学差异。结论建议对上腹部开放手术患者不宜加用氟比洛芬酯。

  12. 保温措施用于胸腹部肿瘤术后患者的效果观察%Effect Observation of Insulation Measures for Patients after Thoracic and Abdominal Tumor Surgeries

    Institute of Scientific and Technical Information of China (English)

    章立楠; 苏文敏

    2013-01-01

    Objective To study the effect of insulation measures for patients after thoracic and abdominal tumor surgeries. Methods From April 2011 to April 2012,80 patients with selective thoracic and abdominal tumor surgeries in the hospital were randomly divided into two groups:experimental group(n = 40) and control group(n= 40). Comprehensive insulation measures including control of ward temperature, early heating of bedding and infusion heating were prepared for the experimental group. While the regular nursing cares were implemented for the control group. The patients' body temperature change within 6 hours, the shiver formation rate and the incidence of postoperative complications were recorded between the two groups. Results Compared with the control group, the body temperature of patients was significantly higher,while the shiver formation rate and the incidence of postoperative complications were significantly lower in the experimental group(P<0. 05). Conclusion Postoperative enhanced insulation measures can effectively maintain normal body temperature and reduce the shiver formation and postoperative complications for patients after thoracic and abdominal tumor surgeries.%目的 观察保温措施用于胸腹部肿瘤术后患者的效果.方法 便利抽样法选取2011年4月至2012年4月在宁波大学医学院附属医院肿瘤胸外科行择期胸腹部肿瘤根治手术的患者80例为研究对象,按随机数字表法将其分为观察组(n=40)和对照组(n=40).观察组患者术后采取综合性保温措施,包括控制病房温度、提前被褥加温、输液加温等,对照组患者术后给予常规护理措施.记录两组患者术后6h内体温变化、寒战和术后并发症的发生情况.结果 观察组患者体温均高于对照组,且寒战发生率和术后并发症的发生率均低于对照组,差异有统计学意义(P<0.05).结论 术后加强保温护理可使胸腹部肿瘤患者术后体温相对恒定,寒战和术后并发症的发生率下降.

  13. Effect analysis of perioperative new nursing intervention in patients with abdominal surgery%围手术期新型护理干预在腹部外科手术患者中的效果分析

    Institute of Scientific and Technical Information of China (English)

    徐迎春

    2014-01-01

    ObjectiveTo explore the effect of perioperative new nursing intervention in patients with abdominal surgery.Methods110 patients with first abdominal surgery from November 2012 to November 2013 in our hospital were selected as the study objects, who were randomly divided into the observation group and the control group, each group had 55 patients, the control group received routine perioperative care, and the observation group received new care on the basis of routine care.Results The heart rate, systolic and diastolic blood pressure in the observation group before anesthesia were lower than those in the control group, the difference was statistically significant(P<0.05). The anxiety, depression, fear, general physical condition, feeling of sadness and social withdrawal item scores in the observation group after intervention were lower than before intervention and in the control group after intervention,the average satisfaction score and satisfaction rate in the observation group were higher than those in the control group,the difference was statistically significant(P<0.05).Conclusion The implement of new nursing for patients with abdominal surgery can make bad mood improve and security increase, and has higher patient's satisfaction,and can be clinical applied.%目的:探讨围手术期新型护理干预在腹部外科手术患者中的效果。方法研究对象为2012年11月~2013年11月来本院进行初次腹部外科手术的110例患者,将其随机分为观察组及对照组,各55例,对照组实施围手术期常规护理,观察组在常规护理的基础上实施新型护理措施。结果观察组麻醉前心率、收缩压及舒张压均低于对照组,差异有统计学意义(P<0.05)。观察组干预后焦虑抑郁、恐惧、一般躯体状况、预感性悲哀、社会退缩项目得分均低于干预前及对照组干预后,满意度总分平均分及满意率高于对照组,差异有统计学意义(P<0.05)。结论

  14. EPIDURAL COMBINED INTRAVENOUS ANESTHESIA AND TOTAL INTRAVENOUS ANESTHESIA IN UPPER ABDOMINAL SURGERY%硬膜外复合静脉全麻与全凭静脉麻醉在上腹部手术中的比较

    Institute of Scientific and Technical Information of China (English)

    朱洪远; 刘充卫; 姜华华

    2011-01-01

    [目的]比较硬膜外复合静脉全麻与全凭静脉麻醉对上腹部手术患者血流动力学、静脉麻醉药用量、术后苏醒、躁动及术后疼痛的影响.[方法]80例择期行上腹部手术患者完全随机分为硬膜外复合全麻组(A组)与全凭静脉麻醉组(B组).观察记录不同时间点两组患者血流动力学、静脉麻醉药用量、术后苏醒时间、躁动例数及术后疼痛VAS评分.[结果]两组患者术前术中血流动力学变化比较,差异无统计学意义.拔管后B组患者MAP和HR明显比A组增加,差异有统计学意义(P<0.05).A组患者丙泊酚、芬太尼、顺苯阿曲库铵用量明显比B组少,差异有统计学意义(P<0.01),术后清醒早,拔管时间明显缩短、躁动例数明显减少、术后镇痛良好.[结论]胸段硬膜外复合静脉全麻用于上腹部手术是一种安全、经济、有效并利于患者术后恢复快通道麻醉的首选麻醉方法.%[Objective] To compare the epidural combined intravenous anesthesia and total intravenous anesthesia on hemodynamics, drug dosage, intravenous anesthesia postoperative effects of waking up, restlessness and postoperative pain of patients with upper abdominal surgery. [Methods] 80 patients with elective abdominal operation on a row totally were randomly divided into epidural combined with General anesthesia Croup (group A) and total intravenous anaesthesia group (Group B). We recorded the blood flow dynamics in patients with two groups at various points the dosage, intravenous anesthesia, postoperative recovery time, number of restlessness and postoperative VAS pain score. [ Results] We compared the hemodynamic changes in patients of the two groups before surgery, and there was significant difference between the two groups. MAP and HR in Group B after extubation significantly increased than the group A (P < 0.05). The propofol, fentanyl and CIS-Atracurium dosage of benzene in Group A were significantly lower than in the B group

  15. Daily intake of rosehip extract decreases abdominal visceral fat in preobese subjects: a randomized, double-blind, placebo-controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Nagatomo A

    2015-03-01

    Full Text Available Akifumi Nagatomo,1 Norihisa Nishida,1 Ikuo Fukuhara,2 Akira Noro,3 Yoshimichi Kozai,3 Hisao Sato,3 Yoichi Matsuura1 1Research and Development Division, Morishita Jintan Co, Ltd, Osaka, Japan; 2Fukuhara Clinic, Hokkaido, Japan; 3New Drug Research Center, Inc., Hokkaido, Japan Background: Obesity has become a great problem all over the world. We repeatedly screened to find an effective food to treat obesity and discovered that rosehip extract shows potent antiobesity effects. Investigations in mice have demonstrated that rosehip extract inhibits body weight gain and decreases visceral fat. Thus, the present study examined the effect of rosehip extract on human body fat in preobese subjects. Methods: We conducted a 12-week, single-center, double-blind, randomized, placebo-controlled study of 32 subjects who had a body mass index of ≥25 but <30. The subjects were assigned to two random groups, and they received one tablet of placebo or rosehip that contained 100 mg of rosehip extract once each day for 12 weeks with no dietary intervention. Abdominal fat area and body fat percent were measured as primary outcomes. The other outcomes were body weight and body mass index. Results: Abdominal total fat area, abdominal visceral fat area, body weight, and body mass index decreased significantly in the rosehip group at week 12 compared with their baseline levels (P<0.01 after receiving the rosehip tablet intake, and the decreases in these parameters were significantly higher when compared with those in the placebo group. Additionally, body fat percent tended to decrease compared with the placebo group and their baseline level. Moreover, the abdominal subcutaneous fat area was significantly lower in the rosehip group than in the placebo group at week 12 after the initiation of intake (P<0.05. In addition, there were no abnormalities, subjective symptoms, and findings that may indicate clinical problems during the study period. Conclusion: These results

  16. Renal effects of dexmedetomidine during coronary artery bypass surgery: a randomized placebo-controlled study

    Directory of Open Access Journals (Sweden)

    Scheinin Harry

    2011-05-01

    Full Text Available Abstract Background Dexmedetomidine, an alpha2-adrenoceptor agonist, has been evaluated as an adjunct to anesthesia and for the delivery of sedation and perioperative hemodynamic stability. It provokes dose-dependent and centrally-mediated sympatholysis. Coronary artery bypass grafting (CABG with extracorporeal circulation is a stressful procedure increasing sympathetic nervous system activity which could attenuate renal function due the interrelation of sympathetic nervous system, hemodynamics and renal function. We tested the hypothesis that dexmetomidine would improve kidney function in patients undergoing elective CABG during the first two postoperative days. Methods This was a double-blind, randomized, parallel-group study. Patients with normal renal function and scheduled for elective CABG were randomized to placebo or to infusion of dexmedetomidine to achieve a pseudo steady-state plasma concentration of 0.60 ng/ml. The infusion was started after anesthesia induction and continued until 4 h after surgery. The primary endpoint was creatinine clearance. Other variables included urinary creatinine and output, fractional sodium and potassium excretion, urinary potassium, sodium and glucose, serum and urinary osmolality and plasma catecholamine concentrations. The data were analyzed with repeated-measures ANOVA or Cochran-Mantel-Haenszel test. Results Sixty-six of 87 randomized patients were evaluable for analysis. No significant between-group differences were recorded for any indices of renal function except for a mean 74% increase in urinary output with dexmedetomidine in the first 4 h after insertion of a urinary catheter (p Conclusions Use of intravenous dexmedetomidine did not alter renal function in this cohort of relatively low-risk elective CABG patients but was associated with an increase in urinary output. This study was carried out in 1994-1997 and was thus not registered.

  17. Fatores de morbimortalidade na cirurgia eletiva do aneurisma da aorta abdominal infra-renal: experiência de 134 casos Morbidity and mortality factors in the elective surgery of infrarenal abdominal aortic aneurysm: a case study with 134 patients

    Directory of Open Access Journals (Sweden)

    Aquiles Tadashi Ywata de Carvalho

    2008-09-01

    Full Text Available CONTEXTO: O tratamento cirúrgico convencional do aneurisma da aorta abdominal (AAA infra-renal pode resultar em complicações graves. A fim de otimizar os resultados na evolução do tratamento, é importante que sejam identificados os pacientes predispostos a determinadas complicações e instituídas condutas preventivas. OBJETIVOS: Avaliar a taxa de mortalidade operatória precoce, analisar as complicações pós-operatórias e identificar os fatores de risco relacionados com a morbimortalidade. MÉTODO: Foram analisados 134 pacientes com AAA infra-renal submetidos a correção cirúrgica eletiva no período de fevereiro de 2001 a dezembro de 2005. RESULTADOS: A taxa de mortalidade foi de 5,2%, sendo secundária principalmente a infarto agudo de miocárdio (IAM e isquemia mesentérica. As complicações cardíacas foram as mais freqüentes, seguidas das pulmonares e renais. A presença de diabetes melito (DM, insuficiência cardíaca congestiva (ICC, insuficiência coronariana (ICO e cintilografia miocárdica positiva para isquemia estiveram associadas às complicações cardíacas. A idade avançada, a doença pulmonar obstrutiva crônica (DPOC e a capacidade vital forçada reduzida aumentaram os riscos de atelectasia e pneumonia. História de nefropatia, tempo de pinçamento aórtico prolongado e níveis de uréia elevados aumentaram os riscos de insuficiência respiratória aguda (IRA. A isquemia dos membros inferiores esteve associada ao tabagismo e à idade avançada, e a maior taxa de mortalidade, à presença de coronariopatia, tempos prolongados de pinçamento aórtico e de cirurgia. CONCLUSÃO: A taxa de morbimortalidade esteve compatível com a literatura nacional e internacional, sendo secundária às complicações cardíacas, respiratórias e renais. Os fatores de risco identificados no pré e transoperatório estiveram relacionados com essas complicações.BACKGROUND: Conventional surgical treatment of infrarenal abdominal

  18. Prevention of Bleeding in Orthognathic Surgery--A Systematic Review and Meta-Analysis of Randomized Controlled Trials

    DEFF Research Database (Denmark)

    Olsen, Jesper J; Skov, Jane; Ingerslev, Janne;

    2016-01-01

    PURPOSE: The objective of the present study was to evaluate the efficacy of hemostatic adjuncts on intraoperative blood loss (IOB) in orthognathic surgery (OS) detected by randomized controlled trials (RCTs) of the highest quality. MATERIALS AND METHODS: A search of the Medline, Cochrane, Embase...

  19. Success and spontaneous pregnancy rates following systemic methotrexate versus laparoscopic surgery for tubal pregnancies: A randomized trial

    DEFF Research Database (Denmark)

    Møller, Lars Bo Krag; Moeller, Charlotte; Thomsen, Sten Grove;

    2009-01-01

    Objective. To determine which treatment should be offered to women with a non-ruptured tubal pregnancy: a single dose of methotrexate (MTX) or laparoscopic surgery. Design. Prospective, randomized, open multicenter study. Setting. Seven Danish departments of obstetrics and gynecology. Sample...

  20. Biologic treatment or immunomodulation is not associated with postoperative anastomotic complications in abdominal surgery for Crohn's disease

    DEFF Research Database (Denmark)

    El-Hussuna, A.; Andersen, J.; Bisgaard, T.;

    2012-01-01

    Objectives: There are concerns that biologic treatments or immunomodulation may negatively influence anastomotic healing. This study investigates the relationship between these treatments and anastomotic complications after surgery for Crohn's disease. Patients and methods. Retrospective study...... on 417 operations for Crohn's disease performed at four Danish hospitals in 2000-2007. Thirty-two patients were preoperatively treated with biologics and 166 were on immunomodulation. In total, 154 were treated with corticosteroids of which 66 had prednisolone 20 mg or more. Results: Anastomotic...... complications were more frequent after a colo-colic anastomosis than after an entero-enteric or entero-colic (33% vs. 12% (p=0.013)). Patients with anastomotic complications were older (40 years vs. 35 years (p=0.014)), had longer disease duration (7.5 years vs. 4 years (p=0.04)), longer operation time (155 min...

  1. Comparative evaluation of oral flupirtine and oral diclofenac sodium for analgesia and adverse effects in elective abdominal surgeries

    OpenAIRE

    Attri, Joginder Pal; Sandhu, Gagandeep Kaur; Khichy, Sudhir; Singh, Harsimrat; Singh, Kulwinder; Sharan, Radhe

    2015-01-01

    Background: Flupirtine is a centrally-acting, nonopioid analgesic that interacts with N-methyl-D-aspartate receptors. Aim: The present study was designed to compare analgesic efficacy and adverse effects of orally administered flupirtine and diclofenac sodium for postoperative pain relief. Settings and Design: In a prospective, randomized double-blind study, 100 patients of American Society of Anesthesiologist grade I and II in the age group of 18–65 years of either sex undergoing elective ab...

  2. Colonic stenting as bridge to surgery versus emergency surgery for management of acute left-sided malignant colonic obstruction: a multicenter randomized trial (Stent-in 2 study

    Directory of Open Access Journals (Sweden)

    Scholten Pieter

    2007-07-01

    Full Text Available Abstract Background Acute left-sided colonic obstruction is most often caused by malignancy and the surgical treatment is associated with a high mortality and morbidity rate. Moreover, these operated patients end up with a temporary or permanent stoma. Initial insertion of an enteral stent to decompress the obstructed colon, allowing for surgery to be performed electively, is gaining popularity. In uncontrolled studies stent placement before elective surgery has been suggested to decrease mortality, morbidity and number of colostomies. However stent perforation can lead to peritoneal tumor spill, changing a potentially curable disease in an incurable one. Therefore it is of paramount importance to compare the outcomes of colonic stenting followed by elective surgery with emergency surgery for the management of acute left-sided malignant colonic obstruction in a randomized multicenter fashion. Methods/design Patients with acute left-sided malignant colonic obstruction eligible for this study will be randomized to either emergency surgery (current standard treatment or colonic stenting as bridge to elective surgery. Outcome measurements are effectiveness and costs of both strategies. Effectiveness will be evaluated in terms of quality of life, morbidity and mortality. Quality of life will be measured with standardized questionnaires (EORTC QLQ-C30, EORTC QLQ-CR38, EQ-5D and EQ-VAS. Morbidity is defined as every event leading to hospital admission or prolonging hospital stay. Mortality will be analyzed as total mortality as well as procedure-related mortality. The total costs of treatment will be evaluated by counting volumes and calculating unit prices. Including 120 patients on a 1:1 basis will have 80% power to detect an effect size of 0.5 on the EORTC QLQ-C30 global health scale, using a two group t-test with a 0.05 two-sided significance level. Differences in quality of life and morbidity will be analyzed using mixed-models repeated measures

  3. Pharmacokinetics and pharmacodynamics of propofol and fentanyl in patients undergoing abdominal aortic surgery - a study of pharmacodynamic drug-drug interactions.

    Science.gov (United States)

    Wiczling, Paweł; Bieda, Krzysztof; Przybyłowski, Krzysztof; Hartmann-Sobczyńska, Roma; Borsuk, Agnieszka; Matysiak, Jan; Kokot, Zenon J; Sobczyński, Paweł; Grześkowiak, Edmund; Bienert, Agnieszka

    2016-07-01

    Propofol is routinely combined with opioid analgesics to ensure adequate anesthesia during surgery. The aim of the study was to assess the effect of fentanyl on the hypnotic effect of propofol and the possible clinical implications of this interaction. The pharmacokinetic/pharmacodynamic (PK/PD) data were obtained from 11 patients undergoing abdominal aortic surgery, classified as ASA III. Propofol was administered by a target-controlled infusion system. Fentanyl 2-3 µg/kg was given whenever insufficient analgesia occurred. The bispectral index (BIS) was used to monitor the depth of anesthesia. A population PK/PD analysis with a non-linear mixed-effect model (NONMEM 7.2 software) was conducted. Two-compartment models satisfactorily described the PK of propofol and fentanyl. The delay of the anesthetic effect in relation to PK was described by the effect compartment. The BIS was linked to propofol and fentanyl effect-site concentrations through an additive Emax model. Context-sensitive decrement times (CSDT) determined from the final model were used to assess the influence of fentanyl on the recovery after anesthesia. The population PK/PD model was successfully developed to describe simultaneously the time course and variability of propofol and fentanyl concentrations and BIS. Additive propofol-fentanyl interactions were observed and quantitated. The duration of the fentanyl infusion had minimal effect on CSDT when it was shorter than the duration of the propofol infusion. If the fentanyl infusion was longer than the propofol infusion, an almost two-fold increase in CSDT occurred. Additional doses of fentanyl administered after the cessation of the propofol infusion result in lower BIS values, and can prolong the time of recovery from anesthesia. Copyright © 2016 John Wiley & Sons, Ltd.

  4. Effect of water-soluble contrast in colorectal surgery: A prospective randomized trial

    Institute of Scientific and Technical Information of China (English)

    Jia-Hui Chen; Chung-Bao Hsieh; Pei-Chieh Chao; Hsiao-Dung Liu; Chung-Jueng Chen; Yao-Chi Liu; Jyh-Cherng Yu

    2005-01-01

    AIM: Postoperative gastrointestinal-tract motility is normally delayed. Early feeding after colorectal surgery has beenreposed recently, but late feeding is common. Gastrografin not only enhances bowel peristalsis, but also decreases bowel-wall edema. Whether contrast medium allows early oral feeding and reduces the duration of hospitalization requires clarification.METHODS: Fifty patients underwent elective colorectal surgery in a regional medical center. Patients were prospectively randomized into a Gastrografin group or control group (n = 25 each). Patients in the Gastrografin group began their feeding schedule with 100 mL of 5% dextrose water with 100 mL of Gastrografin on postoperative d 3 and were advanced to a full liquid diet when the contrast reached the colon in 4 h. Patients in the control group began their feeding schedule with 200 mL of 5% dextrosewater on postoperative d 3 and were advanced to a full liquid diet after the passage of flatus and stool. Nasogastric tubes were inserted for persistent postoperative vomiting. Fullness, nausea, vomiting, complications, time of anesthesia, time of operation, time of mobilization, time of oral feeding, and duration of hospital stay were recorded and analyzed with Student's t-test.RESULTS: In the Gastrografin group, one patient hadaspiration pneumonia and one patient had anastomotic leakage resulting in sepsis and eventual death. This mortality was excluded from the subsequent statistical analysis. In the control group, two patients had wound infections. There was no significant difference between the two groups at the time of anesthesia, time of operation, or time of mobilization. There were significant differences between the two groups in the time of oral feeding (3.3±0.3 d in the Gastrografin group vs4.8±0.4 d in the control group; P = odds ratio--, 95%CI [-0.5 to +0.7 d]) and in the length of hospital stay (7.6±1.1 d in the Gastrografingroup vs10.2±1.3 d in the control group; P = odds ratio--, 95% CI

  5. Methods of thermal incubation on abdominal surgery%开腹手术患者术中保温方法的探讨

    Institute of Scientific and Technical Information of China (English)

    贾风菊; 李丽; 孙奇; 邵丽

    2016-01-01

    目的:探讨开腹手术患者术中使用多种不同的保温方法对患者体温的影响。方法选择2014年1—12月普外科择期开腹手术患者160例,采用输液加温、身体包裹、湿敷料加温、冲洗液加温、保温毯使用等保温方法,监测并记录患者从入室至手术结束时鼻咽温度和直肠温度。本研究为前瞻性研究,采用析因设计方案:5因素2水平共25次即32种组合,每种组合重复5次。结果输液加温+冲洗液加温+保温毯使用组的鼻咽温度为(36.94±0.22)℃,直肠温度为(37.32±0.13)℃,保温效果最好;其次是单用保温毯组,鼻咽温度为(36.90±0.37)℃,直肠温度为(37.26±0.26)℃,保温效果次之;第三是输液加温+身体包裹组,鼻咽温度为(36.48±0.36)℃,直肠温度为(36.82±0.40)℃;差异均有统计学意义(P<0.01)。结论开腹手术患者术中实施保温护理措施比较如下:输液加温+冲洗液加温+保温毯使用保温方法为最优选择,其次为单用保温毯的保温方法,再次为输液加温+身体包裹保温方法的组合。保证手术患者的安全,积极维持患者正常体温,是手术室护士实施优质护理措施的必要之举。%Objective To explore the influences of intraoperative warming methods on body temperature of open abdominal surgery patients. Methods Intraoperative warming methods, which included warming of intravenous infusion or moist dressing or flushing fluids, body wrapping and used insulation blankets, were implemented to 160 elective open abdominal surgery patients from January to December of 2014. Nasopharyngeal and rectal temperatures were monitored from induction to end of surgery. In this prospective study, 5 factors 2 levels were total 25 times ( 32 groups ) combination and each combination repeated 5 times. Results The insulation effect was the best in the combination of intravenous infusion warming, flushing fluids warming and insulation blanket using group with

  6. Day-case stapes surgery : Day-case versus inpatient stapes surgery for otosclerosis: a randomized controlled trial

    NARCIS (Netherlands)

    Derks, Laura S M; Wegner, Inge; Tange, RA; Kamalski, Digna M A; Grolman, Wilko

    2016-01-01

    BACKGROUND: Otosclerosis is characterized by bony deposits in the otic capsule, resulting in stapes fixation and progressive hearing loss. It can be treated effectively by surgically removing (part of) the stapes and replacing it with a prosthesis. Increasingly, stapes surgery is performed as a day-

  7. Postoperative Pain After Abdominal Hysterectomy: A Randomized, Double-Blind, Controlled Trial Comparing the Effects of Tramadol and Gabapentin as Premedication

    Science.gov (United States)

    Farzi, Farnoush; Naderi Nabi, Bahram; Mirmansouri, Ali; Fakoor, Fereshteh; Atrkar Roshan, Zahra; Biazar, Gelareh; Zarei, Tayyebeh

    2016-01-01

    Background: Uncontrolled postoperative pain, characteristic to abdominal hysterectomy, results in multiple complications. One of the methods for controlling postoperative pain is preemptive analgesia. Gabapentin and tramadol are both used for this purpose. Objectives: This study aims to compare the effects of tramadol and gabapentin, as premedication, in decreasing the pain after hysterectomy. Patients and Methods: This clinical trial was performed on 120 eligible elective abdominal hysterectomy patients, divided in three groups of 40, receiving tramadol, gabapentin and placebo, respectively. Two hours before the surgery, the first group was given 300 mg gabapentin, the second one was given 100 mg tramadol, while the other group was given placebo, with 50 ml water. After the surgery, in case of visual analog pain scale (VAS) > 3, up to 3 mg of diclofenac suppository would be used. Pain score, nausea, vomiting, sedation, patient’s satisfaction and the number of meperidine administered during 24 hours (1 - 4 - 8 - 12 - 16 - 20 - 24 hours) were recorded. If patients had VAS > 3, despite using diclofenac, intravenous meperidine (0.25 mg/kg) would be prescribed. Data were analyzed using SPSS 21 software, chi-square test, general linear model and repeated measurement. Results: The three groups were similar regarding age and length of surgery (up to 2 hours). The average VAS, in the placebo group, was higher than in the other two groups (P = 0.0001) and the average received doses of meperidine during 24-hour time were considerably higher in placebo group, compared to the other two groups (55.62 mg in placebo, 18.75 mg in gabapentin and 17.5 mg in tramadol groups, P = 0.0001). Nausea, vomiting and sedation, in the tramadol group, were higher than in the other two groups, although they were not significant. Patients’ dissatisfaction, in the placebo group, during initial hours, especially in the fourth hour, was higher (P = 0.0001). In the gabapentin and tramadol groups

  8. Brief smoking cessation intervention in relation to breast cancer surgery: a randomized controlled trial

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Tønnesen, Hanne; Okholm, Mette;

    2010-01-01

    Smokers are more prone to develop postoperative complications. Smoking cessation intervention beginning 4-8 weeks prior to surgery improves the postoperative outcome. Cancer patients, however, often undergo surgery less than 4 weeks after diagnosis. The primary objective of this study was therefo...... to examine if a brief smoking cessation intervention shortly before breast cancer surgery would influence postoperative complications and smoking cessation....

  9. Brief smoking cessation intervention in relation to breast cancer surgery: a randomized controlled trial

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Tønnesen, Hanne; Okholm, Mette;

    2010-01-01

    Smokers are more prone to develop postoperative complications. Smoking cessation intervention beginning 4-8 weeks prior to surgery improves the postoperative outcome. Cancer patients, however, often undergo surgery less than 4 weeks after diagnosis. The primary objective of this study was therefore...... to examine if a brief smoking cessation intervention shortly before breast cancer surgery would influence postoperative complications and smoking cessation....

  10. Randomized clinical trial of bedside ultrasound among patients with abdominal pain in the emergency department: impact on patient satisfaction and health care consumption

    Directory of Open Access Journals (Sweden)

    Nilsson Laila

    2009-11-01

    Full Text Available Abstract Background Previous research shows that surgeon-performed ultrasound for patients presenting with abdominal pain in the emergency department leads both to higher diagnostic accuracy and to other benefits. We have evaluated the level of patient satisfaction, health condition and further health care consumption after discharge from the emergency department. Methods A total of 800 patients who attended the emergency department for abdominal pain were randomized to surgeon-performed ultrasound or not as a complement to standard examination. All patients were interviewed by telephone six weeks after the visit to the emergency department using a structured questionnaire including information about health condition, satisfaction and medical examinations. A regional health register was used to check health care consumption over two years and mortality was checked for in the personal data register. Results We found a higher self-rated patient satisfaction in the ultrasound group when leaving the emergency department. After six weeks the figures were equal. There were fewer patients in the ultrasound group with completed or planned complementary examinations after six weeks (31.1% compared with the control group (41.4%, p = 0.004. There was no difference found in the two-year health care consumption or mortality between the groups. Conclusion For patients with acute abdominal pain, bedside ultrasound examination is related to higher satisfaction and decreased short-term health care consumption. No major effects were revealed when evaluating effects on a long-term basis, including mortality. The previously proven benefit together with the lack of adverse effects from the method makes ultrasound well worth considering for implementation in emergency departments. Trial registration The study has been registered in ClinicalTrials.gov ID NCT00550511.

  11. Randomized controlled trials of maternal-fetal surgery: a challenge to clinical equipoise.

    Science.gov (United States)

    Rodrigues, H C M L; van den Berg, P P

    2014-10-01

    This article focuses on maternal-fetal surgery (MFS) and on the concept of clinical equipoise that is a widely accepted requirement for conducting randomized controlled trials (RCT). There are at least three reasons why equipoise is unsuitable for MFS. First, the concept is based on a misconception about the nature of clinical research and the status of research subjects. Second, given that it is not clear who the research subject/s in MFS is/are, if clinical equipoise is to be used as a criterion to test the ethical appropriateness of RCT, its meaning should be unambiguous. Third, because of the multidisciplinary character of MFS, it is not clear who should be in equipoise. As a result, we lack an adequate criterion for the ethical review of MFS protocols. In our account, which is based on Chervenak and McCullough's seminal work in the field of obstetric ethics, equipoise is abandoned. and RCT involving MFS can be ethically initiated when a multidisciplinary ethics review board (ERB), having an evidence-based assessment of the risks involved, is convinced that the value of answering the research hypothesis, for the sake of the health interests of future pregnant women carrying fetuses with certain congenital birth defects, justifies the actual risks research participants might suffer within a set limit of low/manageable.

  12. Intrathecal sufentanil versus fentanyl for lower limb surgeries - A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Poonam Motiani

    2011-01-01

    Full Text Available Background:To compare the efficacy and safety of intrathecal sufentanil or fentanyl as adjuvants to hyperbaric bupivacaine in patients undergoing major orthopaedic lower limb surgeries in terms of onset and duration of sensory block, motor block and post-operative pain relief. Patients & Methods: Ninety patients were recruited in this Prospective, randomized double blind study to receive either intrathecal sufentanil 5 μg (Group S, fentanyl 25 μg (Group F or normal saline 0.5 ml (Group C as adjuvants to 15 mg of 0.5% hyperbaric bupivacaine. The onset and duration of sensory and motor block were assessed intraoperatively. The pain scores were assessed postoperatively. Duration of complete and effective analgesia was recorded. The incidence of side effects such as nausea, vomiting, pruritus, shivering and PDPH was recorded. Results: The Demographic data, hemodynamic and respiratory parameters were comparable in the three groups. There was a significantly earlier onset and prolonged duration of sensory block in the sufentanil and fentanyl groups. The duration of complete and effective analgesia were also significantly prolonged in the fentanyl and sufentanil groups. Pruritus was noticed in the study groups (Groups S&F. Conclusions: Intrathecal sufentanil (5 μg and fentanyl (25 μg, as adjuvants lead to an earlier onset and prolonged duration of sensory block. The duration of effective analgesia with intrathecal sufentanil and fentanyl as adjuvants to hyperbaric bupivacaine is longer than that of bupivacaine alone.

  13. A Meta-analysis of Randomized Trials Comparing Surgery versus Endovascular Therapy for Thrombosed Arteriovenous Fistulas and Grafts in Hemodialysis

    Energy Technology Data Exchange (ETDEWEB)

    Kuhan, G., E-mail: gkuhan@nhs.net; Antoniou, G. A. [Central Manchester University Hospital Foundation Trust, Regional Vascular and Endovascular Unit (United Kingdom); Nikam, M.; Mitra, S. [Central Manchester University Hospital Foundation Trust, Department of Renal Medicine (United Kingdom); Farquharson, F. [Central Manchester University Hospital Foundation Trust, Department of Radiology (United Kingdom); Brittenden, J. [University of Aberdeen (United Kingdom); Chalmers, N. [Central Manchester University Hospital Foundation Trust, Department of Radiology (United Kingdom)

    2013-06-15

    Purpose. To carry out a systematic review of randomized trials comparing surgery vs. endovascular therapy for occluded fistulas and grafts. Methods. All randomized trials which compared surgery and endovascular therapy for occluded fistulas and grafts were retrieved from 1990 onwards. The following search terms were used: 'haemodialysis,' 'thrombosis,' 'arteriovenous fistula,' 'arteriovenous shunt,' 'end stage renal failure' on Medline and PubMed. The results of the pooled data were analysed by a fixed-effect model. Results. There were no randomized trials comparing surgery vs. endovascular therapy for native fistulas and vein grafts. Six randomized studies reporting on 573 occluded grafts were identified. Technical success, need for access line and primary patency at 30 days were similar between the two groups (odds ratio [OR] 1.40, 95 % confidence interval [CI] 0.91-2.14; OR 0.77, 95 % CI 0.44-1.34; and OR 1.15, 95 % CI 0.79-1.68, respectively). There was no significant difference in morbidity at 30 days between groups (OR 1.12, 95 % CI 0.67-1.86). There were no statistical difference between the two groups for 1 year primary patency (OR 2.08, 95 % CI 0.97-4.45). Primary assisted patency at 1 year was better with surgery (OR 3.03, 95 % CI 1.12-8.18) in a single study. Conclusion. Comparable results to surgery have been achieved with endovascular techniques for occluded prosthetic grafts for dialysis access. Long-term data comparing the two groups were lacking. Further trials designed to encompass variation in methods are warranted in order to obtain the best available evidence particularly for native fistulas.

  14. The role of surgery for treatment of low back pain: insights from the randomized controlled Spine Patient Outcomes Research Trials

    Directory of Open Access Journals (Sweden)

    Peter Abraham

    2016-01-01

    Full Text Available Low back pain (LBP is a common medical problem with high morbidity and healthcare costs. The optimal management strategy, including the role of surgical intervention, remains controversial. The Spine Patient Outcomes Research Trials were randomized controlled studies conducted to assess the effectiveness of surgery for three of the most common conditions implicated in LBP: Intervertebral disc herniation, degenerative spondylolisthesis, and spinal stenosis. Despite challenges in data interpretation related to patient cross over, these studies support the efficacy of surgery as treatment for these three common conditions.

  15. Health-related quality of life outcomes following elective open or endovascular AAA repair: a randomized controlled trial.

    NARCIS (Netherlands)

    Lottman, P.E.M.; Laheij, R.J.F.; Cuypers, P.W.; Bender, M.H.M.; Buth, J.

    2004-01-01

    PURPOSE: To assess health-related quality of life outcomes after endovascular versus open abdominal aortic aneurysm repair. METHODS: Participants were randomly assigned to receive either endovascular or open abdominal aortic aneurysm (AAA) surgery according to a rate of 3 endovascular patients to 1

  16. [Inflammatory abdominal aortic aneurysm].

    Science.gov (United States)

    Ziaja, K; Sedlak, L; Urbanek, T; Kostyra, J; Ludyga, T

    2000-01-01

    The reported incidence of inflammatory abdominal aortic aneurysm (IAAA) is from 2% to 14% of patients with abdominal aortic aneurysm and the etiology of this disease is still discussed--according to the literature several pathogenic theories have been proposed. From 1992 to 1997 32 patients with IAAA were operated on. The patients were mostly symptomatic--abdominal pain was present in 68.75% cases, back pain in 31.25%, fever in 12.5% and weight loss in 6.25% of the operated patients. In all the patients ultrasound examination was performed, in 4 patients CT and in 3 cases urography. All the patients were operated on and characteristic signs of inflammatory abdominal aortic aneurysm like: thickened aortic wall, perianeurysmal infiltration or retroperitoneal fibrosis with involvement of retroperitoneal structures were found. In all cases surgery was performed using transperitoneal approach; in three cases intraoperatively contiguous abdominal organs were injured, which was connected with their involvement into periaortic inflammation. In 4 cases clamping of the aorta was done at the level of the diaphragmatic hiatus. 3 patients (9.37%) died (one patient with ruptured abdominal aortic aneurysm). Authors present diagnostic procedures and the differences in the surgical tactic, emphasizing the necessity of the surgical therapy in patients with inflammatory abdominal aortic aneurysm.

  17. Randomized comparison of polyglycolic acid and polyglyconate sutures for abdominal fascial closure after laparotomy in patients with suspected impaired wound healing

    DEFF Research Database (Denmark)

    Osther, P J; Gjøde, P; Mortensen, Sophie Berit Bondegaard;

    1995-01-01

    A randomized study of abdominal fascial closure using interrupted polyglyconate and polyglycolic acid sutures after laparotomy was carried out in 204 consecutive patients with suspected impaired wound healing. There were no statistically significant differences between the two sutures with regard...... of fascial disruption and incisional hernia after laparotomy in patients with suspected impaired wound healing but the incidence of wound infection may be reduced compared with that of multifilament polyglycolic acid suture....... to the development of fascial disruption and incisional hernia. Wound infection demanding surgical intervention was found in 7 per cent of patients with polyglyconate sutures and in 16 per cent of those with polyglycolic acid sutures (P = 0.04). Monofilament polyglyconate suture does not reduce the incidence...

  18. Abdominal Adhesions

    Science.gov (United States)

    ... adhesions? Abdominal adhesions can cause intestinal obstruction and female infertility—the inability to become pregnant after a year of trying. Abdominal adhesions can lead to female infertility by preventing fertilized eggs from reaching the uterus, ...

  19. Melatonin reduces cardiac morbidity and markers of myocardial ischemia after elective abdominal aortic aneurism repair

    DEFF Research Database (Denmark)

    Gögenür, Ismail; Kücükakin, Bülent; Panduro Jensen, Leif;

    2014-01-01

    The aim was to examine the effect of perioperative melatonin treatment on clinical cardiac morbidity and markers of myocardial ischemia in patients undergoing elective surgery for abdominal aortic aneurism. Reperfusion injury results in increased cardiac morbidity in patients undergoing surgery...... for abdominal aortic aneurisms (AAA). A randomized, placebo-controlled, clinical trial including patients undergoing surgery for AAA was performed. The patients received by infusion over a 2-hr period either, 50 mg melatonin or placebo intra-operatively, and 10 mg melatonin or placebo orally, the first three...... found in the duration of ST-segment deviations. Melatonin treatment in the perioperative period decreased clinical cardiac morbidity as well as the occurrence of myocardial ischemia after abdominal aortic aneurism repair....

  20. Video-assisted thoracic surgery reduces early postoperative stress. A single-institutional prospective randomized study

    Science.gov (United States)

    Asteriou, Christos; Lazopoulos, Achilleas; Rallis, Thomas; Gogakos, Apostolos S; Paliouras, Dimitrios; Tsakiridis, Kosmas; Zissimopoulos, Athanasios; Tsavlis, Drosos; Porpodis, Konstantinos; Hohenforst-Schmidt, Wolfgang; Kioumis, Ioannis; Organtzis, John; Zarogoulidis, Konstantinos; Zarogoulidis, Paul; Barbetakis, Nikolaos

    2016-01-01

    Background Video-assisted thoracic surgery (VATS) has been shown to effectively reduce postoperative pain, enhance mobilization of the patients, shorten in-hospital length of stay, and minimize postoperative morbidity rates. The aim of this prospective study is to evaluate neuroendocrine and respiratory parameters as stress markers in cancer patients who underwent lung wedge resections, using both mini muscle-sparing thoracotomy and VATS approach. Methods The patients were randomly allocated into two groups: Group A (n=30) involved patients who were operated on using the VATS approach, while in group B (n=30), the mini muscle-sparing thoracotomy approach was used. Neuroendocrine and biological variables assessed included blood glucose levels, C-reactive protein (CRP) levels, cortisol, epinephrine, and adrenocorticotropic hormone (ACTH) levels. Arterial oxygen (PaO2) and carbon dioxide (PaCO2) partial pressure were also evaluated. All parameters were measured at the following time points: 24 hours preoperatively (T1), 4 hours (T2), 24 hours (T3), 48 hours (T4), and 72 hours (T5), after the procedure. Results PaO2 levels were significantly higher 4 and 24 hours postoperatively in group A vs group B, respectively (T2: 94.3 vs 77.9 mmHg, P=0.015, T3: 96.4 vs 88.7 mmHg, P=0.034). Blood glucose (T2: 148 vs 163 mg/dL, P=0.045, T3: 133 vs 159 mg/dL, P=0.009) and CRP values (T2: 1.6 vs 2.5 mg/dL, P=0.024, T3: 1.5 vs 2.1 mg/dL, P=0.044) were found increased in both groups 4 and 24 hours after the procedure. However, their levels were significantly lower in the VATS group of patients. ACTH and cortisol values were elevated immediately after the operation and became normal after 48 hours in both groups, without significant difference. Postoperative epinephrine levels measured in group A vs group B, respectively, (T2: 78.9 vs 115.6 ng/L, P=0.007, T3: 83.4 vs 122.5 ng/L, P=0.012, T4: 67.4 vs 102.6 ng/L, P=0.021). The levels were significantly higher in group B. Conclusion This

  1. DIEP breast reconstruction following multiple abdominal liposuction procedures

    OpenAIRE

    Farid, Mohammed; Nicholson, Simon; Kotwal, Ashutosh; Akali, Augustine

    2014-01-01

    Objective: Previous abdominal wall surgery is viewed as a contraindication to abdominal free tissue transfer. We present two patients who underwent multiple abdominal liposuction procedures, followed by successful free deep inferior epigastric artery perforator flap. We review the literature pertaining to reliability of abdominal free flaps in those with previous abdominal surgery. Methods: Review of case notes and radiological investigations of two patients, and a PubMed search using the ter...

  2. 昂丹司琼单用与联用地塞米松预防腹部术后恶心呕吐效果的Meta分析%Meta-analysis of Ondansetron and Ondansetron combined with Dexamethasone for preventing postoperative nausea and vomiting after abdominal surgery

    Institute of Scientific and Technical Information of China (English)

    黄轶婷

    2013-01-01

    目的 评价昂丹司琼单用与联用地塞米松预防腹部术后恶心、呕吐的效果.方法 通过检索PubMed、中国知网和万方数据库,搜集以昂丹司琼单用与联用地塞米松预防腹部术后恶心呕吐的随机对照试验研究(random controlled trial,RCT).以昂丹司琼单用组为对照组,以昂丹司琼单用与联用地塞米松组为试验组,采用Meta分析评价昂丹司琼联用地塞米松预防术后恶心、呕吐的效果.结果 共纳入11篇文献,共1 021例腹部手术患者,其中试验组509例,对照组512例.Meta分析结果显示,试验组预防腹部术后恶心、呕吐效果均优于对照组(P < 0.05).预防恶心和呕吐合并效应比值比(odd ratio,OR)及95%可信区间(confidence interval,CI)分别为2.73(1.71,4.34)和3.20(1.86,4.92).结论 昂丹司琼联用地塞米松能够有效预防腹部术后恶心、呕吐的发生,但是仍需要严格、标准、高质量、大样本、长期随访证实昂丹司琼联用地塞米松的安全性和有效性.%Objective To evaluate the efficacy of Ondansetron combined with Dexamethasone for preventing postoperative nausea and vomiting after abdominal surgery. Methods PubMed, CNKI and Wanfang electronic databases were searched to collected randomized controlled trials (RCT) that were interfere in Ondansetron or Ondansetron combined with Dexamethasone in controlling postoperative nausea and vomiting, Ondansetron was taken as control group, Ondansetron combined with Dexamethasone was taken as test group, The efficacy of Ondansetron combined with Dexamethasone for preventing postoperative nausea and vomiting after abdominal surgery with Meta-analysis was evaluated. Results 11 RCT and 1 021 patients with abdominal surgery were included. There was 509 cases in test groups and 512 cases in control group, Meta analysis showed that the test group was better than the control group in improving the incidence of the total postoperative nausea and vomiting (P < 0

  3. Comparative efficacy assessment of Tramadol versus Morphine for post operative pain relief following abdominal surgery, Shariati Hospital (1999

    Directory of Open Access Journals (Sweden)

    Soroosh AR

    2002-11-01

    Full Text Available Introduction: The objective of the present study is to compare the respiratory function and pain relief of two parenteral analgesics tramadol and morphine under clinical conditions. Materials and Methods: The trial was conducted as an open label-randomized, single center study. The study was performed during 3 months in 1999. In total, 64 patients were enrolled in Shariatie University Hospital, while the other 32 patients were treated with morphine. Results: There were 12 male and 20 female in either groups. The mean age was 48±15 in tramadol versus 43±16 morphine group. Concerning the amount of the medication given to the patients. It would be observed that tramadol patients received 194±72 mg and morphine patients 17±7 mg out of drugs. At study admission vital signs were recorded. The pulse rate, blood pressure and respiratory rate are presented revealing no obvious differences between the treatment groups. There was a broad range regarding the underlying type of operation, however, a laparatomy or a cholecystectomy was performed in 24 (75.0% Vs. 26 (81.3% patients, respectively. All 64 patients were receiving anaesthetics as stipulated in the protocol. Of them being diazepam, sufentanil, succinylcholine chloride and thiopental as the most frequent reported, 4 Vs. 3 patient were given additional fentanylin a mean dosage of 220 mg Vs. 83 mcg. The oxygen saturation was the main safety parameter of the present study. No obvious differences between the two treatment groups can be detected (P<0.472. Primary efficacy end point was the pain assessment. The pain intensity at each scheduled time point was recorded. At study inclusion no differences between the treatment groups uncured, but during the 24 hour observation period the tramadol patients were in advantage (P<0.001. Conclusion: This study shows that long-term efficacy of tramadol is better than morphine.

  4. CONTROLLED HYPOTENSIVE ANAESTHESIA WITH DEXMEDETOMIDINE FOR FUNCTIONAL ENDOSCOPIC SINUS SURGERY: A PROSPECTIVE RANDOMIZED DOUBLE BLIND STUDY

    Directory of Open Access Journals (Sweden)

    Sunil

    2014-08-01

    Full Text Available : OBJECTIVE: Controlled hypotension is commonly used to achieve a bloodless operative field which is needed for successful FESS. This study was carried out to assess the hypotensive effect of dexmedetomidine (DEX during FESS. METHODS: Fifty ASA grades I and II patients of either sex aged 20–50 years undergoing FESS were randomly divided into two groups of 25 each. Group D received 10–15 min prior to induction of anesthesia 1 μg/kg IV bolus DEX diluted in 10 ml of normal saline over 10 min. Immediately thereafter an infusion of 0.4 μg/kg/hr of DEX commenced. Group C received placebo bolus and infusion of saline at a rate similar to DEX in Group D. Standard anesthetic technique was used. The surgical field was assessed using Average Category Scale and average blood loss was calculated. Hemodynamic variables (MAP and HR; emergence time and total recovery from anesthesia (Aldrete score ≥9 were recorded. RESULT: Group D reached the desired MAP (55-65 mmHg. In group D patients the average MAP was 55.9±5.3 mm of Hg, where as in group C it was 86.2±11.4 mm of Hg. Patients in group D had a better surgical field, and the duration of surgery was significantly reduced(78.34±16.7mins in group D vs 103.2±113.1 mins in group C The mean awakening time was significantly reduced in patients of Group D (9.1±2.7 mins in group D vs12.8±2.2 mins in group C when compared to patients of Group C. CONCLUSION: This study demonstrated that dexmedetomidine is a safe agent for controlled hypotension and is effective in providing ideal surgical field during FESS.

  5. PONV in Ambulatory surgery: A comparison between Ramosetron and Ondansetron: a prospective, double-blinded, and randomized controlled study

    Directory of Open Access Journals (Sweden)

    Debasis Banerjee

    2014-01-01

    Full Text Available Background: postoperative nausea and vomiting (PONV frequently hampers implementation of ambulatory surgery in spite of so many antiemetic drugs and regimens. Aims: the study was carried out to compare the efficacy of Ramosetron and Ondansetron in preventing PONV after ambulatory surgery. Setting and Design: it was a prospective, double blinded, and randomized controlled study. Methods: 124 adult patients of either sex, aged 25-55, of ASA physical status I and II, scheduled for day care surgery, were randomly allocated into Group A [(n=62 receiving (IV Ondansetron (4 mg] and Group B [(n=62 receiving IV Ramosetron (0.3 mg] prior to the induction of general anesthesia in a double-blind manner. Episodes of PONV were noted at 0.5, 1, 2, 4 h, 6 , 12, and 18 h postoperatively. Statistical Analysis and Results: statistically significant difference between Groups A and B (P <0.05 was found showing that Ramosetron was superior to Ondansetron as antiemetic both regarding frequency and severity. Conclusion: it was evident that preoperative prophylactic administration of single dose IV Ramosetron (0.3 mg has better efficacy than single dose IV Ondansetron (4 mg in reducing the episodes of PONV over 18 h postoperatively in patients undergoing day-care surgery under general anesthesia.

  6. Real-Time Measurement of the Tool-Tissue Interaction in Minimally Invasive Abdominal Surgery: The First Step to Developing the Next Generation of Smart Laparoscopic Instruments.

    Science.gov (United States)

    Barrie, Jenifer; Jayne, David G; Neville, Anne; Hunter, Louise; Hood, Adrian J; Culmer, Peter R

    2016-10-01

    Introduction Analysis of force application in laparoscopic surgery is critical to understanding the nature of the tool-tissue interaction. The aim of this study is to provide real-time data about manipulations to abdominal organs. Methods An instrumented short fenestrated grasper was used in an in vivo porcine model, measuring force at the grasper handle. Grasping force and duration over 5 small bowel manipulation tasks were analyzed. Forces required to retract gallbladder, bladder, small bowel, large bowel, and rectum were measured over 30 seconds. Four parameters were calculated-T(hold), the grasp time; T(close), time taken for the jaws to close; F(max), maximum force reached; and F(rms), root mean square force (representing the average force across the grasp time). Results Mean F(max) to manipulate the small bowel was 20.5 N (±7.2) and F(rms) was 13.7 N (±5.4). Mean T(close) was 0.52 seconds (±0.26) and T(hold) was 3.87 seconds (±1.5). In individual organs, mean F(max) was 49 N (±15) to manipulate the rectum and 59 N (±13.4) for the colon. The mean F(max) for bladder and gallbladder retraction was 28.8 N (±7.4) and 50.7 N (±3.8), respectively. All organs exhibited force relaxation, the F(rms) reduced to below 25 N for all organs except the small bowel, with a mean F(rms) of less than 10 N. Conclusion This study has commenced the process of quantifying tool-tissue interaction. The static measurements discussed here should evolve to include dynamic measurements such as shear, torque, and retraction forces, and be correlated with evidence of histological damage to tissue.

  7. 大承气汤联合针灸治疗对腹部手术后肠道功能恢复的影响%Therapeutic effect of Dachengqi decoction combined with acupuncture on intestinal function after abdominal surgery

    Institute of Scientific and Technical Information of China (English)

    邹劲林; 李振东; 袁琦文

    2011-01-01

    目的 探讨大承气汤联合针灸治疗在促进腹部手术后患者肠道功能恢复中的价值.方法 选择2005年4月至2007年4月中山大学附属第五医院普外科住院治疗的300例腹部手术患者,按随机原则均分为西医组、大承气汤组和联合治疗组.西医组给予常规西医对症处理,大承气汤组在西医常规治疗基础上给予中药大承气汤加味[大黄(后下)10 g,芒硝6 g,枳实12 g,厚朴15 g,丹参12 g,桃仁12 g,赤芍12 g]500 ml保留灌肠或100 ml口服,均每日2次.联合治疗组在大承气汤组治疗基础上针刺双侧足三里、上巨虚及下巨虚穴,每日2次,共治疗4 d.观察术后患者肠道功能恢复情况、术后并发症发生情况,并分析影响肠道功能恢复的因素.结果 大承气汤组和联合治疗组肠鸣音恢复时间(h:35.38±7.47、18.96±9.13)、排气或排便时间(h:47.0g±5.36、24.82±4.05)均较西医组(59.20±6.32、86.74±5.11)明显缩短(均P<0.01),术后腹胀、肺部感染和肠梗阻的发生率均较西医组明显降低(腹胀:27.0%、11.0%比43.0%,肺部感染:11.0%、5.0%比19.0%,肠梗阻:3.0%、1.0%比7.0%,均P<0.01);联合治疗组明显优于大承气汤组(均P<0.05).年龄、手术时间及是否为胃肠道手术均是影响术后肠道功能恢复的因素(均P<0.05),而麻醉方式对患者肠道功能恢复无影响.结论 采用大承气汤联合针灸治疗能明显促进腹部手术后患者肠道功能的恢复,有利于减少术后并发症的发生;且患者年龄、手术时间及是否为胃肠道手术是影响术后肠道功能恢复的因素.%Objective To study the role of Dachengqi decoction (大承气汤) combined with acupuncture in promoting bowel functional restoration in patients after abdominal surgery. Methods Three hundred patients admitted to the Fifth Affiliated Hospital of Zhongshan University from April 2005 to April 2007 for abdominal surgery were randomly divided into three groups: western medicine

  8. Intensive perioperative glucose control does not improve outcomes of patients submitted to open-heart surgery: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Raquel Pei Chen Chan

    2009-01-01

    Full Text Available BACKGROUND: The objective of this study was to investigate the relationship between different target levels of glucose and the clinical outcomes of patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: We designed a prospective study in a university hospital where 109 consecutive patients were enrolled during a six-month period. All patients were scheduled for open-heart surgery requiring cardiopulmonary bypass. Patients were randomly allocated into two groups. One group consisted of 55 patients and had a target glucose level of 80-130 mg/dl, while the other contained 54 patients and had a target glucose level of 160-200 mg/dl. These parameters were controlled during surgery and for 36 hours after surgery in the intensive care unit. Primary outcomes were clinical outcomes, including time of mechanical ventilation, length of stay in the intensive care unit, infection, hypoglycemia, renal or neurological dysfunction, blood transfusion and length of stay in the hospital. The secondary outcome was a combined end-point (mortality at 30 days, infection or length of stay in the intensive care unit of more than 3 days. A p-value of 0.05. CONCLUSIONS: In 109 patients undergoing cardiac surgery with cardiopulmonary bypass, both protocols of glycemic control in an intraoperative setting and in the intensive care unit were found to be safe, easily achieved and not to differentially affect clinical outcomes.

  9. Continence promotion for older hospital patients following surgery for fractured neck of femur: Pilot of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Lynne Parkinson

    2007-01-01

    Full Text Available Lynne Parkinson1,2, Pauline Chiarelli3, Jennifer Byrne1, Richard Gibson1, Suzanne McNeill4, Gillian Lloyd5, Wendy Watts6, Julie Byles11Research Centre for Gender, Health and Ageing, Faculty of Health, The University of Newcastle, NSW, Australia; 2Hunter Ageing Research, Faculty of Health, The University of Newcastle, NSW, Australia; 3Faculty of Health, The University of Newcastle, NSW, Australia; 4NC Trauma Orthopedics, John Hunter Hospital, New Lambton Heights, NSW, Australia; 5Hunter New England Health, Wallsend Community Health Centre, Wallsend, NSW, Australia; 6Royal Newcastle Centre, John Hunter Hospital, New Lambton Heights, NSW, AustraliaAbstract: Evidence suggests that bladder control problems develop or worsen as a result of fractured neck of femur (#NOF and its subsequent management. The primary aim of this study was to reduce the prevalence and severity of post surgery continence problems among patients, aged from 60-years, undergoing surgery for #NOF, using a best practice “case-management model” multifactorial intervention. Eligible consenting patients admitted with #NOF were randomized to intervention or control group. Self-report questionnaires compared pre-surgery, post surgery, and follow-up continence status between groups.This pilot randomized controlled trial, which included 45 eligible patients aged 60 to 93-years, found no evidence that the intervention was effective in reducing prevalence of post-surgery incontinence in this acute setting. Staff surveys highlighted the need for open communication between the research team and hospital staff. Unclear results were attributed to the small sample size.A central outcome was evidence that intervention to improve continence management for older people post-surgery is imperative. Focused assessment and treatment for those most at risk of incontinence after #NOF would be more acceptable to staff and a more efficient use of resources. A simple screening tool would ensure that

  10. Hemodynamic Consequences of Malignant Ascites in Epithelial Ovarian Cancer Surgery*: A Prospective Substudy of a Randomized Controlled Trial.

    Science.gov (United States)

    Hunsicker, Oliver; Fotopoulou, Christina; Pietzner, Klaus; Koch, Mandy; Krannich, Alexander; Sehouli, Jalid; Spies, Claudia; Feldheiser, Aarne

    2015-12-01

    Malignant ascites (MA) is most commonly observed in patients scheduled for epithelial ovarian cancer (EOC) surgery and is supposed as a major risk factor promoting perioperative hemodynamic deterioration. We aimed to assess the hemodynamic consequences of MA on systemic circulation in patients undergoing cytoreductive EOC surgery.This study is a predefined post-hoc analysis of a randomized controlled pilot trial comparing intravenous solutions within a goal-directed algorithm to optimize hemodynamic therapy in patients undergoing cytoreductive EOC surgery. Ascites was used to stratify the EOC patients prior to randomization in the main study. We analyzed 2 groups according to the amount of ascites (NLAS: none or low ascites [500 mL]). Differences in hemodynamic variables with respect to time were analyzed using nonparametric analysis for longitudinal data and multivariate generalized estimating equation adjusting the analysis for the randomized study groups of the main study.A total of 31 patients in the NLAS and 16 patients in the HAS group were analyzed. Although cardiac output was not different between groups suggesting a similar circulatory blood flow, the HAS group revealed higher heart rates and lower stroke volumes during surgery. There were no differences in pressure-based hemodynamic variables. In the HAS group, fluid demands, reflected by the time to reindication of a fluid challenge after preload optimization, increased steadily, whereas stroke volume could not be maintained at baseline resulting in hemodynamic instability after 1.5 h of surgery. In contrast, in the NLAS group fluid demands were stable and stroke volume could be maintained during surgery. Clinically relevant associations of the type of fluid replacement with hemodynamic consequences were particularly observed in the HAS group, in which transfusion of fresh frozen plasma (FFP) was associated to an improved circulatory flow and reduced vasopressor and fluid demands, whereas the

  11. Protocol design and current status of CLIVIT: a randomized controlled multicenter relevance trial comparing clips versus ligatures in thyroid surgery

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    Wollermann C

    2006-09-01

    Full Text Available Abstract Background Annually, more than 90000 surgical procedures of the thyroid gland are performed in Germany. Strategies aimed at reducing the duration of the surgical procedure are relevant to patients and the health care system especially in the context of reducing costs. However, new techniques for quick and safe hemostasis have to be tested in clinically relevance randomized controlled trials before a general recommendation can be given. The current standard for occlusion of blood vessels in thyroid surgery is ligatures. Vascular clips may be a safe alternative but have not been investigated in a large RCT. Methods/design CLIVIT (Clips versus Ligatures in Thyroid Surgery is an investigator initiated, multicenter, patient-blinded, two-group parallel relevance randomized controlled trial designed by the Study Center of the German Surgical Society. Patients scheduled for elective resection of at least two third of the gland for benign thyroid disease are eligible for participation. After surgical exploration patients are randomized intraoperatively into either the conventional ligature group, or into the clip group. The primary objective is to test for a relevant reduction in operating time (at least 15 min when using the clip technique. Since April 2004, 121 of the totally required 420 patients were randomized in five centers. Discussion As in all trials the different forms of bias have to be considered, and as in this case, a surgical trial, the role of surgical expertise plays a key role, and will be documented and analyzed separately. This is the first randomized controlled multicenter relevance trial to compare different vessel occlusion techniques in thyroid surgery with adequate power and other detailed information about the design as well as framework. If significant, the results might be generalized and may change the current surgical practice.

  12. Analysis of diagnosis and treatment of acute intestinal obstruction caused by abdominal hernia after surgery%术后腹内疝致急性肠梗阻的诊治分析

    Institute of Scientific and Technical Information of China (English)

    姜冰

    2015-01-01

    目的:探讨术后腹内疝致急性肠梗阻的诊断以及治疗方法.方法:收治术后腹内疝致急性肠梗阻患者 48例,回顾性分析其临床资料.进行胃空肠吻合术的患者在手术后横结肠系膜与小肠疝入输入段的空肠形成裂隙导致内疝致急性肠梗阻6例,腹会阴联合直肠癌根治术后患者侧腹壁与降结肠形成间隙导致内疝2例,腹会阴联合直肠癌根治术后盆底筋膜出现裂开导致内疝6例,因各种手术导致腹腔粘连,肠壁、腹腔脏器、腹膜以及肠与肠之间的孔隙导致术后腹内疝致急性肠梗阻34例,所有患者均实行裂孔修补、粘连松解、疝入肠复位,其中16例患者出现肠坏死,实行肠切除吻合手术.结果:经尽早确诊及手术治疗 46 例患者均治愈出院,2 例患者在术后因中毒性休克死亡.结论:腹部手术后腹内疝致急性肠梗阻,病情危险,需及早诊治和手术避免肠坏死及手术并发症的发生,而且CT在术后诊治腹内疝致急性肠梗阻诊治中具有重要意义.%Objective:To explore the diagnosis and treatment of acute intestinal obstruction caused by abdominal hernia after surgery.Methods:48 patients with acute intestinal obstruction caused by abdominal hernia after surgery were selected,and the clinical data were retrospectively analyzed.In the gastrojejunostomy patients,after operation,6 cases of acute intestinal obstruction were due to internal hernia of transverse mesocolon and hernia of the small intestine into the input segment for the jejunum formation;in patients after combined abdominal perineal rectal cancer radical resection,lateral abdominal wall and descending colon for gap formation leaded to internal hernia in 2 cases;after radical resection of abdominal perineal rectal cancer,basin fascia dehiscence leaded to internal hernia in 6 cases;because of all kinds of operation lead to peritoneal adhesions,intestinal wall, abdominal peritoneum and bowel,and intestinal pore

  13. 咀嚼口香糖对腹腔镜腹部手术后胃肠功能的影响%Effect of chewing gum on gastrointestinal function after laparoscopic abdominal surgery

    Institute of Scientific and Technical Information of China (English)

    任彦; 秦晓云; 戴晓云

    2010-01-01

    目的 观察咀嚼口香糖对腹腔镜手术后患者胃电图、血液胃动素及肛门排气时间的影响.方法 选取择期腹腔镜胆囊切除术后患者200例,随机分为咀嚼口香糖组(G组)和对照组(C组)各100例.G组术后第2天早餐时间开始咀嚼口香糖,午餐、晚餐时间各1次,30 min/次,直到第1次肛门排气为止;对照组不咀嚼口香糖.记录2组从手术结束到第1次肛门排气时间;测量术后第1、2、3天早晨咀嚼口香糖后30 min血液胃动素,同时测量胃电图.结果 2组间第1次肛门排气时间比较无显著差异;G组术后第1、2天胃动素水平显著高于C组,第3天2组间无显著差异;2组间胃电图术后第1、2、3天都无显著差异.结论 术后咀嚼口香糖对腹腔手术后胃肠功能无显著影响.%Objective To observe the effect of chewing gum on EGG,blood motilin and anus exhausting after laparoscopic abdominal surgery. Methods 200 patients after laparoscopic cholecystectomy were randomly arranged into chewing gum group (Group G): to start chewing gum for 30 min at breakfast time on first day after operation, and also at lunch and dinner time, and stopped until the first anus exhausting, and the control group(Group C): no chewing gum. The time between endpoint of operation to first anus exhausting was recorded; blood motilin and electrogastrography (EGG)on the morning of 1,2,3 days postoperation after chewing gum was detected. Results The time between endpoint of operation to first anus exhausting was not significantly different between two groups, compared with the control group, blood motilin significantly improved on the first day and the second day,but there was no difference between two groups on 3rd day; EGG was no different in all three days between two groups. Conclusions Chewing gum doesn't improve bowel function after laparoscopic abdominal surgery.

  14. Early enteral nutrition versus parenteral nutrition in postoperative patients of abdominal surgery%腹部手术后患者早期肠内营养支持治疗效果观察

    Institute of Scientific and Technical Information of China (English)

    费伦; 吴丹; 王培云; 陈以明

    2012-01-01

    Objective To evaluate the feasibility of early enteral nutrition (EEN) in postoperative patients of abdominalsurgery.Methods MethodsForty postoperative patients of abdominal surgery were randomized into EEN group(n=20) and total par-enteral l nutrition(TPN) group(n=20). The nutritive index, the return of bowel function, the mean postoperative length of hospital stay and the mean cost of nutrition support were observed and compared between two groups.results ResultsLevels of nutritive in-dex were significantly elevated after nutrition support in two groups(P0.05). Return of bowel function as measured by time to first passage of flatus and time to first defecation was significantly earlier in EEN group than those in TPN group(P0.05).concluslon This study suggests that EEN can effectivelyimprove nutritional condition in postoperative patients of abdominal surgery with earlier return of bowel function, less cost and shorter postoperative hospital days than those of TPN.%目的 探讨腹部手术后患者早期肠内营养(EEN)支持治疗的可行性.方法 将40例中等腹部手术后患者,随机分成EEN组和肠外营养(TPN)组,自术后第2天起分别给予肠内和肠外营养支持治疗,观察并比较两组患者营养支持治疗前后血清营养指标及术后的消化道症状、肠功能恢复情况、术后感染性并发症的发生情况、营养药物费用、术后住院时间.结果 两组患者的营养指标均较营养支持治疗前明显上升(均P<0.05),而两组之间的差异无统计学意义(P >0.05);EEN组肛门恢复排气和排便时间较TPN组缩短(均P<0.01),营养药物费用及术后住院时间亦少于TPN组(均P<0.01),两组感染性并发症发生率的差异无统计学意义(P >0.05).结论 腹部手术后进行EEN可显著改善患者的营养状况,促进肠功能恢复,并能节省医药费用,缩短术后住院时间.

  15. Clinical observation on recovering gastrointestinal function following abdominal surgery with the Weichang Fuyuan decoction%胃肠复原汤对腹部手术后胃肠功能恢复的疗效观察

    Institute of Scientific and Technical Information of China (English)

    王苏; 武文杰; 毛淑平; 孟红艳; 王晶晶; 李韶山

    2014-01-01

    Objective: To observe clinical effects of the Weichang Fuyuan decoction on recovering gastrointestinal function following abdominal surgery. Methods: 106 patients were randomly divided into two groups. All accepted the same treatment before recovery of gastrointestinal function. The treatment group was given the Weichang Fuyuan decoction, 20mL once, 6 hour interval, until flatus up;postoperative recovery of bowel sounds, first flatus, defecation, 48~72 hours average credit of the main clinical symptoms were observed;preoperative and postoperative 24 hour, 48 hour, 72 hour MTL level were tested. Results:Recovery time of bowel sounds, flatus, defecation, 48~72 hours average credit of the main clinical symptoms in the treatment were shorter than those in the control (P<0.05), the difference was statistically significant;postoperative 48 hour and 72 hour MTL level in the treatment were obviously higher (P<0.05), the difference was statistically significant. Conclusion: The Weichang Fuyuan decoction can effectively improve gastrointestinal function following abdominal surgery with better clinical value, and was worthy of promotion.%目的:观察胃肠复原汤对促进腹部手术后胃肠道功能恢复的疗效。方法:选取自2012年6月-2013年4月间接受腹部手术的住院患者106例,随机分为治疗组和对照组,术后胃肠功能恢复前均接受相同的治疗措施。治疗组患者术后6h开始服用胃肠复原汤20mL,间隔6h 1次,直至肛门排气为止;观察患者术后肠鸣音恢复情况,术后首次肛门排气、排便时间,术后48~72h主要临床症状平均积分和;测定术前、术后24h、术后48h及术后72h的胃动素(MTLilin,MTL)水平。结果:治疗组患者的术后肠鸣音恢复时间、术后首次肛门排气、排便时间、术后48~72h 主要临床症状平均积分和明显短于或低于对照组(P<0.05),差异有统计学意义;术后48h、72h胃动素水平

  16. Voice Quality After Treatment of Early Vocal Cord Cancer: A Randomized Trial Comparing Laser Surgery With Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Aaltonen, Leena-Maija, E-mail: leena-maija.aaltonen@hus.fi [Department of Otorhinolaryngology–Head and Neck Surgery, Helsinki University Central Hospital, and University of Helsinki, Helsinki (Finland); Rautiainen, Noora; Sellman, Jaana [Institute of Behavioural Sciences, University of Helsinki, Helsinki (Finland); Saarilahti, Kauko [Department of Oncology, Helsinki University Central Hospital, and University of Helsinki, Helsinki (Finland); Mäkitie, Antti; Rihkanen, Heikki [Department of Otorhinolaryngology–Head and Neck Surgery, Helsinki University Central Hospital, and University of Helsinki, Helsinki (Finland); Laranne, Jussi; Kleemola, Leenamaija [Department of Otorhinolaryngology–Head and Neck Surgery, Tampere University Hospital, and University of Tampere, Tampere (Finland); Wigren, Tuija [Department of Oncology, Tampere University Hospital, and University of Tampere, Tampere (Finland); Sala, Eeva [Department of Otorhinolaryngology–Head and Neck Surgery, Turku University Hospital, and University of Turku, Turku (Finland); Lindholm, Paula [Department of Oncology, Turku University Hospital, and University of Turku, Turku (Finland); Grenman, Reidar [Department of Otorhinolaryngology–Head and Neck Surgery, Turku University Hospital, and University of Turku, Turku (Finland); Joensuu, Heikki [Department of Oncology, Helsinki University Central Hospital, and University of Helsinki, Helsinki (Finland)

    2014-10-01

    Objective: Early laryngeal cancer is usually treated with either transoral laser surgery or radiation therapy. The quality of voice achieved with these treatments has not been compared in a randomized trial. Methods and Materials: Male patients with carcinoma limited to 1 mobile vocal cord (T1aN0M0) were randomly assigned to receive either laser surgery (n=32) or external beam radiation therapy (n=28). Surgery consisted of tumor excision with a CO{sub 2} laser with the patient under general anaesthesia. External beam radiation therapy to the larynx was delivered to a cumulative dose of 66 Gy in 2-Gy daily fractions over 6.5 weeks. Voice quality was assessed at baseline and 6 and 24 months after treatment. The main outcome measures were expert-rated voice quality on a grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, videolaryngostroboscopic findings, and the patients' self-rated voice quality and its impact on activities of daily living. Results: Overall voice quality between the groups was rated similar, but voice was more breathy and the glottal gap was wider in patients treated with laser surgery than in those who received radiation therapy. Patients treated with radiation therapy reported less hoarseness-related inconvenience in daily living 2 years after treatment. Three patients in each group had local cancer recurrence within 2 years from randomization. Conclusions: Radiation therapy may be the treatment of choice for patients whose requirements for voice quality are demanding. Overall voice quality was similar in both treatment groups, however, indicating a need for careful consideration of patient-related factors in the choice of a treatment option.

  17. Surgical site infections following colorectal cancer surgery: a randomized prospective trial comparing common and advanced antimicrobial dressing containing ionic silver

    Directory of Open Access Journals (Sweden)

    Biffi Roberto

    2012-05-01

    Full Text Available Abstract Background An antimicrobial dressing containing ionic silver was found effective in reducing surgical-site infection in a preliminary study of colorectal cancer elective surgery. We decided to test this finding in a randomized, double-blind trial. Methods Adults undergoing elective colorectal cancer surgery at two university-affiliated hospitals were randomly assigned to have the surgical incision dressed with Aquacel® Ag Hydrofiber dressing or a common dressing. To blind the patient and the nursing and medical staff to the nature of the dressing used, scrub nurses covered Aquacel® Ag Hydrofiber with a common wound dressing in the experimental arm, whereas a double common dressing was applied to patients of control group. The primary end-point of the study was the occurrence of any surgical-site infection within 30 days of surgery. Results A total of 112 patients (58 in the experimental arm and 54 in the control group qualified for primary end-point analysis. The characteristics of the patient population and their surgical procedures were similar. The overall rate of surgical-site infection was lower in the experimental group (11.1% center 1, 17.5% center 2; overall 15.5% than in controls (14.3% center 1, 24.2% center 2, overall 20.4%, but the observed difference was not statistically significant (P = 0.451, even with respect to surgical-site infection grade 1 (superficial versus grades 2 and 3, or grade 1 and 2 versus grade 3. Conclusions This randomized trial did not confirm a statistically significant superiority of Aquacel® Ag Hydrofiber dressing in reducing surgical-site infection after elective colorectal cancer surgery. Trial registration Clinicaltrials.gov: NCT00981110

  18. 2013 WSES guidelines for management of intra-abdominal infections

    Directory of Open Access Journals (Sweden)

    Sartelli Massimo

    2013-01-01

    Full Text Available Abstract Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. The 2013 update of the World Society of Emergency Surgery (WSES guidelines for the management of intra-abdominal infections contains evidence-based recommendations for management of patients with intra-abdominal infections.

  19. Morbidade respiratória nos pacientes com e sem síndrome pulmonar obstrutiva submetidos a cirurgia abdominal alta Respiratory morbidity in patients with and without pulmonary obstrutive syndrome after upper abdominal surgery

    OpenAIRE

    E.D.B. Pereira; S.M. Farensin; A.L.G. Fernandes

    2000-01-01

    OBJETIVO: Estudar a morbidade respiratória nos pacientes com síndrome pulmonar obstrutiva submetidos a cirurgia abdominal alta. CASUÍSTICA E MÉTODO: Durante o pré-operatório, 196 pacientes candidatos à cirurgia abdominal alta eletiva responderam a um questionário padronizado e logo em seguida realizaram espirometria. Houve acompanhamento no pós-operatório até a alta hospitalar ou óbito. Os pacientes foram divididos em quatro grupos: 27 pacientes com DPOC (diagnóstico de bronquite crônica ou e...

  20. Abdominal Aortic Surgery: Anesthetic Implications

    OpenAIRE

    Cunningham, Anthony J.

    1991-01-01

    The objectives of the review are to highlight the clinical characteristics of the patient population; to assess multivariate risk factor analysis and the invasive/non-invasive techniques available for risk factor identification and management in this high-risk surgical population; to assess the major hemodynamic, metabolic, and regional blood flow changes associated with aortic cross-clamping/unclamping procedures and techniques for their modification or attenuation; and to assess the influen...

  1. Nutrition before and during Surgery and the Inflammatory Response of the Heart: A Randomized Controlled Trial

    OpenAIRE

    Marlieke Visser; Niessen, Hans W M; Kok, Wouter E. M.; Riccardo Cocchieri; Willem Wisselink; Paul A. M. van Leeuwen; de Mol, Bas A. J. M.

    2015-01-01

    Major surgery induces a long fasting time and provokes an inflammatory response which increases the risk of infections. Nutrition given before and during surgery can avoid fasting and has been shown to increase the arginine/asymmetric dimetlhylarginine ratio, a marker of nitric oxide availability, in cardiac tissue and increased concentrations of branched chain amino acids in blood plasma. However, the effect of this new nutritional strategy on organ inflammatory response is unknown. Therefor...

  2. Effect of desmopressin administration on intraoperative blood loss and quality of the surgical field during functional endoscopic sinus surgery: a randomized, clinical trial

    OpenAIRE

    Shao, Hua; Kuang, Li-Ting; Hou, Wei-Jian; Zhang,Tao

    2015-01-01

    Background Bleeding during functional endoscopic sinus surgery is a challenge for the quality of the surgical field for surgeons. This study aimed to evaluate the effect of desmopressin premedication on blood loss and the quality of the surgical field in endoscopic sinus surgery. Methods A total of 90 American Society of Anesthesiologists physical status I–II patients underwent endoscopic sinus surgery for chronic sinusitis. They were randomly allocated to receive either desmopressin 0.3 μg/k...

  3. Prolonged conservative treatment or 'early' surgery in sciatica caused by a lumbar disc herniation: Rationale and design of a randomized trial [ISRCT 26872154

    NARCIS (Netherlands)

    W.C. Peul (Wilco); H.C. van Houwelingen (Hans); W.B. van den Hout (Wilbert); R. Brand (René); J.A.H. Eekhof (Just); J.T.J. Tans (Th); R.T.W.M. Thomeer (Raph); B.W. Koes (Bart)

    2005-01-01

    textabstractBackground: The design of a randomized multicenter trial is presented on the effectiveness of a prolonged conservative treatment strategy compared with surgery in patients with persisting intense sciatica (lumbosacral radicular syndrome). Methods/design: Patients presenting themselves to

  4. Clonazepam for the Management of Anxiety Associated with Oral Surgery: A Randomized Double-blind Controlled Trial

    Directory of Open Access Journals (Sweden)

    Zamiri B.

    2012-06-01

    Full Text Available Statement of Problem: Anxiety is one of the most common challenges which affect both the patient and the surgeon throughout dental procedures. Thus, there has been growing interest in the application of sedatives in dentistry. Purpose: This study evaluated the efficacy of clonazepam in reducing anxiety prior to oral surgery. Materials and Method: The participants of this, randomized controlled trial, study included 60 patients who referred to the Department of Oral and Maxillof-acial Surgery, Shiraz University of Medical Sciences. They were randomly allocated to either a single 2 mg dose of Clonazepam or a placebo one hour prior to the surgery. The participants and the outcome assessors were blind to the inter-vention. Levels of anxiety were recorded using Visual Analogue Scale (VAS and measuring blood pressure (BP, pulse rate and arterial oxygen saturation percentage. After collecting the data, the Chi-square test was run and then the data was analyzed.Results: The participants in the treatment and control groups were matched for age, sex, education, marital status and employment status ( p >0.05. All anxiety determinants (VAS, BP, pulse, and oxygen saturation rates changed significan-tly one hour after the administration of clonazepam ( p <0.05.Conclusion: Clonazepam is an effective anxiolytic drug with minimal side effects which can be used to reduce anxiety in dental patients.

  5. Natural orifice transluminal endoscopic surgery (NOTES): implications for anesthesia.

    Science.gov (United States)

    Schaefer, Michael

    2009-01-01

    Natural orifice transluminal endoscopic surgery (NOTES) has recently evolved as a novel approach for abdominal surgery with great potential to further improve the advantages of laparoscopy over laparotomy. The first patients undergoing NOTES cholecystectomy or appendectomy reported no or only minimal pain, required no narcotic analgesics, and were discharged early from the hospital and immediately resumed daily activities. If this is confirmed by randomized controlled clinical trials, what are the potential implications for anesthesia? PMID:20948698

  6. Natural orifice transluminal endoscopic surgery (NOTES): implications for anesthesia

    OpenAIRE

    Schaefer, Michael

    2009-01-01

    Natural orifice transluminal endoscopic surgery (NOTES) has recently evolved as a novel approach for abdominal surgery with great potential to further improve the advantages of laparoscopy over laparotomy. The first patients undergoing NOTES cholecystectomy or appendectomy reported no or only minimal pain, required no narcotic analgesics, and were discharged early from the hospital and immediately resumed daily activities. If this is confirmed by randomized controlled clinical trials, what ar...

  7. Effect of Continuing Care on Bladder Cancer Patients after Abdominal Stoma Surgery%连续性护理在膀胱癌腹壁造口术后病人护理中的应用

    Institute of Scientific and Technical Information of China (English)

    蔺玉霞

    2015-01-01

    Objective To observe and analyze the effect of continuing care on bladder cancer patients after abdominal stoma surgery. Methods 100 bladder cancer patients underwent abdominal stoma surgery in the Department of Urology of our hospital from April 2012 to April 2014 were selected as the subjects of this study. The patients were randomly and equally divided into two groups, the control group and the observation group in accordance with the postoperative nursing model given to them. 50 cases in the control group were given the conventional postoperative nursing, while 50 cases in the observation group were given continuing care intervention based on the conventional nursing. And the nursing efficacy was observed and compared between the two groups. Results After surgery, compared with the patients in the control group, the 50 cases in the observation group were much better in grasping the health care knowledge about self-monitoring, prevention of complications, dietary knowledge, replacement of ostomy bag and so on with statistically significant difference (P<0.05). After postoperative nursing, the observation group had much better ADL, mental state, and Spitzer QOL scores than the control group (P<0.05). The nursing satisfaction of the observation group was obviously higher than that of the control group (100.00%vs 88.00%) with statistically significant difference (P<0.05). Conclusion For bladder cancer patients underwent abdominal ostomy, conventional nursing combined with continuing care intervention can ef-fectively ensure the postoperative quality of life, improve the postoperative self-care ability and self-protection ability after dis-charge, enhance the level of rehabilitation with high nursing satisfaction, so it has the value of clinical application.%目的:观察分析连续性护理措施在膀胱癌腹壁造口术后病人护理中的护理效果。方法随机选取该院泌尿外科2012年4月-2014年4月期间接收进行腹壁造口术治疗的100

  8. A prospective, multi centre, randomized clinical study to compare the efficacy and safety of Ertapenem 3 days versus Ampicillin - Sulbactam 3 days in the treatment of localized community acquired intra-abdominal infection. (T.E.A. Study: Three days Ertapenem vs three days Ampicillin-sulbactam

    Directory of Open Access Journals (Sweden)

    Gazzotti Filippo

    2011-04-01

    Full Text Available Abstract Background The recommendations outlined in the latest guidelines published by the Surgical Infection Society (SIS and the Infectious Disease Society of America (IDSA regarding the proper duration of antibiotic therapy in patients with intra-abdominal infections are limited and non-specific. This ambiguity is due mainly to the lack of clinical trials on the topic of optimal duration of therapy. It is well known that the overuse of antibiotics has several important consequences such as increased treatment costs, reduced clinical efficacy, and above all, the increased emergence of antibiotic-resistant pathogens. Ampicillin-Sulbactam is a commonly used "first line" antibiotic for intra-abdominal infections. Ertapenem and Ampicillin-sulbactam are recommended as primary treatment agents for localized peritonitis by both the SIS and IDSA guidelines. Methods/Design This study is a prospective multi-center randomized investigation. The study will be performed in the Departments of General, Emergency, and Transplant Surgery of Sant'Orsola-Malpighi University Hospital in Bologna, Italy, in the General Surgery Department of the Ospedali Riuniti of Bergamo, Italy, and in the Trauma and Emergency Surgery Department of Maggiore Hospital in Bologna, Italy, and will be conducted by all surgeons willing to participate in the study. The inclusion period of the study will take approximately two years before the planned number of 142 enrolled patients is reached. Discussion Ertapenem and Ampicillin-sulbactam are recommended both as primary treatment agents for localized peritonitis by both the SIS and IDSA guidelines. As one of the discussed topic is the optimal duration of the antibiotic therapy and this ambiguity is due mainly to the lack of clinical trials on the topic, the present study aims for obtain precise data. Trial Registration ClinicalTrials.gov: NCT00630513

  9. 黄白通气颗粒对家兔腹部手术后小肠功能的影响%Effect of Huangbaitongqi Granules on the recovery of small intestine function of rabbit after abdominal surgery

    Institute of Scientific and Technical Information of China (English)

    袁转梅; 邵璐

    2014-01-01

    目的:研究黄白通气颗粒对家兔腹部手术后小肠功能的恢复作用,初步探讨其促进腹部手术后家兔小肠功能恢复的作用机制。方法检测其对腹部手术后家兔肠鸣音恢复、首次排便时间、小肠肌电节律及肠推进功能的影响,并对胃动素(MTL)、缩胆囊素(CCK)、P物质(SP)、血管活性肠肽(VIP)等胃肠激素进行含量测定。结果黄白通气颗粒能缩短肠鸣音恢复及术后首次排便时间,加快小肠肌电节律恢复,促进肠推进功能。结论黄白通气颗粒具有增强家兔腹部手术后的胃肠蠕动、促进胃肠功能恢复的作用,其作用机制可能是通过刺激消化道MTL、SP、CCK及VIP的分泌。%Objective To study the effect of Huangbaitongqi Granules on the recovery of small intestine function of rabbit after ab-dominal surgery ,and to study the mechanism of the drug on promoting the recovery of small intestine function of rabbit after ab-dominal surgery .Methods The influence of the drug on the recovery of bowel sounds ,the first time of defecation ,small intestine muscle electric rhythm and the intestinal propulsion function in rabbit after abdominal surgery were tested .The gastrointestinal hormone content such as MTL ,CCK ,SP and VIP was determined .Results Huangbaitongqi Granules can shorten the recovery of bowel sounds and the first time of defecation after operation ;accelerate the recovery of intestinal basic electric rhythm ;promote the intestinal propulsion .Conclusion Huangbaitongqi Granules could enhance the gastrointestinal peristalsis and promote the re-covery of gastrointestinal function in rabbit after abdominal surgery ,which may stimulate the secretion of MTL ,SP ,CCK and VIP of digestive tract .

  10. [ENDOVASCULAR ABDOMINAL AORTIC ANEURISM REPAIR].

    Science.gov (United States)

    Maĭstrenko, D N; Generalov, M I; Tarazov, P G; Zherebtsov, F K; Osovskikh, V V; Ivanov, A S; Oleshchuk, A N; Granov, D A

    2015-01-01

    The authors analyzed the single-center experience of treatment of 72 patients with abdominal aortic aneurisms and severe accompanied pathology. The aneurisms were repaired by stent-grafts. All the patients had abdominal aortic aneurisms with the diameters from 41 to 84 mm against the background of severe somatic pathology. It was a contraindication to planned open surgery. An installation of stent-graft was successful in all 72 follow-ups. It wasn't necessary to use a conversion to open surgery. The follow-up period consisted of 44,6?2,1 months. Control ultrasound and computer tomography studies hadn't revealed an increase of aneurism sack sizes or "eakages". A reduction of abdominal aortic aneurism sizes was noted in 37 patients on 4-5% during first year after operation. The stent-graft implantation extends the possibilities of abdominal aortic aneurism treatment for patients from a high surgical risk group. PMID:26234059

  11. Ibuprofen - a Safe Analgesic During Cardiac Surgery Recovery? A Randomized Controlled Trial?

    Directory of Open Access Journals (Sweden)

    Saddiq Mohammad Qazi

    2015-12-01

    Conclusion: The results of this study suggest that patients treated postoperatively, following cardiac surgery, are at no greater risk of harm if short term slow release ibuprofen combined with lansoprazole treatment is used when compared to an oxycodone based regimen. Renal function should, however, be closely monitored and in the event of any decrease in renal function ibuprofen must be discontinued.

  12. Multimodal analgesia versus traditional opiate based analgesia after cardiac surgery, a randomized controlled trial

    DEFF Research Database (Denmark)

    Rafiq, Sulman; Steinbrüchel, Daniel Andreas; Wanscher, Michael Jaeger;

    2014-01-01

    BACKGROUND: To evaluate if an opiate sparing multimodal regimen of dexamethasone, gabapentin, ibuprofen and paracetamol had better analgesic effect, less side effects and was safe compared to a traditional morphine and paracetamol regimen after cardiac surgery. METHODS: Open-label, prospective...

  13. Nutrition before and during Surgery and the Inflammatory Response of the Heart: A Randomized Controlled Trial

    Science.gov (United States)

    Visser, Marlieke; Niessen, Hans W. M.; Kok, Wouter E. M.; Cocchieri, Riccardo; Wisselink, Willem; van Leeuwen, Paul A. M.; de Mol, Bas A. J. M.

    2015-01-01

    Major surgery induces a long fasting time and provokes an inflammatory response which increases the risk of infections. Nutrition given before and during surgery can avoid fasting and has been shown to increase the arginine/asymmetric dimetlhylarginine ratio, a marker of nitric oxide availability, in cardiac tissue and increased concentrations of branched chain amino acids in blood plasma. However, the effect of this new nutritional strategy on organ inflammatory response is unknown. Therefore, we studied the effect of nutrition before and during cardiac surgery on myocardial inflammatory response. In this trial, 32 patients were randomised between enteral, parenteral, and no nutrition supplementation (control) from 2 days before, during, up to 2 days after coronary artery bypass grafting. Both solutions included proteins or amino acids, glucose, vitamins, and minerals. Myocardial atrial tissue was sampled before and after revascularization and was analysed immunohistochemically, subdivided into cardiomyocytic, fatty, and fibrotic areas. Inflammatory cells, especially leukocytes, were present in cardiac tissue in all study groups. No significant differences were found in the myocardial inflammatory response between the enteral, parenteral, and control groups. In conclusion, nutrition given before and during surgery neither stimulates nor diminishes the myocardial inflammatory response in patients undergoing coronary artery bypass grafting. The trial was registered in Netherlands Trial Register (NTR): NTR2183. PMID:26294967

  14. Nutrition before and during Surgery and the Inflammatory Response of the Heart: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Marlieke Visser

    2015-01-01

    Full Text Available Major surgery induces a long fasting time and provokes an inflammatory response which increases the risk of infections. Nutrition given before and during surgery can avoid fasting and has been shown to increase the arginine/asymmetric dimetlhylarginine ratio, a marker of nitric oxide availability, in cardiac tissue and increased concentrations of branched chain amino acids in blood plasma. However, the effect of this new nutritional strategy on organ inflammatory response is unknown. Therefore, we studied the effect of nutrition before and during cardiac surgery on myocardial inflammatory response. In this trial, 32 patients were randomised between enteral, parenteral, and no nutrition supplementation (control from 2 days before, during, up to 2 days after coronary artery bypass grafting. Both solutions included proteins or amino acids, glucose, vitamins, and minerals. Myocardial atrial tissue was sampled before and after revascularization and was analysed immunohistochemically, subdivided into cardiomyocytic, fatty, and fibrotic areas. Inflammatory cells, especially leukocytes, were present in cardiac tissue in all study groups. No significant differences were found in the myocardial inflammatory response between the enteral, parenteral, and control groups. In conclusion, nutrition given before and during surgery neither stimulates nor diminishes the myocardial inflammatory response in patients undergoing coronary artery bypass grafting. The trial was registered in Netherlands Trial Register (NTR: NTR2183.

  15. Estenose carotídea acima de 70% em pacientes no pré-operatório de cirurgia da aorta abdominal: freqüência e fatores de risco Frequency and risk factors for carotid stenosis above 70% in patients undergoing abdominal aortic surgery

    Directory of Open Access Journals (Sweden)

    André Ventura Ferreira

    2006-03-01

    Full Text Available OBJETIVO: Analisar a freqüência e os fatores de risco associados à estenose carotídea acima de 70% em pacientes que serão submetidos a cirurgias de aorta abdominal. MATERIAL E MÉTODO: Foram analisados 94 pacientes que realizaram ultra-som Doppler de carótidas no pré-operatório de cirurgias de aorta abdominal entre janeiro de 2000 e janeiro de 2003, pela disciplina de Cirurgia Vascular da Santa Casa de São Paulo. RESULTADOS: Sessenta e sete pacientes (71% eram homens. Dentre os 94 pacientes, 42 (44,6% tinham doença oclusiva aorto-ilíaca, e 52 (53,4%, aneurismas da aorta abdominal (AAA. A análise dos dados mostrou uma prevalência de estenose de carótidas acima de 70% em 8,33% dos pacientes com AAA e em 13,51% dos pacientes com doença oclusiva aorto-ilíaca, diferença esta sem significância estatística (P = 0,5. Nos pacientes que apresentavam antecedente de isquemia cerebral - acidente vascular cerebral (AVC ou ataque isquêmico transitório (AIT -, houve uma prevalência estatisticamente maior de estenose carotídea entre 70 e 99%. Outros fatores de risco para aterosclerose, como sexo masculino, diabetes, hipertensão arterial e tabagismo, não foram preditivos da presença de estenose carotídea acima de 70%. CONCLUSÃO: A freqüência de estenose da carótida acima de 70% em pacientes no pré-operatório de cirurgia de aorta foi de 9,57%, e a presença de antecedente de AVC ou AIT na história foi preditiva de estenose acima de 70% neste grupo de pacientes.OBJECTIVE: To analyze the frequency and risk factors of carotid stenosis above 70% in patients undergoing abdominal aortic reconstruction. MATERIAL AND METHOD: Ninety-four patients who underwent Doppler ultrasound preoperative screening for abdominal aortic surgery between January 2000 and January 2003 were analyzed by the Vascular Surgery Unit of the Santa Casa of São Paulo (Faculty of Medical Sciences. RESULTS: Sixty-seven (71% patients were male. Of the 94 patients, 42

  16. Preinduction incentive spirometry versus deep breathing to improve apnea tolerance during induction of anesthesia in patients of abdominal sepsis: A randomized trial

    Directory of Open Access Journals (Sweden)

    M Tripathi

    2013-01-01

    Full Text Available Background: Abdominal sepsis is associated with varied degree of hypoxemia and atelactasis in the lung and can enhance the onset of desaturation of arterial blood during apnea. Aims : This study looked at methods to improve safety margin of apnea during induction of anesthesia in these high-risk patients. Settings and Design: It was a randomized, single blind study on adult patients presenting for emergency laparotomy due to peritonitis in a university teaching hospital setting. Materials and Methods: In group 1 (IS (n = 32, three sessions of incentive spirometry (IS were performed within one hour before induction of anesthesia. In group 2 (DB (n = 34, patients were subjected to deep breathing sessions in a similar manner. All patients received preoxygenation (100% by mask for 3 min, followed by rapid-sequence induction of anesthesia using fentanyl, thiopental, and suxamethonium and endotracheal intubation. Patients were subjected to a period of apnea by keeping the end of the endotracheal tube open to air till they developed 95% hemoglobin saturation (SpO 2 by pulse oxymetry. Positive pressure ventilation was resumed at the end. We observed for hemodynamic changes, apnea time, and SpO 2 (100% recovery time on resuming ventilation. Arterial blood gas samples were taken before intervention, after IS or DB, after preoxygenation, and at the end of apnea. Statistical analysis used: One-way analysis of variance (ANOVA, X 2 test, Kaplan-Meier graph, and log-rank tests were applied to compare the two study groups. Results: Oxygenation level in group 1 (265 ± 76.7 mmHg patients was significantly (P < 0.001 higher than in group 2 (221 ± 61.8 mmHgat the end of preoxygenation. The apnea time (median: lower bound - upper bound Confidence Interval apnea time (272:240-279 s in group 1 (IS patients was significantly higher P < 0.05 than in group 2 (180:163-209 s patients. Saturation recovery time (35:34-46 s in group 1 (IS patients was also quicker than in

  17. Meta analysis of outcomes of open surgery versus endovascular aneurysm repair for ruptured abdominal aortic aneurysms%开放手术和腔内修复术治疗腹主动脉瘤破裂的 meta 分析(附2例报告)

    Institute of Scientific and Technical Information of China (English)

    戈小川; 刘建伟

    2013-01-01

      目的比较开放手术和腔内修复术(EVAR)治疗腹主动脉瘤破裂的效果和预后的差异。方法从2例行 EVAR 治疗腹主动脉瘤破裂的经验出发,检索 EVAR 和开放手术治疗该疾病的文献报道并作 meta 分析。结果一共纳入14篇文献,均是单中心研究,大部分都是观察报告,只有1篇是随机对照试验。EVAR 组术后30天死亡率为18%(95%CI:12%~23%),开放手术组为39%(95%CI:34%~44%),两组比较差异有统计学意义(P <0.01)。EVAR 组的平均住院天数及ICU 天数比开放手术组的时间明显缩短,两组比较差异有统计学意义(P <0.05)。EVAR 组平均术中出血量也小于开放手术组(746 ml vs 3435 ml,P <0.01);但在平均术中输液(血)量、手术时间和术后并发症上,两组比较差异无统计学意义(P <0.05)。结论EVAR 治疗腹主动脉瘤破裂和开放手术比较有更低的死亡率、更短的住院时间和更少的出血量,患者术后恢复较快,但术后并发症发生率无显著性差异,而长期生存率仍不明确。%Objective To compare the result of endovascular aneurysm repair(EVAR) and open surgery for ruptured abdominal aortic aneurysms. Method From the experience of 2 patients underwent EVAR treatment of abdominal aortic aneurysm in our hospital, we retrieved the reports on EVAR and surgical treatment of ruptured abdominal aortic aneurysms and made meta-analysis literature. Results Total 14 studies were included in this study. All studies were single-center study, including 13 observational reports and a randomized controlled trial (RCT) report. The 30-day mortality of EVAR group was 18% (95% CI: 12% ~ 23%), while surgery group was 39% (95% CI: 34% ~ 44%), the difference was statistically significant (P < 0.01 ). EVAR group was significantly shorter time than surgery group on the average days in hospital and in ICU (P < 0.05). The average blood loss in EVAR group was

  18. Recombinant human growth hormone and rosiglitazone for abdominal fat accumulation in HIV-infected patients with insulin resistance: a randomized, double-blind, placebo-controlled, factorial trial.

    Directory of Open Access Journals (Sweden)

    Marshall J Glesby

    Full Text Available BACKGROUND: Recombinant human growth hormone (rhGH reduces visceral adipose tissue (VAT volume in HIV-infected patients but can worsen glucose homeostasis and lipoatrophy. We aimed to determine if adding rosiglitazone to rhGH would abrogate the adverse effects of rhGH on insulin sensitivity (SI and subcutaneous adipose tissue (SAT volume. METHODOLOGY/PRINCIPAL FINDINGS: Randomized, double-blind, placebo-controlled, multicenter trial using a 2×2 factorial design in which HIV-infected subjects with abdominal obesity and insulin resistance were randomized to rhGH 3 mg daily, rosiglitazone 4 mg twice daily, combination rhGH + rosiglitazone, or double placebo (control for 12 weeks. The primary endpoint was change in SI by frequently sampled intravenous glucose tolerance test from entry to week 12. Body composition was assessed by whole body magnetic resonance imaging (MRI and dual Xray absorptiometry (DEXA. Seventy-seven subjects were randomized of whom 72 initiated study drugs. Change in SI from entry to week 12 differed across the 4 arms by 1-way ANCOVA (P = 0.02; by pair-wise comparisons, only rhGH (decreasing SI; P = 0.03 differed significantly from control. Changes from entry to week 12 in fasting glucose and glucose area under the curve on 2-hour oral glucose tolerance test differed across arms (1-way ANCOVA P = 0.004, increasing in the rhGH arm relative to control. VAT decreased significantly in the rhGH arms (-17.5% in rhGH/rosiglitazone and -22.7% in rhGH but not in the rosiglitazone alone (-2.5% or control arms (-1.9%. SAT did not change significantly in any arm. DEXA results were consistent with the MRI data. There was no significant rhGH x rosiglitazone interaction for any body composition parameter. CONCLUSIONS/SIGNIFICANCE: The addition of rosiglitazone abrogated the adverse effects of rhGH on insulin sensitivity and glucose tolerance while not significantly modifying the lowering effect of rhGH on VAT. TRIAL REGISTRATION

  19. Postoperative pain management with transdermal fentanyl after forefoot surgery: a randomized, placebo-controlled study

    Directory of Open Access Journals (Sweden)

    Merivirta R

    2015-01-01

    Full Text Available Riika Merivirta,1 Mikko Pitkänen,2 Jouko Alanen,3 Elina Haapoja,1 Mari Koivisto,4 Kristiina Kuusniemi11Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine of Turku University Hospital and University of Turku, Turku, 2Department of Anaesthesia, Hospital Orton, Invalid Foundation, Helsinki, 3Terveystalo Clinic Hospital, Helsinki, 4Department of Biostatistics, University of Turku, Turku, FinlandBackground: Quality of life is decreased in patients with hallux valgus deformity, mainly because of pain. Significant improvement is usually achieved by surgery. However, postoperative pain can be moderate to severe for 2–3 days. The aim of the present study was to evaluate the use of transdermal fentanyl for postoperative pain management after forefoot surgery.Methods: Sixty patients undergoing hallux valgus or hallux rigidus surgery were allocated to receive a patch delivering either fentanyl 12 µg/hour or placebo for postoperative pain. The consumption of rescue opioid oxycodone, the primary outcome measure, was evaluated daily until the fourth postoperative day. Total consumption of oxycodone during the study period was also assessed. Pain scores and possible adverse effects were evaluated every 6 hours during the first 24 hours and on the fourth postoperative day.Results: The use of rescue opioid was low in both groups, the median (range consumption of oxycodone being 10 (0–50 mg on the day of surgery (no difference between the groups, P=0.31 and 0 (0–35 mg thereafter. The total combined consumption was 10 (0–105 mg in the fentanyl group and 20 (0–70 mg in the placebo group (P=0.23. There were no statistically significant differences in pain scores or adverse effects between the groups.Conclusion: As a part of multimodal analgesia with ibuprofen and acetaminophen, a patch delivering fentanyl 12 µg/hour did not significantly decrease the consumption of rescue opioid or pain scores after forefoot surgery

  20. COLOR II. A randomized clinical trial comparing laparoscopic and open surgery for rectal cancer

    DEFF Research Database (Denmark)

    2009-01-01

    INTRODUCTION: Laparoscopic resection of rectal cancer has been proven efficacious but morbidity and oncological outcome need to be investigated in a randomized clinical trial. Trial design: Non-inferiority randomized clinical trial. METHODS: The COLOR II trial is an ongoing international randomized...... clinical trial. Currently 27 hospitals from Europe, South Korea and Canada are including patients. The primary endpoint is loco-regional recurrence rate three years post-operatively. Secondary endpoints cover quality of life, overall and disease free survival, post-operative morbidity and health economy...

  1. A PROSPECTIVE, RANDOMIZED CONTROL STUDY EVALUATING THE POSTOPERATIVE ANALGESIA USING RECTAL DICLOFENAC IN PATIENTS UNDERGOING ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY SURGERIES

    Directory of Open Access Journals (Sweden)

    Padmaja

    2015-05-01

    Full Text Available BACKGROUND: To assess the efficacy of rectal diclofenac suppository in patients undergoing elective laparoscopic cholecystectomy surgeries in management of postoperative pain, in reduction of intra operative opioid requirement and in prolongation of postoperative anal gesic initiation time. OBJECTIVES: This prospective randomized single blinded clinical trial evaluates the efficacy of rectal diclofenac suppository for the management of postoperative pain. MATERIALS AND METHODS: 100 patients undergoing elective laparosco pic cholecystectomy surgeries were randomized into two groups, Group 1 patients receiving 100mg diclofenac rectal suppository after induction of general anaesthesia, Group 2 patients does not receive any diclofenac rectal suppository. Intra operative hemod ynamic monitoring, post - operative VAS score and adverse reactions were recorded over period of 24 hrs. Intra operative opioid (fentanyl was repeated when heart rate and blood pressure variability of more than 20% from base line are noted. Post operatively if VAS score is more than 4 rescue analgesia with inj. Tramadol is given intramuscularly. RESULTS: Administration of single dose of rectal diclofenac had statistically significant reduction in VAS score post operatively compared to control group, reduced requirement of intra operative opioids (fentanyl. Post - operative rescue analgesia initiation time is prolonged in group 1 mean 9.56 hrs compared to group 2, mean 0.72 hrs (p - 0.000. CONCLUSION: Rectal Diclofenac used in laparoscopic cholecystectomy cases provide adequate, effective prolonged analgesia in the post - operative period with good safety profile

  2. Controlled-Release Oxycodone Versus Naproxen at Home After Ambulatory Surgery: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Björn Stessel, MD

    2014-12-01

    Conclusions: Paracetamol/CR oxycodone and paracetamol/naproxen are equally effective in treatment of acute postoperative pain at home after ambulatory surgery with comparable patient satisfaction level. We suggest paracetamol/CR oxycodone to be a valuable alternative for the current paracetamol/naproxen gold standard, particularly in patients with a contraindication for nonsteroidal anti-inflammatory drugs. ClinicalTrials.gov identifier: NCT02152592.

  3. Prevalence of acute post-operative pain in patients in adult age-group undergoing inpatient abdominal surgery and correlation of intensity of pain and satisfaction with analgesic management: A cross-sectional single institute-based study

    Science.gov (United States)

    Singh, Prashant Kumar; Saikia, Priyam; Lahakar, Mangala

    2016-01-01

    Background and Aims: Considering the paucity of regional data, this study was designed to investigate the prevalence of post-operative pain and determine if there exists any correlation between the intensity of post-operative pain and patient's level of satisfaction with their pain management after inpatient abdominal surgery at an academic tertiary care government centre. Methods: Pain intensity was measured in 120 patients with numeric rating scale at the fifth post-operative hour, second and third post-operative day. A questionnaire was used to measure the level of satisfaction with nurse's and doctor's response to their pain and overall pain management. Results: The prevalence of post-operative pain was 84.17%, 92.5% and 96.66% at the fifth post-operative hour, second and third post-operative day, respectively. Less number of patients experienced severe intensity pain on the third post-operative day (P = 0.00046), whereas the number of patients experiencing mild pain increased (P management was − 0.0218 (P = 0.8107), 0.1307 (P = 0.1553) and 0.0743 (P = 0.4195), respectively. Conclusion: There is a high prevalence of acute post-operative pain in patients undergoing inpatient abdominal surgery at our institute. There is a weak correlation between the intensity of pain and level of satisfaction with pain management.

  4. Clinical Use and Advances of ω-3 Fish Oil Emulsion in Abdominal Surgery%ω-3鱼油脂肪乳对腹部手术患者的临床应用及进展

    Institute of Scientific and Technical Information of China (English)

    黄小羚

    2011-01-01

    Patients undergoing abdominal surgery are prone to systemic inflammatory response syndrome and further multiple organ dysfunction syndrome, due to surgical stress, massive release of inflammatory factors, and initiation of inflammatory response. ω-3 polyunsaturated fatty acids are regulatory in inflammation and immunity and able to improve the postsurgical early inflammatory response and immunity.The clinical use and potential of ω-3 have been increasingly recognized. This article reviews the clinical use and advances of ω-3 fish oil emulsion in patients undergoing abdominal surgeries.%腹部手术后患者因为手术应激打击、炎性因子大量释放、启动炎性反应,引起全身炎性反应综合征,进一步可导致多器官功能不全综合征.ω-3多不饱和脂肪酸具有调节炎症和免疫功能的作用,它能够改善术后早期患者的炎性反应和免疫功能,它的临床应用价值和潜力逐渐得到人们的认识.在此就目前国内外ω-3鱼油脂肪乳对腹部手术后患者的临床应用及进展予以综述.

  5. Study on Effect of Kangyanling(抗炎灵) on Cytokine and C-Reactive Protein inPatients of Systemic Inflammatory Reaction Syndrome and Multi-Organ Dysfunction Syndrome after Abdominal Surgery

    Institute of Scientific and Technical Information of China (English)

    陈哲宇; 齐清会

    2001-01-01

    Objective: To observe the clinical efficacy and mechanism of Kangyanling (KYL) in treating patients with systemic inflammatory reaction syndrome and multi-organ dysfunction syndrome (SIRS/MODS) after abdominal surgery. Methods: Eighty-two patients of SIRS/MODS after abdominal surgery were divided into two groups according to admission time, the KYL treated group (n=35) and the control group (n=47). The levels of serum C-reactive protein (CRP), plasma tumor necrosis factor α (TNFα) and interleukin-6 (IL-6) were measured at the 1st, 3rd and 7th days post-operationally. Results: The levels of CRP, TNFα and IL-6 decreased gradually after surgical operation in both groups, but the reducing velocity was shorter in the KYL group than that in the control group, so the comparison of the levels in the two groups showed significant difference on the 3rd day after operation. Conclusion:KYL could inhibit the release of inflammatory mediator and relieve the inflammatory response so as to treat post-operational SIRS/MODS effectively.

  6. The effect of yoga in stress reduction for dental students performing their first periodontal surgery: A randomized controlled study

    Directory of Open Access Journals (Sweden)

    Rajesh Shankarapillai

    2012-01-01

    Full Text Available Context: The dental students experience a lot of stress, which increase when they perform their first surgical procedure. Yoga as an anxiolytic tool in anxiety reduction has been practiced over centuries in India. Aim: To assess the efficacy of yoga in reducing the state trait anxiety of dental students before their first periodontal surgery performance. Settings and Design: A randomized controlled study using a two-way split plot design (pre-post-test was conducted in the department of periodontics, Pacific Dental College, Udaipur, India. Materials and Methods: One hundred clinical dental students who were ready to perform their first periodontal surgery were selected. Students were randomly assigned to two groups and were given a 60-min session on stress reduction. Group A, yogic intervention group, were instructed to do yoga and their performances were monitored for a period of one week and Group B, control group, were given a lecture on stress reduction without any yoga instructions. The investigator who was unaware of the groups had taken the state trait anxiety score of the students three times a before assigning them to each group, b prior to the surgical procedure and c immediately after the performance of surgery. Statistical Analysis Used: Analyses of variance (ANOVA by SPSS V.16. Results: The statistical results showed a significant reduction in the VAS and state trait anxiety of Group A compared to Group B (ANOVA; P<0.001. Conclusions: This study concludes that Yogic breathing has a significant effect on the reduction of state trait anxiety level of dental students.

  7. Assessment of the abdominal wall function after pedicled TRAM flap surgery for breast reconstruction: Use of modified mesh repair for the donor defect

    Directory of Open Access Journals (Sweden)

    Cyriac Chacko

    2010-01-01

    Full Text Available Background: The pedicled TRAM flap has been a workhorse of autologous breast reconstruction for decades. However, there has been a rising concern about the abdominal wall donor site morbidity with the use of conventional TRAM flap. This has generally been cited as one of the main reasons for resorting to "abdominal wall friendly" techniques. This study has been undertaken to assess the abdominal wall function in patients with pedicled TRAM flap breast reconstruction. The entire width of the muscle and the overlying wide disk of anterior rectus sheath were harvested with the TRAM flap in all our patients and the anterior rectus sheath defect was repaired by a Proline mesh. Materials and Methods: Abdominal wall function was studied in 21 patients who underwent simultaneous primary unipedicled TRAM flap reconstruction after mastectomy for cancer. In all the patients, the abdominal wall defect was repaired using wide sheet of Proline mesh both as inlay and onlay. The assessment tools included straight and rotational curl ups and a subjective questionnaire. The abdominal wall was also examined for any asymmetry, bulge, or hernia. The minimal follow-up was 6 months postoperative. The objective results were compared with normal unoperated volunteers. Results and Conclusions: The harvesting the TRAM flap certainly results in changes to the anterior abdominal wall that can express themselves to a variable degree. A relatively high incidence of asymptomatic asymmetry of the abdomen was seen. There was total absence of hernia in our series even after a mean follow-up period of 15.5 months. A few patients were only able to partially initiate the sit up movement and suffered an important loss of strength. In most patients, synergists took over the functional movement but as the load increased, flexion and rotation performances decreased. The lack of correlation between exercise tests and the results of the questionnaire suggests that this statistically

  8. 复合七氟醚时地佐辛用于上腹部手术患者麻醉的适宜剂量%Optimum dose of dezocine when combined with sevoflurane for upper abdominal surgery

    Institute of Scientific and Technical Information of China (English)

    吕帅国; 杨现会; 吕淼淼; 袁峰; 吕志峰; 付红光; 孙凯; 李廷坤; 卢锡华

    2014-01-01

    ,weighing 45-75 kg,undergoing elective upper abdominal surgery under general anesthesia,were randomly divided into 4 groups using a random number table:control group (group C) and different doses of dezocine groups (D1,D2 and D3 groups).Dezocine 0.1,0.2 and 0.3 mg/kg (in 5 ml of normal saline) was intravenously injected immediately before induction of anesthesia in D1,D2 and D3 groups,respectively,while 5 ml of normal saline was given instead in group C.Anesthesia was induced with 8 % sevoflurane inhalation.As soon as the patients lost consciousness,tracheal intubation was facilitated with succinyl choline 1.5 mg/kg.The patients were mechanically ventilated.Anesthesia was maintained with sevoflurane.The first patient received sevoflurane with the end-tidal concentrations of 3.0%,3.0%,2.5% and 2.0% in C,D1,D2 and D3 groups,respectively.After at least 15 min of equilibration and when neuro-muscular function returned to T4/T1 ≥ 0.7,skin incision in 50% of patients was made.The end-tidal concentration of sevoflurane was determined by modified Dixon' s up-and-down sequential experiment.According to the patient's somatic responses,the end-tidal concentrationofsevoflurane w asincreased/ decreased in the next patient.The ratio between the two successive concentrations was 0.2.At least six independent crossover pairs were observed in each group.The minimum alveolar concentration (MAC) of sevoflurane for blunting the body movement evoked by skin incision in 50% of patients-was determined,and 95%confidence interval (CI) was calculated.The development of hypotension and bradycardia was recorded.Results The MAC (95% CI)ofsevoflurane was 2.4% (2.2%-2.6%),1.8% (1.5%-2.1%),1.4% (1.2%-1.6%)and 1.2% (0.9%-1.5%) in C,D1,D2 and D3 groups,respectively.The MAC of sevoflurane was significantly lower in D1,D2 and D3 groups than in group C,and in D2 and D3 groups than in group D1.There was no significant difference in the MAC of sevoflurane between D2 and D3

  9. The Application of Cinical Pathway in Health Education about the Prevention of Postoperative Abdominal Distention of Abdominal Surgery%临床路径在预防腹部手术后腹胀健康教育中的应用

    Institute of Scientific and Technical Information of China (English)

    孙园园

    2014-01-01

    目的:探讨临床路径在预防腹部手术后腹胀患者健康教育中的实施效果。方法:选择在2012年4月~2013年3月进行腹部手术的患者108例,随机分成实验组56例和对照组52例。比较两组患者术后肛门排气时间及腹胀情况,进行χ2以及t检验。结果:实验组的数据显示采用临床路径可以显著缩短排气时间,减少腹胀情况(P<0.05)。结论:临床路径在预防腹部手术后腹胀健康教育中的应用有很高的临床价值,可以促进患者尽快通气,很大程度减少腹胀的发生。%Objective:This paper is to study the effect of implementing Clinica Pathway in the healthcare af-ter abdominal surgery. Method:108 cases were are chosen between April 2012 and March 2013, 56 cases into the experimental group and 52 cases into the control group were arerandomly assigned. The average times of restart of anal exhaust and the case numbers of abdominal distension were recorded and compared between the two groups, with x2-test and t-test. Results: A significant shorter average time of restart of anal exhaust and fewer cases of ab-dominal distension (P<0.05) were are founded in the experiment group. Conclusion: Clinical Pathway can acceler-ate the restart of anal exhaust, reduce the apparent of abdominal distension, so it has a high clinical value in the healthcare after abdominal surgery and we should continuously apply and improve it.

  10. Fatores de morbimortalidade na cirurgia eletiva do aneurisma da aorta abdominal infra-renal: experiência de 134 casos Morbidity and mortality factors in the elective surgery of infrarenal abdominal aortic aneurysm: a case study with 134 patients

    OpenAIRE

    Aquiles Tadashi Ywata de Carvalho; Vanessa Prado dos Santos; Álvaro Razuk Filho; Walter Karakhaian; Henrique Jorge Guedes Neto; Valter Castelli Jr.; Roberto Augusto Caffaro

    2008-01-01

    CONTEXTO: O tratamento cirúrgico convencional do aneurisma da aorta abdominal (AAA) infra-renal pode resultar em complicações graves. A fim de otimizar os resultados na evolução do tratamento, é importante que sejam identificados os pacientes predispostos a determinadas complicações e instituídas condutas preventivas. OBJETIVOS: Avaliar a taxa de mortalidade operatória precoce, analisar as complicações pós-operatórias e identificar os fatores de risco relacionados com a morbimortalidade. MÉTO...

  11. Study on influence of comprehensive thermal insulation on body temperature of patients undergoing abdominal surgery%开腹手术患者全程综合保温对体温变化影响的研究

    Institute of Scientific and Technical Information of China (English)

    彭玉娜; 薄金华; 苑广洁; 张华; 刘春英

    2014-01-01

    目的:通过探讨3种不同保温措施对开腹手术患者围术期体温变化的影响,为患者采取有效的保温措施提供依据。方法选取择期开腹手术患者共90例,随机分为3组,医用升温毯组、充气式升温毯组和综合保温组,每组各30例,对患者在手术中的不同时间点监测其直肠温度、脉搏、血压和麻醉复苏时间等变化。结果3组患者所在手术间温度及其入手术室的体温差异无统计学意义;麻醉1 h开始医用升温毯组患者体温为(36.43±0.48)℃与充气加温组(36.69±0.40)℃比较显著下降( P<0.05),麻醉2 h 医用电热升温毯组(36.12±0.46)℃较充气组(36.61±0.43℃和综合保温组(36.47±0.42)℃均显著下降( P<0.05),而充气加温组和综合保温组间差异无统计学意义。结论在开腹手术过程中应用医用升温毯虽能起到一定保温作用,但是随着手术时间延长,患者仍然会有低体温出现,充气式升温毯法和综合保温法均可有效避免围手术期低体温的发生。%OBJECTIVE To observe the influence of three thermal insulation measures on change of body tempera‐ture during the perioperative period of abdominal surgery so as to take more effective thermal insulation method . METHODS A total of 90 patients who underwent the elective abdominal surgery were enrolled in the study and randomly divided into the three groups :the medical electric blanket group ,the forced‐air warming blanket group , and the comprehensive thermal insulation group ;the changes of rectal temperature ,pulse rate ,blood pressure , and time of recovery from anesthesia were monitored at different time points during the surgery .RESULTS There was no statistically significant difference in the intraoperative body temperature or the body temperature at admis‐sion to the hospital between the three groups of patients .At 1 hour of anesthesia ,the body

  12. 体液平衡和微循环动态监测在腹部术后病人容量状态评估中的应用研究%Study on application of body fluid balance and microcirculation dynamic monitoring for volume state assessment of patients after accepting abdominal surgery

    Institute of Scientific and Technical Information of China (English)

    薛颢; 马丽英; 张艳燕

    2011-01-01

    [目的]评价体液平衡和微循环动态监测在腹部手术后病人容量状态评估中的作用.[方法]选取我院外科病房接受腹部外科手术的成年病人300例,随机分为加强监测治疗组和常规治疗组各150例.加强监测治疗组根据2008年英国及爱尔兰外科学会对病人加强体液平衡的动态监测和微循环状态的观察并及时调整液体治疗方案.常规治疗组病人根据国内诊疗常规及本院以往经验进行常规的监测和治疗.收集并比较两组病人术后脏器功能不全的发生率、病死率,并对两组脏器功能不全病人的构成情况进行分析.[结果]加强监测治疗组病人手术后脏器功能不全的发生率、病死率较常规治疗组显著降低,差异有统计学意义(P<0.05);心功能不全和呼吸功能不全是两组病人脏器功能不全的主要原因.[结论]通过加强对腹部手术后病人容量和微循环状态的动态监测和有效评估有助于及时调整并制订合理的个体化液体治疗方案,降低手术后脏器功能不全的发生率和病死率,改善腹部手术病人的预后.%Objective: To evaluate the effect of body fluid balance and microcirculation dynamic monitoring in volume state assessment for patients after accepting abdominal surgery. Methods: A total of 300 adult patients accepted abdominal surgery in surgical wards in our hospital were selected and randomly divided into test group and control group 150 cases each. Patients of test group were strengthened the dynamic monitoring of fluid balance and observation of microcirculation state and adj usted fluids treatment regimen in time according to the 2008 British and Irish surgical association "Treatment guidelines for adult surgical patients undergoing intravenous fluid infusion". Patients of control were just given conventional monitoring and treatment based on routing diagnosis and treatment in China and previous experiences. Both the incidence rate of

  13. Impact of epidural anaesthesia combined with general anesthesia on hemodynamics and immune function in patients with abdominal surgery%硬膜外复合全麻对腹部手术患者血液循环及免疫功能的影响

    Institute of Scientific and Technical Information of China (English)

    马海燕

    2013-01-01

    目的 探讨硬膜外复合全麻对腹部外科手术患者血流循环及免疫功能的影响.方法 将90例行腹部手术患者随机分成实验组(应用硬膜外复合全麻)和对照组(单纯应用全身麻醉),每组45例.记录并比较2组的血流动力学及免疫功能的变化情况.结果 实验组术毕时、术后12h及术后1、2d的SBP、DBP、HR、SpO2波动幅度均明显小于对照组(P<0.05);实验组术后6h及术后1、3、5、7d的CD3+、CD4+、CD4+/CD8+水平下降幅度均明显小于对照组(P<0.05).结论 硬膜外复合全麻较单纯全麻对患者的血流循环及免疫功能的影响更小,临床应用于腹部外科手术麻醉的前景良好.%Objective To investigate the impact of epidural anaesthesia combined with general anesthesia on hemodynamics and immune function in patients with abdominal surgery.Methods Ninety patients with abdominal surgery were randomly divided into two groups,treatment group (n =45) and control group (n =45).The control group was given general anesthesia only,and the treatment group was given epidural anaesthesia combined with general anesthesia.The changes of hemodynamic and the immune function in both groups were observed and compared.Results The fluctuation range of SBP,DBP,HR,SpO2 in the end of operation,12 hours after operation,ld and 2ds after operation in the treatment group were significantly less than the control group (P < 0.05).The decline of CD3+,CD4+,CD4+/CD8+ 6 hours after operation,1d,3 ds,5 ds and 7 ds after operation in the treatment group were significantly less than the control group (P < 0.05).Conclusion The impact of epidural anaesthesia combined with general anesthesia on hemodynamics and immune function is significantly smaller in patients with abdominal surgery,and the epidural anaesthesia combined with general anesthesia has good prospects in abdominal surgery.

  14. Auricular or body acupuncture: which one is more effective in reducing abdominal fat mass in Iranian men with obesity: a randomized clinical trial

    OpenAIRE

    Darbandi, Mahsa; Darbandi, Sara; Owji, Ali Akbar; Mokarram, Pooneh; Mobarhan, Majid Ghayor; Fardaei, Majid; Zhao, Baxiao; Abdi, Hamid; Nematy, Mohsen; Safarian, Mohammad; Parizadeh, Mohammad Reza; Dabbaghmanesh, Mohammad Hossein; Abbasi, Parisa; FERNS, Gordon

    2014-01-01

    Background The prevalence of abdominal obesity is on the rise worldwide. Previous studies have indicated the higher diagnostic value of body fat distribution pattern compared with general body in abdominal obesity assessments. Several non-pharmacological methods have been suggested for obesity management, of which acupuncture has gained a great deal of research interest with promising results. This study aimed to comparatively evaluate the effects of conventional auricular and body electroacu...

  15. Assessment of risk of bias in randomized clinical trials in surgery

    DEFF Research Database (Denmark)

    Gurusamy, K S; Gluud, C; Nikolova, D;

    2009-01-01

    BACKGROUND: Meta-analysis of randomized clinical trials (RCTs) with low risk of bias is considered the highest level of evidence available for evaluating an intervention. Bias in RCTs may overestimate or underestimate the true effectiveness of an intervention. METHODS: The causes of bias...

  16. Neoadjuvant chemoradiation therapy with gemcitabine/cisplatin and surgery versus immediate surgery in resectable pancreatic cancer. Results of the first prospective randomized phase II trial

    Energy Technology Data Exchange (ETDEWEB)

    Golcher, Henriette; Merkel, Susanne; Hohenberger, Werner [University Hospital Erlangen, Department of Surgery, Erlangen (Germany); Brunner, Thomas B. [University Hospital Erlangen, Department of Radiation Oncology, Erlangen (Germany); University Hospital Freiburg, Department of Radiation Oncology, Freiburg (Germany); Witzigmann, Helmut [University Hospital Leipzig, Department of Surgery, Leipzig (Germany); Hospital Dresden-Friedrichstadt, General Surgery, Dresden (Germany); Marti, Lukas [Hospital of Kanton St. Gallen, General Surgery, St. Gallen (Switzerland); Bechstein, Wolf-Otto [University Hospital Frankfurt, Department of Surgery, Frankfurt/Main (Germany); Bruns, Christiane [University Hospital Munich, Department of Surgery - Hospital Campus Grosshadern, Munich (Germany); University Hospital Magdeburg, Department of Surgery, Magdeburg (Germany); Jungnickel, Henry [Hospital Dresden-Friedrichstadt, General Surgery, Dresden (Germany); Schreiber, Stefan [University Hospital Leipzig, Department of Surgery, Leipzig (Germany); Grabenbauer, Gerhard G. [University Hospital Erlangen, Department of Radiation Oncology, Erlangen (Germany); Hospital Coburg, Department of Radiation Oncology, Coburg (Germany); Meyer, Thomas [University Hospital Erlangen, Department of Surgery, Erlangen (Germany); Hospital Ansbach, General Surgery, Ansbach (Germany); Fietkau, Rainer [University Hospital Erlangen, Department of Radiation Oncology, Erlangen (Germany)

    2014-09-25

    In nonrandomized trials, neoadjuvant treatment was reported to prolong survival in patients with pancreatic cancer. As neoadjuvant chemoradiation is established for the treatment of rectal cancer we examined the value of neoadjuvant chemoradiotherapy in pancreatic cancer in a randomized phase II trial. Radiological staging defining resectability was basic information prior to randomization in contrast to adjuvant therapy trials resting on pathological staging. Patients with resectable adenocarcinoma of the pancreatic head were randomized to primary surgery (Arm A) or neoadjuvant chemoradiotherapy followed by surgery (Arm B), which was followed by adjuvant chemotherapy in both arms. A total of 254 patients were required to detect a 4.33-month improvement in median overall survival (mOS). The trial was stopped after 73 patients; 66 patients were eligible for analysis. Twenty nine of 33 allocated patients received chemoradiotherapy. Radiotherapy was completed in all patients. Chemotherapy was changed in 3 patients due to toxicity. Tumor resection was performed in 23 vs. 19 patients (A vs. B). The R0 resection rate was 48 % (A) and 52 % (B, P = 0.81) and (y)pN0 was 30 % (A) vs. 39 % (B, P = 0.44), respectively. Postoperative complications were comparable in both groups. mOS was 14.4 vs. 17.4 months (A vs. B; intention-to-treat analysis; P = 0.96). After tumor resection, mOS was 18.9 vs. 25.0 months (A vs. B; P = 0.79). This worldwide first randomized trial for neoadjuvant chemoradiotherapy in pancreatic cancer showed that neoadjuvant chemoradiation is safe with respect to toxicity, perioperative morbidity, and mortality. Nevertheless, the trial was terminated early due to slow recruiting and the results were not significant. ISRCTN78805636; NCT00335543. (orig.) [German] Mehrere nichtrandomisierte Studien zeigten, dass eine neoadjuvante Therapie das Ueberleben bei Patienten mit Pankreaskarzinom verlaengert. Beim lokal fortgeschrittenen Rektumkarzinom gehoert die

  17. Abdominal wall repair with human acellular dermal autograft

    Directory of Open Access Journals (Sweden)

    Roel E. Genders

    2011-12-01

    Full Text Available Repair of abdominal wall defects in the presence of contamination or infection is a significant problem. The loss of tissue warrants enforcement of the abdominal wall, preferably by autologous material. However, autologous repair often requires extensive surgery. This paper presents a review of available literature of placement of an acellular human dermis to repair an abdominal fascia defect, in contaminated as well as in non-contaminated surgical fields. It is illustrated with a case report that describes the successful reconstruction of an infected abdominal wall defect with a human acellular dermis allograft. A systematic literature review was undertaken with searches performed in the Pubmed and Cochrane databases for the period up till March 2009, using the search terms Alloderm [Substance Name], Hernia [Mesh] and the key words acellular dermis, acellular dermal matrix, human acellular dermal allograft and abdominal wall defect. To assess methodological quality, each article was subjected to a modification of the methodological index for non-randomized studies (MINORS according to Slim et al. Two items from the original index were not included because none of the studies selected had an unbiased assessment of the study end points and in none of the studies was a prospective calculation of the study size performed. Seventeen studies were included in the review. Data were extracted regarding study design, number of patients, surgical technique, followup period, contaminated or non-contaminated area of the fascia defect, mortality and morbidity (hemorrhage, seroma, wound dehiscence, infection of the operative procedure, the longterm results (removal of the graft, reherniation and bulging and level of evidencey. A total of 169 short-term complications and 151 longterm complications occurred after 643 surgical procedures reconstructing both contaminated and clean abdominal wall defects by implantation of an HADA. Human acellular dermal allograft

  18. A randomized study of telephonic care support in populations at risk for musculoskeletal preference-sensitive surgeries

    Directory of Open Access Journals (Sweden)

    Veroff David R

    2013-02-01

    Full Text Available Abstract Background The rate of elective surgeries varies dramatically by geography in the United States. For many of these surgeries, there is not clear evidence of their relative merits over alternate treatment choices and there are significant tradeoffs in short- and long-term risks and benefits of selecting one treatment option over another. Conditions and symptoms for which there is this lack of a single clear evidence-based treatment choice present great opportunities for patient and provider collaboration on decision making; back pain and joint osteoarthritis are two such ailments. A number of decision aids are in active use to encourage this shared decision-making process. Decision aids have been assessed in formal studies that demonstrate increases in patient knowledge, increases in patient-provider engagement, and reduction in surgery rates. These studies have not widely demonstrated the added benefit of health coaching in support of shared decision making nor have they commonly provided strong evidence of cost reductions. In order to add to this evidence base, we undertook a comparative study testing the relative impact on health utilization and costs of active outreach through interactive voice response technology to encourage health coaching in support of shared decision making in comparison to mailed outreach or no outreach. This study focused on individuals with back pain or joint pain. Methods We conducted four waves of stratified randomized comparisons for individuals with risk for back, hip, or knee surgery who did not have claims-based evidence of one or more of five chronic conditions and were eligible for population care management services within three large regional health plans in the United States. An interactive voice response (IVR form of outreach that included the capability for individuals to directly connect with health coaches telephonically, known as AutoDialog®, was compared to a control (mailed outreach or

  19. Non-inferiority of short-term urethral catheterization following fistula repair surgery: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Barone Mark A

    2012-03-01

    Full Text Available Abstract Background A vaginal fistula is a devastating condition, affecting an estimated 2 million girls and women across Africa and Asia. There are numerous challenges associated with providing fistula repair services in developing countries, including limited availability of operating rooms, equipment, surgeons with specialized skills, and funding from local or international donors to support surgeries and subsequent post-operative care. Finding ways of providing services in a more efficient and cost-effective manner, without compromising surgical outcomes and the overall health of the patient, is paramount. Shortening the duration of urethral catheterization following fistula repair surgery would increase treatment capacity, lower costs of services, and potentially lower risk of healthcare-associated infections among fistula patients. There is a lack of empirical evidence supporting any particular length of time for urethral catheterization following fistula repair surgery. This study will examine whether short-term (7 day urethral catheterization is not worse by more than a minimal relevant difference to longer-term (14 day urethral catheterization in terms of incidence of fistula repair breakdown among women with simple fistula presenting at study sites for fistula repair service. Methods/Design This study is a facility-based, multicenter, non-inferiority randomized controlled trial (RCT comparing the new proposed short-term (7 day urethral catheterization to longer-term (14 day urethral catheterization in terms of predicting fistula repair breakdown. The primary outcome is fistula repair breakdown up to three months following fistula repair surgery as assessed by a urinary dye test. Secondary outcomes will include repair breakdown one week following catheter removal, intermittent catheterization due to urinary retention and the occurrence of septic or febrile episodes, prolonged hospitalization for medical reasons, catheter blockage, and

  20. Component Separation for Complex Abdominal Wall Reconstruction

    Medline Plus

    Full Text Available COMPONENT SEPARATION FOR COMPLEX ABDOMINAL WALL RECONSTRUCTION ALBANY MEDICAL CENTER ALBANY, NY April 30, 2008 00:00: ... Koumanis. The surgery comes to you from Albany Medical Center in Albany, New York. In just moments, ...

  1. Intraoperative Ultrasound Guidance in Breast-Conserving Surgery Improves Cosmetic Outcomes and Patient Satisfaction: Results of a Multicenter Randomized Controlled Trial (COBALT)

    OpenAIRE

    Haloua, Max H; Volders, José H.; Krekel, Nicole M. A.; Lopes Cardozo, Alexander M. F.; de Roos, Wifred K.; de Widt-Levert, Louise M.; van der Veen, Henk; Rijna, Herman; Bergers, Elisabeth; Jóźwiak, Katarzyna; Meijer, Sybren; van den Tol, M. Petrousjka

    2015-01-01

    Background Ultrasound-guided breast-conserving surgery (USS) results in a significant reduction in both margin involvement and excision volumes (COBALT trial). Objective The aim of the present study was to determine whether USS also leads to improvements in cosmetic outcome and patient satisfaction when compared with standard palpation-guided surgery (PGS). Methods A total of 134 patients with T1–T2 invasive breast cancer were included in the COBALT trial (NTR2579) and randomized to either US...

  2. Corpos estranhos provenientes de acessos cirúrgicos à cavidade abdominal: aspectos fisiopatológicos e implicações médico legais Foreign bodies following intra-abdominal surgeries: pathophysiological aspects and medicolegal implications

    Directory of Open Access Journals (Sweden)

    Alberto Schanaider

    2006-08-01

    Full Text Available There is no large series about retained foreign bodies in abdominal cavity. In fact data are underestimated because of the lack of reports considering its serious medicolegal implications. An inflammatory fibrotic process inside the peritoneal cavity, a virtual discharge of inorganic material through the surgical incision and also a slow process of transmural migration into the intestinal lumen are the most frequent pathophysiologic situations. It is not uncommon the incidental diagnosis of foreign body and radiographic studies may be particularly helpful to elucidate the etiology. An early recognition minimizes the surgical risks and contributes to avoid severe complications. The best approach is to adopt preventive measures. Careful peroperative materials vigilance and instrumentation and also a meticulous check at the end of operations are essential to avoid such legal responsibility.

  3. Childhood abdominal cystic lymphangioma

    International Nuclear Information System (INIS)

    Background: Abdominal lymphangioma is a rare benign congenital malformation of the mesenteric and/or retroperitoneal lymphatics. Clinical presentation is variable and may be misleading; therefore, complex imaging studies are necessary in the evaluation of this condition. US and CT have a major role in the correct preoperative diagnosis and provide important information regarding location, size, adjacent organ involvement, and expected complications. Objective: To evaluate the clinical and imaging findings of seven children with proven abdominal cystic lymphangioma. Materials and methods: Clinical and imaging files of seven children with pathologically proven abdominal lymphangioma, from three university hospitals, were retrospectively evaluated. Patient's ages ranged from 1 day to 6 years (mean, 2.2 years). Symptoms and signs included evidence of inflammation, abnormal prenatal US findings, chronic abdominal pain, haemorrhage following trauma, clinical signs of intestinal obstruction, and abdominal distension with lower extremities lymphoedema. Plain films of five patients, US of six patients and CT of five patients were reviewed. Sequential imaging examinations were available in two cases. Results: Abdominal plain films showed displacement of bowel loops by a soft tissue mass in five of six patients, two of them with dilatation of small bowel loops. US revealed an abdominal multiloculated septated cystic mass in five of six cases and a single pelvic cyst in one which changed in appearance over 2 months. Ascites was present in three cases. CT demonstrated a septated cystic mass of variable sizes in all available five cases. Sequential US and CT examinations in two patients showed progressive enlargement of the masses, increase of fluid echogenicity, and thickening of walls or septa in both cases, with multiplication of septa in one case. At surgery, mesenteric lymphangioma was found in five patients and retroperitoneal lymphangioma in the other two. Conclusions: US

  4. Childhood abdominal cystic lymphangioma

    Energy Technology Data Exchange (ETDEWEB)

    Konen, Osnat; Rathaus, Valeria; Shapiro, Myra [Department of Diagnostic Imaging, Meir General Hospital, Sapir Medical Centre, Kfar Saba (Israel); Dlugy, Elena [Department of Paediatric Surgery, Schneider Medical Centre, Sackler School of Medicine, Tel-Aviv University (Israel); Freud, Enrique [Department of Paediatric Surgery, Sapir Medical Centre, Sackler School of Medicine, Tel-Aviv University (Israel); Kessler, Ada [Department of Diagnostic Imaging, Sourasky Medical Centre, Tel-Aviv (Israel); Horev, Gadi [Department of Diagnostic Imaging, Schneider Medical Centre, Tel-Aviv (Israel)

    2002-02-01

    Background: Abdominal lymphangioma is a rare benign congenital malformation of the mesenteric and/or retroperitoneal lymphatics. Clinical presentation is variable and may be misleading; therefore, complex imaging studies are necessary in the evaluation of this condition. US and CT have a major role in the correct preoperative diagnosis and provide important information regarding location, size, adjacent organ involvement, and expected complications. Objective: To evaluate the clinical and imaging findings of seven children with proven abdominal cystic lymphangioma. Materials and methods: Clinical and imaging files of seven children with pathologically proven abdominal lymphangioma, from three university hospitals, were retrospectively evaluated. Patient's ages ranged from 1 day to 6 years (mean, 2.2 years). Symptoms and signs included evidence of inflammation, abnormal prenatal US findings, chronic abdominal pain, haemorrhage following trauma, clinical signs of intestinal obstruction, and abdominal distension with lower extremities lymphoedema. Plain films of five patients, US of six patients and CT of five patients were reviewed. Sequential imaging examinations were available in two cases. Results: Abdominal plain films showed displacement of bowel loops by a soft tissue mass in five of six patients, two of them with dilatation of small bowel loops. US revealed an abdominal multiloculated septated cystic mass in five of six cases and a single pelvic cyst in one which changed in appearance over 2 months. Ascites was present in three cases. CT demonstrated a septated cystic mass of variable sizes in all available five cases. Sequential US and CT examinations in two patients showed progressive enlargement of the masses, increase of fluid echogenicity, and thickening of walls or septa in both cases, with multiplication of septa in one case. At surgery, mesenteric lymphangioma was found in five patients and retroperitoneal lymphangioma in the other two

  5. Comparing the Effect of Dexamethasone before and after Tracheal Intubation on Sore Throat after Tympanoplasty Surgery: A Randomized Controlled trial

    Directory of Open Access Journals (Sweden)

    Mahmoud Eidi

    2014-04-01

    Full Text Available Introduction: Presence of a sore throat after surgery is a common side effect of general anesthesia with intratracheal intubation and can cause discomfort for the patient and prolong the recovery process. In this study we compared the effect of dexamethasone before and after intubation on the incidence of sore throat after tympanoplasty surgery.   Materials and Methods: In a double-blind, randomized clinical trial, 70 patients aged 30–60 years with American Society of Anesthesiologists (ASA physical status I or II who were candidates for tympanoplasty under anesthetic conditions were studied in two separate groups. The first group received intravenous (IV dexamethasone (8 mg 30 mins prior to intubation while the second group received the same dose of dexamethasone 30 mins after intubation. The incidence and severity of the sore throat in both groups were then evaluated.   Results: There was no significant difference between two groups in intensity of sore throat (62.9% vs. 57.1%, cough (65.7% vs. 62.9%, or hoarseness (62.9% vs. 65.7% within 24 h after surgery. Detection of blood in oral secretions or on the tracheal tube was the same in both groups (5.7%. The incidence of coughs during the extubation was 0% in first group and 11.4% in second group.   Conclusion:  According to the results of this research there was no significant difference in incidence and intensity of sore throat in patients receiving dexamethasone before or after intubation. Further, no significant difference in intensity of coughs or hoarseness was observed.  

  6. A PROSPECTIVE RANDOMIZED STUDY ON THE CLINICO - ELECTROPHYSIOLOGICAL RESULTS OF OPEN AND ENDOSCOPIC CARPAL TUNNEL RELEASE SURGERIES

    Directory of Open Access Journals (Sweden)

    Sreejith

    2015-09-01

    Full Text Available OBJECTIVE: To compare short term surgical outcome of carpal tunnel syndrome release, against endoscopic approach. MATERIALS AND METHODS: A prospective randomized study was conducted on 91 patients with carpal tunnel syndrome, who were treated endoscopically or surgically from 2011 to 2013 at KMCT medical college, Calicut . All the patients were confirmed as a case of carpal tunnel syndrome after correlating sensory nerve conduction studies with clinical findings. None of these cases responded to medical treatment and hence opted surgery. Out of these 91 cases, 71 patients were available for post - surgical follow up. On 35 cases endoscopic CTR was performed and remaining 36 were open CTR. These patients were followed up for 6 months and each patient was evaluated for symptom amelioration, complications, operation time, time needed to resume normal lifestyle and the frequency of revision surgery if needed. RESULTS: First few months after surgery, it was observed that endoscopically treated patients were better symptomatically and functionally. Wound scarring, scar tenderness and other local wound problems were significantly more pronounced in patients who underwent open CTR. R eturn to normal daily activities were more delayed in open CTR patients compared to endoscopically treated wrists. Even then there was no significant symptom amelioration, electromyographic testing and complications at the end of six months between these two methods. CONCLUSION: Immediate, short term results were better in endoscopically treated patients due to cosmetic advantages as there is less scar and early return to activities of daily living. On a 6 month review, it was found that both the methods gave comparable results.

  7. The Effects of Perioperative Music Interventions in Pediatric Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

    Directory of Open Access Journals (Sweden)

    Marianne J E van der Heijden

    Full Text Available Music interventions are widely used, but have not yet gained a place in guidelines for pediatric surgery or pediatric anesthesia. In this systematic review and meta-analysis we examined the effects of music interventions on pain, anxiety and distress in children undergoing invasive surgery.We searched 25 electronic databases from their first available date until October 2014.Included were all randomized controlled trials with a parallel group, crossover or cluster design that included pediatric patients from 1 month to 18 years old undergoing minimally invasive or invasive surgical procedures, and receiving either live music therapy or recorded music.4846 records were retrieved from the searches, 26 full text reports were evaluated and data was extracted by two independent investigators.Pain was measured with the Visual Analogue Scale, the Coloured Analogue Scale and the Facial Pain Scale. Anxiety and distress were measured with an emotional index scale (not validated, the Spielberger short State Trait Anxiety Inventory and a Facial Affective Scale.Three RCTs were eligible for inclusion encompassing 196 orthopedic, cardiac and day surgery patients (age of 1 day to 18 years receiving either live music therapy or recorded music. Overall a statistically significant positive effect was demonstrated on postoperative pain (SMD -1.07; 95%CI-2.08; -0.07 and on anxiety and distress (SMD -0.34 95% CI -0.66; -0.01 and SMD -0.50; 95% CI -0.84; - 0.16.This systematic review and meta-analysis indicates that music interventions may have a statistically significant effect in reducing post-operative pain, anxiety and distress in children undergoing a surgical procedure. Evidence from this review and other reviews suggests music therapy may be considered for clinical use.

  8. Centrifugal pump and roller pump in adult cardiac surgery: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Saczkowski, Richard; Maklin, Michelle; Mesana, Thierry; Boodhwani, Munir; Ruel, Marc

    2012-08-01

    Centrifugal pump (CP) and roller pump (RP) designs are the dominant main arterial pumps used in cardiopulmonary bypass (CPB). Trials reporting clinical outcome measures comparing CP and RP are controversial. Therefore, a meta-analysis was undertaken to evaluate clinical variables from randomized controlled trials (RCTs). Keyword searches were performed on Medline (1966-2011), EmBase (1980-2011), and CINAHL (1981-2011) for studies comparing RP and CP as the main arterial pump in adult CPB. Pooled fixed-effects estimates for dichotomous and continuous data were calculated as an odds ratio and weighted-mean difference, respectively. The P value was utilized to assess statistical significance (P pump-related malfunction or mishap. The meta-analysis of RCTs comparing CP and RP in adult cardiac surgery suggests no significant difference for hematological variables, postoperative blood loss, transfusions, neurological outcomes, or mortality.

  9. Abdominal Sepsis.

    Science.gov (United States)

    De Waele, Jan J

    2016-08-01

    Abdominal infections are an important challenge for the intensive care physician. In an era of increasing antimicrobial resistance, selecting the appropriate regimen is important and, with new drugs coming to the market, correct use is important more than ever before and abdominal infections are an excellent target for antimicrobial stewardship programs. Biomarkers may be helpful, but their exact role in managing abdominal infections remains incompletely understood. Source control also remains an ongoing conundrum, and evidence is increasing that its importance supersedes the impact of antibiotic therapy. New strategies such as open abdomen management may offer added benefit in severely ill patients, but more data are needed to identify its exact role. The role of fungi and the need for antifungal coverage, on the other hand, have been investigated extensively in recent years, but at this point, it remains unclear who requires empirical as well as directed therapy. PMID:27363829

  10. Perioperative glucose managements for patients undergoing abdominal surgery%糖尿病患者腹部手术围手术期的处理

    Institute of Scientific and Technical Information of China (English)

    卫洪波; 雷普润

    2016-01-01

    糖尿病已成为全球威胁人类健康的三大慢性非传染性疾病之一。需要外科手术的患者占所有糖尿病患者的25%,其围手术期病死率、并发症以及住院时间较正常人明显增加,因此对于糖尿病患者围手术期的处理方案显得尤为重要。但目前对于围手术期血糖控制范围仍众说纷纭,综合各研究结论,笔者认为将血糖控制在7.8~10 mmol/L是一个较为理想的范围。在患者术前、术中及术后应联合多学科制定各项相应的治疗方案,围手术期尤为注意避免患者发生低血糖和电解质紊乱的发生。也亟待后续大规模的随机对照试验进一步确定有效的血糖控制目标。%Diabetes have become one of three most common chronic non-infectious diseases in China.25% of patients undergoing surgery sufferred diabetes , of whom perioperative complications and mortality were significantly increased and hospital stay was delayed than those of patients without diabetes . Therefore glucose control played an important role in the perioperative management .According to the global guidelines, we recommend 7.8-10.0mmol/L as a moderate glucose level .Perioperative multiple displinary therapeutic strategies for patients could help to avoid hypoglycemia and electrolyte disturbance should be carefully managed .The accurate level of glucose control might be achieved by further large scale randomized controlled trials .

  11. Surgery is more cost-effective than splinting for carpal tunnel syndrome in the Netherlands: results of an economic evaluation alongside a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Adèr Herman J

    2006-11-01

    Full Text Available Abstract Background Carpal tunnel syndrome (CTS is a common disorder, often treated with surgery or wrist splinting. The objective of this economic evaluation alongside a randomized trial was to evaluate the cost-effectiveness of splinting and surgery for patients with CTS. Methods Patients at 13 neurological outpatient clinics with clinically and electrophysiologically confirmed idiopathic CTS were randomly allocated to splinting (n = 89 or surgery (n = 87. Clinical outcome measures included number of nights waking up due to symptoms, general improvement, severity of the main complaint, paraesthesia at night and during the day, and utility. The economic evaluation was performed from a societal perspective and involved all relevant costs. Results There were no differences in costs. The mean total costs per patient were in the surgery group EURO 2,126 compared to EURO 2,111 in the splint group. After 12 months, the success rate in the surgery group (92% was significantly higher than in the splint group (72%. The acceptability curve showed that at a relatively low ceiling ratio of EURO 2,500 per patient there is a 90% probability that surgery is cost-effective. Conclusion In the Netherlands, surgery is more cost-effective compared with splinting, and recommended as the preferred method of treatment for patients with CTS.

  12. Effectiveness of a Cognitive Behavioral Therapy for Dysfunctional Eating among Patients Admitted for Bariatric Surgery: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Hege Gade

    2014-01-01

    Full Text Available Objective. To examine whether cognitive behavioral therapy (CBT alleviates dysfunctional eating (DE patterns and symptoms of anxiety and depression in morbidly obese patients planned for bariatric surgery. Design and Methods. A total of 98 (68 females patients with a mean (SD age of 43 (10 years and BMI 43.5 (4.9 kg/m2 were randomly assigned to a CBT-group or a control group receiving usual care (i.e., nutritional support and education. The CBT-group received ten weekly intervention sessions. DE, anxiety, and depression were assessed by the TFEQ R-21 and HADS, respectively. Results. Compared with controls, the CBT-patients showed significantly less DE, affective symptoms, and a larger weight loss at follow-up. The effect sizes were large (DE-cognitive restraint, g=-.92, P≤.001; DE-uncontrolled eating, g=-.90, P≤.001, moderate (HADS-depression, g=-.73, P≤.001; DE-emotional eating, g=-.67, P≤.001; HADS-anxiety, g=-.62, P=.003, and low (BMI, g=-.24, P=.004. Conclusion. This study supports the use of CBT in helping patients preparing for bariatric surgery to reduce DE and to improve mental health. This clinical trial is registered with NCT01403558.

  13. A RANDOMIZED CLINICAL TRIAL ON THE ANTI - INFLAMATORY EFFECT OF INTRACAMERAL LOW MOLECULAR WE HEPARIN (ENOXAPAIN IN DIABETIC CATARACT SURGERY

    Directory of Open Access Journals (Sweden)

    Shivanand

    2015-08-01

    Full Text Available AIM: To study the effect intracameral low molecular weight on postoperative inflammation after cataract surgery in diabetic patients. SETTING: Department of Ophtha lmology J. N. Medical College. Belgaum. DESIGN: Randomized control trial . MATERIAL AND METHODS: Forty patients with diabetes undergoing small incision cataract surgery with posterior chamber intraocular lens (IOL implantation were randomly assigned to two groups, group A and group B. All patients in g roup A received low molecular weight heparin (enoxaparin in the concentration of 40 IU in 500ml in the irrigating solution and patients in group B received irrigating solution without low molecular weight heparin. In all patients polymethyl methacrylate ( PMMA IOLs were implanted. The patients were examined postoperatively on day 1, day 7, day 30 and day 60 for anterior chamber cells and flare and iris pigments on cell by slit lamp biomicroscopy. RESULTS: A statistically significant reduction in postoperat ive cells, flare and intraocular lens surface pigments was noted in group with addition of low molecular weight heparin (enoxaparin at day 1(p0.001 and 1 week (p<0.001. At 4 weeks and 8 weeks no statistically significant reduction in post - operative cell s and flare was seen between the two groups but there was a significant reduction in the intraocular lens pigments in the group with addition of low molecular weight heparin (enoxaparin. CONCLUSION: Intraoperative use of low molecular weight heparin (enox aparin reduced disturbance in the blood - aq ueous barrier in the early post - operative period evidenced by lower postoperative anterior chamber cells and flare, and also reduced iris pigments on the intraocular lens. At 8 weeks cells and flare in both the gr oups did not show significant difference.

  14. A longitudinal analysis of the relationship between in-hospital mortality in New York State and the volume of abdominal aortic aneurysm surgeries performed.

    OpenAIRE

    Hannan, E L; Kilburn, H; O'Donnell, J. F.; Bernard, H R; Shields, E P; Lindsey, M L; Yazici, A.

    1992-01-01

    This study uses New York State hospital discharge data to examine the relationship between in-hospital mortality for a patient receiving an abdominal aortic aneurysm resection and the volume of aneurysm operations performed in the previous year at the hospital where the operation took place and by the surgeon performing the operation. Previous research on this topic is extended in several respects: (1) A three-year data base is used to examine the manner in which hospital and surgeon volume j...

  15. Body Mass Index Is a Marker of Nutrition Preparation Sufficiency Before Surgery for Crohn's Disease From the Perspective of Intra-Abdominal Septic Complications

    OpenAIRE

    Min ZHANG; Gao, Xiang; Chen, Yuanhan; Zhi, Min; Chen, Huangwei; Tang, Jian; Su, Minli; Yao, Jiayin; Yang, Qingfan; Chen, Junrong; Hu, Pinjin; Liu, Huanliang

    2015-01-01

    Abstract Poor preoperative nutritional status for individuals with Crohn's disease (CD) is associated with intra-abdominal septic complications (IASCs). The present study aimed to investigate the association of the common nutrition indices serum albumin and body mass index (BMI) with IASCs. Sixty-four CD patients who had received elective intestinal operations were retrospectively investigated. Among these patients, 32 had received individualized fortified nutrition support. IASCs occurred in...

  16. ¿Sirve la goma de mascar para acelerar la recuperación luego de una cirugía abdominal?

    Directory of Open Access Journals (Sweden)

    Gabriel Rada

    2014-12-01

    Full Text Available Postoperative ileus is a common condition that delays recovery after an abdominal surgery. The early use of sham feeding, with chewing gum, stimulates peristalsis; thus should allow an earlier nutrition. Searching in Epistemonikos database, which is maintained by screening 20 databases, we identified 14 systematic reviews including 24 randomized trials. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded that chewing gum probably reduces the length of hospital stay after an abdominal surgery.

  17. A genotype-specific, randomized controlled behavioral intervention to improve the neuroemotional outcome of cardiac surgery: study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Hauer, D.; Kolassa, I.T.; Laubender, R.P.; Mansmann, U.; Hagl, C.; Roozendaal, B.; Quervain, D.J. de; Schelling, G.

    2013-01-01

    BACKGROUND: Cardiac surgery is one of the most commonly performed surgical procedures worldwide with >700,000 surgeries in 2006 in the US alone. Cardiac surgery results in a considerable exposure to physical and emotional stress; stress-related disorders such as depression or post-traumatic stres

  18. Respiratory Muscle Training in Patients Recovering Recent Open Cardiothoracic Surgery: A Randomized-Controlled Trial

    Directory of Open Access Journals (Sweden)

    Ernesto Crisafulli

    2013-01-01

    Full Text Available Objectives. To evaluate the clinical efficacy and feasibility of an expiratory muscle training (EMT device (Respilift applied to patients recovering from recent open cardiothoracic surgery (CTS. Design. Prospective, double-blind, 14-day randomised-controlled trial. Participants and Setting. A total of 60 inpatients recovering from recent CTS and early admitted to a pulmonary rehabilitation program. Interventions. Chest physiotherapy plus EMT with a resistive load of 30 cm H2O for active group and chest physiotherapy plus EMT with a sham load for control group. Measures. Changes in maximal expiratory pressure (MEP were considered as primary outcome, while maximal inspiratory pressures (MIP, dynamic and static lung volumes, oxygenation, perceived symptoms of dyspnoea, thoracic pain, and well being (evaluated by visual analogic scale—VAS and general health status were considered secondary outcomes. Results. All outcomes recorded showed significant improvements in both groups; however, the change of MEP (+34.2 mmHg, and +26.1%, for absolute and % of predicted, resp. was significantly higher in active group. Also VAS dyspnoea improved faster and more significantly ( at day 12, and 14 in active group when compared with control. The drop-out rate was 6%, without differences between groups. Conclusions. In patients recovering from recent CTS, specific EMT by Respilift is feasible and effective. This trial is registered with ClinicalTrials.gov NCT01510275.

  19. Abdominal Pain

    Science.gov (United States)

    ... relaxation. Guided imagery for abdominal pain About self-hypnosis and kids See YourChild : Pain and Your Child or Teen for more detail ... how to help your baby cope with the pain of medical procedures, circumcision, and teething. ... Helping Kids YourChild : A Look at Biofeedback YourChild : ...

  20. Antibioticoterapia no trauma abdominal penetrante com lesão gastrintestinal: estudo comparativo entre dois esquemas terapêuticos Antibiotic therapy in penetrating abdominal trauma with gastrointestinal lesion: randomized clinical trial with two therapeutics schemes

    OpenAIRE

    Hamilton Petry de Souza; Mario Mantovani; Ricardo Breigeiron; Mauro de Souza Siebert; Gémerson Gabiatti

    2002-01-01

    OBJETIVO: Comparar a eficácia de dois esquemas terapêuticos de antibióticos em vítimas de trauma penetrante de abdome com lesão gastrintestinal. MÉTODO: O estudo selecionou de forma prospectiva e randomizada, vítimas de trauma abdominal penetrante com lesão gastrintestinal, dividindo-os em dois grupos, conforme o esquema terapêutico: cefoxitina perioperatória exclusivamente (Grupo 1) e associação de gentamicina e metronidazol por cinco dias (Grupo 2). Os grupos foram estratificados em três ní...

  1. The beneficial effect of transversus abdominis plane block after laparoscopic cholecystectomy in day-case surgery

    DEFF Research Database (Denmark)

    Petersen, Pernille Lykke; Stjernholm, Pia; Kristiansen, Viggo B;

    2012-01-01

    Laparoscopic cholecystectomy is associated with postoperative pain of moderate intensity in the early postoperative period. Recent randomized trials have demonstrated the efficacy of transversus abdominis plane (TAP) block in providing postoperative analgesia after abdominal surgery. We hypothesi...... hypothesized that a TAP block may reduce pain while coughing and at rest for the first 24 postoperative hours, opioid consumption, and opioid side effects in patients undergoing laparoscopic cholecystectomy in day-case surgery....

  2. Effects of ovariohysterectomy on intra-abdominal pressure and abdominal perfusion pressure in cats.

    Science.gov (United States)

    Bosch, L; Rivera del Álamo, M M; Andaluz, A; Monreal, L; Torrente, C; García-Arnas, F; Fresno, L

    2012-12-15

    Intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) have shown clinical relevance in monitoring critically ill human beings submitted to abdominal surgery. Only a few studies have been performed in veterinary medicine. The aim of this study was to assess how pregnancy and abdominal surgery may affect IAP and APP in healthy cats. For this purpose, pregnant (n=10) and non-pregnant (n=11) queens undergoing elective spaying, and tomcats (n=20, used as controls) presented for neutering by scrotal orchidectomy were included in the study. IAP, mean arterial blood pressure (MAP), APP, heart rate and rectal temperature (RT) were determined before, immediately after, and four hours after surgery. IAP increased significantly immediately after abdominal surgery in both female groups when compared with baseline (P<0.05) and male (P<0.05) values, and returned to initial perioperative readings four hours after surgery. Tomcats and pregnant females (P<0.05) showed an increase in MAP and APP immediately after surgery decreasing back to initial perioperative values four hours later. A significant decrease in RT was appreciated immediately after laparotomy in both pregnant and non-pregnant queens. IAP was affected by abdominal surgery in this study, due likely to factors, such as postoperative pain and hypothermia. Pregnancy did not seem to affect IAP in this population of cats, possibly due to subjects being in early stages of pregnancy. PMID:23118052

  3. A Prospective Randomized Trial of Imipenem-Cilastatin Versus Clindamycin/Tobramycin in the Treatmentof Intra-Abdominal and Pelvic Infections

    Directory of Open Access Journals (Sweden)

    Lionel A Mandell

    1993-01-01

    Full Text Available Objective: A Canadian multicentre clinical trial in the treatment of intra-abdominal and pelvic infections to compare the efficacy and safety of monotherapy using imipenem-cilastatin (imipenem (500 mg intravenously every 6 h versus combination therapy with clindamycin/tobramycin (clindamycin 600 mg intravenously every 6 h and tobramycin 1.7 mg/kg intravenously every 8 h.

  4. 腹部术后患者疼痛知识、态度及行为的现状调查%Investigation on Postoperative Pain Knowledge, Attitudes and Behavior Related to Abdominal Surgery

    Institute of Scientific and Technical Information of China (English)

    王晓庆; 段培蓓; 陶艳; 陈毓雯; 张晓琴; 李菊云; 诸建华

    2013-01-01

    Objective To investigate the current status of postoperative pain knowledge, attitudes and behavior of abdominal surgery patients,and to provide basis for pain education and interventions. Methods A self-designed questionnaire was applied among 116 patients undergoing abdominal surgery in a grade-Ⅲ level-A hospital from November 2011 to March 2012 using convenience sampling concerning their demographic data,history of previous surgery,history of pain education and postoperative pain knowledge, belief and behavior. Results The scores of postoperative pain knowledge of the abdominal surgery patients were at a lower level(63. 03 ± 2. 68). Significant differences were observed on the scores of history of previous surgery and history of pain education(P<0. 05). Regarding to attitude, the lowest scores were detected in the four entries in behavior change disorder dimensions(2. 974 ± 0. 639,2. 991±0. 582,2. 491 ± 0. 502 and 2. 241 ± 0. 430). The scores of postoperative pain knowledge of the abdominal surgery patients were varied from 1. 517 ± 0. 502 to 3. 448 ± 0. 499. Conclusion The current status of postoperative pain knowledge of abdominal surgery patients is not ideal. There is a wrong concept of pain and use of analgesics and patients' involvement in postoperative pain control is far from satisfaction. Appropriate choice of health education, improvement of patient understanding of postoperative pain related knowledge, firm beliefs of postoperative analgesia and strengthened self-management of postoperative analgesic behavior contribute to enhance effect of pain control.%目的 了解腹部术后患者疼痛知识、信念及行为的现状,为制定疼痛健康教育对策提供参考.方法 采用方便抽样法,选取江苏省某三级甲等医院2011年11月至2012年3月行腹部手术的患者116名进行问卷调查,调查内容包括患者一般人口学资料、既往手术史和疼痛教育史及术后疼痛知识、信念、行为等.结果 患者

  5. Lack of Preemptive Analgesia by Intravenous Flurbiprofen in Thyroid Gland Surgery: A Randomized, Double-blind and Placebo-controlled Clinical Trial

    Directory of Open Access Journals (Sweden)

    Zhaodi Zhang, Haifang Zhao, Changsong Wang, Fei Han, Guonian Wang

    2011-01-01

    Full Text Available Background Nowadays, increasingly more preemptive analgesia studies focus on postoperative pain; however, the impact of preemptive analgesia on perioperative opioid requirement is not well defined. This study was carried out in order to evaluate whether preoperative intravenous flurbiprofen axetil can reduce perioperative opioid consumption and provide postoperative analgesia in patients undergoing thyroid gland surgery.Methods Ninety patients undergoing elective thyroid gland surgery were randomly assigned to three groups. Group A (Control was administered Intralipid® 2 ml as a placebo 15 min before the cervical plexus block and at the end of the surgery; Group B (Routine analgesia was administered a placebo 15 min before the cervical plexus block and flurbiprofen 50 mg at the end of the surgery; Group C (Preemptive analgesia was administered intravenous flurbiprofen 50 mg 15 min before the cervical plexus block and a placebo at the end of the surgery. Sufentanil administration during the surgery and the 24 h satisfaction score on analgesic therapy were both recorded. The analgesic efficacy was assessed at 1, 2, 4, 6, 8, 12, and 24 hours after the surgery, based on visual analog scales.Results Ninety patients were involved in the study. One patient from Group B did not have their scheduled surgery; eighty-nine patients completed the study. There were no significant differences in the patient demographics between the three groups. Visual analog scales: 1, 2, 4 h for Group A was significantly higher than Groups B and C (P<0.05; Sufentanil administration during surgery: Group C was obviously lower compared to Groups A and B (P<0.05; 24 h satisfaction score: Groups B and C were higher than Group A (P<0.05.Conclusion Preoperative administration of intravenous Flurbiprofen axetil reduced analgesic consumption during surgery, but not postoperative pain scores.

  6. Lack of Preemptive Analgesia by Intravenous Flurbiprofen in Thyroid Gland Surgery: A Randomized, Double-blind and Placebo-controlled Clinical Trial

    Science.gov (United States)

    Zhang, Zhaodi; Zhao, Haifang; Wang, Changsong; Han, Fei; Wang, Guonian

    2011-01-01

    Background Nowadays, increasingly more preemptive analgesia studies focus on postoperative pain; however, the impact of preemptive analgesia on perioperative opioid requirement is not well defined. This study was carried out in order to evaluate whether preoperative intravenous flurbiprofen axetil can reduce perioperative opioid consumption and provide postoperative analgesia in patients undergoing thyroid gland surgery. Methods Ninety patients undergoing elective thyroid gland surgery were randomly assigned to three groups. Group A (Control) was administered Intralipid® 2 ml as a placebo 15 min before the cervical plexus block and at the end of the surgery; Group B (Routine analgesia) was administered a placebo 15 min before the cervical plexus block and flurbiprofen 50 mg at the end of the surgery; Group C (Preemptive analgesia) was administered intravenous flurbiprofen 50 mg 15 min before the cervical plexus block and a placebo at the end of the surgery. Sufentanil administration during the surgery and the 24 h satisfaction score on analgesic therapy were both recorded. The analgesic efficacy was assessed at 1, 2, 4, 6, 8, 12, and 24 hours after the surgery, based on visual analog scales. Results Ninety patients were involved in the study. One patient from Group B did not have their scheduled surgery; eighty-nine patients completed the study. There were no significant differences in the patient demographics between the three groups. Visual analog scales: 1, 2, 4 h for Group A was significantly higher than Groups B and C (P<0.05); Sufentanil administration during surgery: Group C was obviously lower compared to Groups A and B (P<0.05); 24 h satisfaction score: Groups B and C were higher than Group A (P<0.05). Conclusion Preoperative administration of intravenous Flurbiprofen axetil reduced analgesic consumption during surgery, but not postoperative pain scores. PMID:21814477

  7. Off-pump CABG surgery reduces systemic inflammation compared with on-pump surgery but does not change systemic endothelial responses : a prospective randomized study

    NARCIS (Netherlands)

    Jongman, Rianne M.; Zijlstra, Jan G.; Kok, Wendelinde F.; van Harten, Annemarie E.; Mariani, Massimo A.; Moser, Jill; Struys, Michel M. R. F.; Absalom, Anthony R.; Molema, Grietje; Scheeren, Thomas W. L.; van Meurs, Matijs

    2014-01-01

    Coronary artery bypass graft (CABG) surgery can result in severe postoperative organ failure. During CABG surgery, cardiopulmonary bypass (CPB) with cardiac arrest is often used (on-pump CABG), which often results in a systemic inflammatory response. To reduce this inflammatory response, off-pump CA

  8. Preoperative peribulbar block in patients undergoing retinal detachment surgery under general anesthesia: a randomized double-blind study.

    Science.gov (United States)

    Morel, Jérôme; Pascal, Jean; Charier, David; De Pasquale, Véronique; Gain, Philippe; Auboyer, Christian; Molliex, Serge

    2006-04-01

    Retinal detachment surgery is frequently associated with significant postoperative pain and emesis in adults. In this randomized, double-blind, controlled study we sought to demonstrate that 1% ropivacaine peribulbar (PB) block in conjunction with general anesthesia (GA) improves operative conditions and postoperative analgesia compared with GA combined with subcutaneous normal saline injection into the inferior eyelid. Thirty-one patients were included in each group. Anesthesia was performed with target-controlled infusion propofol and continuous remifentanil infusion adjusted to maintain bispectral index values between 40 and 50. Postoperative analgesia included fixed-dose IV infusion of propacetamol and IV injection of nefopam via a patient-controlled analgesia device. Tramadol was infused IV as rescue medication. Demographic data were comparable between the groups and bispectral index values were maintained at the objective target. In the PB group, fewer patients presented an oculocardiac reflex (6 versus 17; P < 0.01); bleeding interfering with the surgical field was reduced (1 versus 11 patients; P < 0.01); mean time to first nefopam request was longer (148 +/- 99 versus 46 +/- 58 min; P < 0.01); mean nefopam consumption was diminished during the first 6 h after tracheal extubation (18.9 +/- 13.9 versus 28.5 +/- 14.7 mg; P < 0.05); immediate postoperative pain scores were lower; and fewer patients required rescue medication (5 versus 23; P < 0.01). The two groups were similar with respect to the incidence of postoperative nausea and vomiting. Overall, PB block combined with GA improved operating conditions and postoperative analgesia in retinal detachment surgery. PMID:16551903

  9. Telemedicine, virtual reality, and surgery

    Science.gov (United States)

    Mccormack, Percival D.; Charles, Steve

    1994-01-01

    Two types of synthetic experience are covered: virtual reality (VR) and surgery, and telemedicine. The topics are presented in viewgraph form and include the following: geometric models; physiological sensors; surgical applications; virtual cadaver; VR surgical simulation; telesurgery; VR Surgical Trainer; abdominal surgery pilot study; advanced abdominal simulator; examples of telemedicine; and telemedicine spacebridge.

  10. Abdominal separation in an adult male patient with acute abdominal pain

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    We report a male patient with prolonged post-prandial abdominal distension and a sudden onset of epigastric pain initially diagnosed as acute abdomen. The patient had no history of surgery. Physical examination revealed peritonitis and abdominal computed tomography scan showed upper abdominal mesentery intorsion. The patient then underwent surgical intervention. It was found that the descending mesocolon dorsal root was connected to the ascending colon and formed a membrane encapsulating the small intestine...

  11. Synthetic porous ceramic compared with autograft in scoliosis surgery. A prospective, randomized study of 341 patients.

    Science.gov (United States)

    Ransford, A O; Morley, T; Edgar, M A; Webb, P; Passuti, N; Chopin, D; Morin, C; Michel, F; Garin, C; Pries, D

    1998-01-01

    We have evaluated the use of a synthetic porous ceramic (Triosite) as a substitute for bone graft in posterior spinal fusion for idiopathic scoliosis. In a prospective, randomised study 341 patients at five hospitals in the UK and France were randomly allocated either to autograft from the iliac crest or rib segments (171) or to receive Triosite blocks (170). All patients were assessed after operation and at 3, 6, 12 and 18 months. The two groups were similar with regard to all demographic and baseline variables, but the 184 treated in France (54%) had Cotrel-Dubouset instrumentation and the 157 treated in the UK usually had Harrington-Luque implants. In the Triosite group the average Cobb angle of the upper curve was 56 degrees, corrected to 24 degrees (57%). At 18 months, the average was 26 degrees (3% loss). In the autograft group the average preoperative upper curve of 53 degrees was corrected to 21 degrees (60%). At 18 months the mean curve was 25 degrees (8% loss). Pain levels after operation were similar in the two groups, being mild in most cases. In the Triosite group only three patients had problems of wound healing, but in the autograft group, 14 patients had delayed healing, infection or haematoma in the spinal wound. In addition, 15 autograft patients had pain at the donor site at three months. Seven had infections, two had haematoma and four had delayed healing. The haematological and serum biochemistry results showed no abnormal trends and no significant differences between the groups. There were no adverse events related to the graft material and no evidence of allergenicity. Our results suggest that Triosite synthetic porous ceramic is a safe and effective substitute for autograft in these patients. Histological findings on biopsy indicate that Triosite provides a favourable scaffolding for the formation of new bone and is gradually incorporated into the fusion mass.

  12. Synergistic effects of compound physical factor treatment on neurological outcome after peripheral nerve entrapment surgery A randomized controlled study

    Institute of Scientific and Technical Information of China (English)

    Gaofeng Li; Dehu Tian; Jianli Yu; Wenzhi Li; Jie Meng

    2008-01-01

    BACKGROUND: Iatrophysics can improve the velocity of local microcirculation at peripheral nerve injured sites and promote the recovery from injury. Research has shown that simultaneous application of two physical factors has synergistic effects on the recovery of peripheral nerve function.OBJECTIVE: To treat patients that received peripheral nerve entrapment surgery with comprehensive rehabilitation by decimeter wave therapy and electrical stimulation, and to observe the clinical effects of promoting nerve function recovery. DESIGN: Randomized controlled study.SETTINGS: Department of Orthopaedics, the Third Hospital of Baoding; Department of Hand Surgery, the Third Hospital of Hebei Medical University; Woman-Children Healthcare Center, Southern District, Baoding. PARTICIPANTS: A total of 124 patients, who received peripheral nerve entrapment surgery, were selected from the Department of Orthopaedics, the Third Hospital of Baoding between July 2001 and May 2007. All patients met the diagnostic standard of peripheral nerve entrapment syndrome defined by Doctor Chen in 1995. All subjects gave informed consent for treatments and conditions involved. The experiment was approved by a local ethics committee. All patients were randomly divided into four groups: electrical stimulation group, decimeter wave group, compound physical factor group, and control group, with 31 subjects in each group. METHODS: Patients received neurolysis at an appropriate interval after hospitalization. ① Multi-form wave therapeutic equipment made in China was used to treat patients in the electrical stimulation group after neurolysis. Wave form, stimulus width, interval time, and stimulus intensity were regulated based on the grade of nerve injury. The details were as follows: mild nerve injury: 50–100-ms stimulus width and 1 500–2 000-ms intervals; moderate nerve injury: 100–200-ms stimulus width and 3 000–4 000-ms intervals; severe nerve injury: 200–300-ms stimulus width and 3 000

  13. Study on the effect of laparoscopic surgery in the treatment of pediatric abdominal cryptorchidism%腹腔镜手术治疗小儿腹腔型隐睾的效果研究

    Institute of Scientific and Technical Information of China (English)

    王宏利

    2014-01-01

    目的:探讨腹腔镜手术治疗小儿腹腔型隐睾的临床效果。方法行腹腔镜治疗的腹腔型隐睾患儿47例,脐上横切口,先行腹腔镜探查,根据睾丸发育情况处理:睾丸发育良好者游离精索及输精管周围筋膜,分离皮肤与肉膜,将睾丸牵引至囊袋内,睾丸萎缩者行切除术,睾丸未发育者直接结束手术。回顾性收集分析38例常规手术治疗的病例资料对比分析。结果47例患儿中,彩超未定位的隐睾7例全部经腹腔镜准确定位,达到100%。与常规手术治疗组比较,腹腔镜治疗组患儿的术后住院天数减少,住院费用增高(P<0.05),但是腹腔镜治疗组发烧、阴囊肿胀、切口感染减少,术后抗菌药应用减少(P<0.05),患儿家长满意度提高(P<0.05)。术后随访12个月未发现睾丸萎缩。结论腹腔镜手术治疗小儿腹腔型隐睾效果更好,并发症减少。%Objective To investigate the clinical effect of laparoscopic surgery in the treatment of pediatric abdominal cryptorchidism.Methods Chose 47 patients with abdominal cryptorchidism as research objects, they were treated by laparoscopic surgery with transverse incision above the umbilicus. Laparoscopic exploration performed firstly, treatment performed according to the status of testicle: testicle with good underwent dissociation of spermatic cord and fascia around the spermatic cord, then skin and flesh of membrane separated, the testicle was traced to the capsular bag. Atrophic testis underwent resection surgery, and testis with no development to ended the operation directly. Data of 38 patients treated by conventional operation were collected retrospectively and analyzed. Results Among 47 cases, 7 cases that ultrasound not positioned all positioned by laparoscopic accurately, the rate achieved 100%. Compared to conventional operation, treatment with abdominal cryptorchidism reduced days of postoperative hospitalization, but increased

  14. Complicações pós-operatórias em pacientes submetidos à abdominoplastia isolada e combinada à outras cirurgias do abdome Postoperative complications in patients submitted to isolated abdominoplasty alone or associated to other abdominal surgeries

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Porchat

    2004-12-01

    Full Text Available OBJETIVO: A realização de abdominoplastias associadas a outras cirurgias da parede ou da cavidade abdominal, embora atrativa, é motivo de controvérsias. O objetivo deste trabalho é avaliar o grau de morbidade e mortalidade destas associações. MÉTODO: Foram estudados retrospectivamente 75 pacientes com indicação de abdominoplastia dos quais 39 submeteram-se a abdominoplastia isoladamente (grupo 1 e 36 à associação de abdominoplastia a outras cirurgias do abdome (grupo 2, como correção de hérnias, histerectomias e colecistectomias. Foram analisados os diversos fatores capazes de interferir na evolução do paciente, como doenças pré-existentes, assim como as complicações pós-operatórias. RESULTADOS: As complicações observadas foram: seroma (grupo 1: 2.6% , grupo 2: 25%,, epidermólise (grupo 1: 12.82% , grupo 2: 5.55%, deiscência de sutura (grupo 1: 5.12% , grupo 2: 5.55%, infecção da ferida operatória (grupo 1: 0%, grupo 2: 8.33% e hematoma (grupo 1: 0%, grupo 2: 5.55%. Não houve diferença estatisticamente significante entre os dois grupos no que se refere a complicações pós-operatórias, exceto quanto ao seroma (p=0,009. CONCLUSÕES: Concluímos que não houve aumento significativo da morbidade e da mortalidade dos pacientes submetidos a cirurgias combinadas quando comparados aos pacientes submetidos à abdominoplastia isoladamente.BACKGROUND: The association of abdominoplasty with other surgeries of the abdominal wall and cavity is an attractive approach although it has been a matter of controversies.Our objective is to evaluate the morbidity and mortality of these procedures. METHODS: We studied retrospectively 75 patients with indication for abdominoplasty. Thirty nine of them were submitted to abdominoplasty alone (group 1 and 36 were associated with other abdominal surgeries (group2, as hernioplasties, hysterectomies or cholecystectomies. RESULTS: The complications were seroma (group 1: 2.56%, group 2: 25

  15. A prospective study on geriatric abdominal surgical emergencies

    OpenAIRE

    Deepak R. Chavan; Shailesh Kannur; B. B. Metan; Girish Kullolli

    2014-01-01

    Background: Geriatric population is a special subgroup of population undergoing emergency abdominal surgeries. Both higher age group and emergency surgical procedure are considered as high risk factors. In this study, we study the most common cause for geriatric population to undergo an emergency abdominal surgery and the therapeutic outcomes. Methods: All the patients aged more than 60 years coming to surgical department, BLDEU's hospital with acute abdominal conditions. Study period was ...

  16. Factors analysis of hypothermia in infants undergoing abdominal surgery under comprehensive heat preservation measures%保温措施下腹部手术婴幼儿术中低体温发生的影响因素分析

    Institute of Scientific and Technical Information of China (English)

    王晓丹; 李美清; 谢曼英; 马育璇; 谢文

    2012-01-01

    目的 探讨保温措施下腹部手术婴幼儿术中低体温发生的影响因素.方法 对98例行腹部手术的婴幼儿术中实施保温措施,观察并记录婴幼儿的体温变化情况.分析腹部手术婴幼儿术中低体温发生的影响因素.结果 98例婴幼儿发生术中低体温42例,发生率为42.86%.体表面积、手术时间和术中输血是影响手术低体温发生的影响因素.结论 腹部手术婴幼儿术中低体温发生率较高.在保温措施的基础上做好术前保温工作有利于降低婴幼儿腹部手术中低体温的发生.%Objective To explore the factors leading to hypothermia during the abdominal surgery process in infants under comprehensive heat preservation measure. Methods Ninety eight infants undergoing abdominal surgery in our hospital from April 2009 to March 2011 were under comprehensive heat preservation measures. The core temprature were recorded continually. The factors causing hypothermia during the abdominal surgery for infants were analyzed. Results Among all the 98 infants, 42 cases experienced intraoperative hypothermia and the incidence was 42.86%. The factors leading to hypothermia were body size, duration of operation and blood transfusion. Conclusions The infants are prone to suffer from hypothermia intraoperative abdominal surgery. Effective preoperative intervention is helpful to prevent hypothermia during the infant abdominal surgery under comprehensive heat preservation measures intraoperative heat preservation.

  17. Comparison of the acute-phase response after laparoscopic versus open aortobifemoral bypass surgery: a substudy of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Krog AH

    2016-09-01

    Full Text Available Anne H Krog,1,2 Mehdi Sahba,3 Erik M Pettersen,4 Irene Sandven,5 Per M Thorsby,1,6 Jørgen J Jørgensen,1,2 Jon O Sundhagen,2 Syed SS Kazmi2 1Institute of Clinical Medicine, University of Oslo, 2Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, 3Department of Vascular Surgery, Østfold Central Hospital, Fredrikstad, 4Department of Vascular Surgery, Sørlandet Hospital HF, Kristiansand, 5Oslo Center for Biostatistics and Epidemiology (OCBE, 6Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway Purpose: Minimally invasive surgical techniques have been shown to reduce the inflammatory response related to a surgical procedure. The main objective of our study was to measure the inflammatory response in patients undergoing a totally laparoscopic versus open aortobifemoral bypass surgery. This is the first randomized trial on subjects in this population.Patients and methods: This is a substudy of a larger randomized controlled multicenter trial (Norwegian Laparoscopic Aortic Surgery Trial. Thirty consecutive patients with severe aortoiliac occlusive disease eligible for aortobifemoral bypass surgery were randomized to either a totally laparoscopic (n=14 or an open surgical procedure (n=16. The inflammatory response was measured by perioperative monitoring of serum interleukin-6 (IL-6, IL-8, and C-reactive protein (CRP at six different time points.Results: The inflammatory reaction caused by the laparoscopic procedure was reduced compared with open surgery. IL-6 was significantly lower after the laparoscopic procedure, measured by comparing area under the curve (AUC, and after adjusting for the confounding effect of coronary heart disease (P=0.010. The differences in serum levels of IL-8 and CRP did not reach statistical significance.Conclusion: In this substudy of a randomized controlled trial comparing laparoscopic and open aortobifemoral bypass

  18. A prospective randomized comparative clinical trial comparing the efficacy between ondansetron and metoclopramide for prevention of nausea and vomiting in patients undergoing fractionated radiotherapy to the abdominal region

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hee Chul; Suh, Chang Ok; Seong, Jin Sil; Cho, Jae Ho; Lim, John Jihoon; Park, Won; Song, Jae Seok; Kim, Gwi Eon [College of Medicine, Yonsei Univ., Seoul (Korea, Republic of)

    2001-06-01

    This study is a prospective randomized clinical trial comparing the efficacy and complication of anti-emetic drugs for prevention of nausea and vomiting after radiotherapy which has moderate emetogenic potential. The aim of this study was to investigate whether the anti-emetic efficacy at ondansetron(Zofran) 8 mg bid dose (Group O) is better than the efficacy of metoclopramide 5 mg tid dose (Group M) in patients undergoing fractionated radiotherapy to the abdominal region. Study entry was restricted to those patients who met the following eligibility criteria: histologically confirmed malignant disease; no distant metastasis; performance status of not more than ECOG grade 2; no previous chemotherapy and radiotherapy. Between March 1997 and February 1998, 60 patients enrolled in this study. All patients signed a written statement of informed consent prior to enrollment. Blinding was maintained by dosing identical number of tables including one dose of matching placebo for Group O. The extent of nausea, appetite loss, and the number of emetic episodes were recorded everyday using diary card. The mean score of nausea, appetite loss and the mean number of emetic episodes were obtained in a weekly interval. Prescription error occurred in one patient. And diary cards have not returned in 3 patients due to premature refusal of treatment. Card from one patient was excluded from the analysis because she had a history of treatment for neurosis. As a result, the analysis consisted of 55 patients. Patient characteristics and radiotherapy characteristics were similar except mean age was 52.9{+-} 11.2 in group M, 46.5{+-}9.6 in group O. The difference of age was statistically significant. The mean score of nausea, appetite loss and emetic episodes in a weekly interval was higher in group M than O. In group M, the symptoms were most significant at 5th week. In a panel data analysis using mixed procedure, treatment group was only significant factor detecting the difference of

  19. Attenuation of Hemodynamic Responses to Intubation by Gabapentin in Coronary Artery Bypass Surgery: a Randomized Clinical Trial.

    Science.gov (United States)

    Marashi, Seyed Mojtaba; Saeedinia, Seyed Mostafa; Sadeghi, Mostafa; Movafegh, Ali; Marashi, Shaqayeq

    2015-12-01

    A varieties of medications have been suggested to prevent hemodynamic instabilities following laryngoscopy and endotracheal intubation. This study was conducted to determine the beneficial effects of gabapentin on preventing hemodynamic instabilities associated with intubation in patients who were a candidate for coronary artery bypass surgery (CABG). This double blinded randomized, parallel group clinical trial was carried out on 58 normotensive patients scheduled for elective CABG under general anesthesia with endotracheal intubation in Shariati Hospital. Patients were randomly allocated to two groups of 29 patients that received 1200 mg of gabapentin in two dosages (600 mg, 8 hours before anesthesia induction and 600 mg, 2 hours before anesthesia induction) as gabapentin group or received talc powder as placebo (placebo group). Heart rate, mean arterial pressure, systolic and diastolic blood pressure were measured immediately before intubation, during intubation, immediately after intubation, 1 and 2 minutes after tracheal intubation. Inter-group comparisons significantly showed higher systolic and diastolic blood pressure, mean arterial pressure and heart rate immediately before intubation, during intubation, immediately after intubation, 1 and 2 minutes after tracheal intubation in the placebo group in comparison to gabapentin group. The median of anxiety verbal analog scale (VAS) at the pre-induction room in gabapentin and placebo groups were 2 and 4, respectively that was significantly lower in the former group (P. value =0.04 ); however, regarding median of pain score no difference was observed between them (P. value =0.07). Gabapentin (1200 mg) given preoperatively can effectively attenuate the hemodynamic response to laryngoscopy, intubation and also reduce preoperative related anxiety in patients who were a candidate for CABG.

  20. 机器人手术系统在腹部肿瘤外科手术中的应用%Current Updates on Robot-assisted Surgeries of Abdominal Tumors

    Institute of Scientific and Technical Information of China (English)

    王宝贵

    2011-01-01

    Minimally invasive surgeries signify medical progress. Laparoscopic surgeries are widely conducted domestically and internationally. However, in the case of abdominal tumors, the dissection and/or resection of local lymph nodes, as well as the reconstruction of the gastrointestinal tract is still difficultly achieved using only traditional laparoscopic techinques. With the development of techniques in informatics, laparoscopy, and robotics, robot-assisted operation systems have been used in surgical procedures. Robot-assisted surgery is a novel technology advantageous in terms of better band-eye coordination, three-dimensional magnified stereoscopic vision with depth perception, intuitive movements with increased precision, and minimized hand tremors. In most recently performed surgical procedures, the outcomes of those that are robot-assisted appear to be relatively superior compared with traditional laparoscopies. Robot-assisted systems are currently used in cardiology, urology, gynecology, and abdominal surgery. The history, composition,characteristics, and current applications of robotics in abdominal tumors are reviewed in this article.%微创手术已成为外科医疗水平的象征.传统腹腔腔镜手术已广泛应用于临床,但其在腹部肿瘤外科中的应用受到一定限制,主要原因在于腹部肿瘤外科手术所必须的区域淋巴结清扫以及消化道重建等复杂操作在传统腹腔镜下完成相当困难.随着通讯技术、医用内窥镜技术和机器人技术的不断发展,机器人手术系统成功应用到临床医疗.该系统具有微创、高清3D视野、操作准确稳定以及可远程控制等优势,镜下手眼协调能力大大增强,并可通过计算机滤除手部震颤,加之机械手的灵活性,可以更加容易的在镜下完成各种复杂、精细的手术操作(如缝合、打结等),使得全腹腔镜下完成复杂手术成为可能.目前机器人手术系统已用于临床10余年,在心脏外

  1. Comparison of the analgesic efficacy of oral ketorolac versus intramuscular tramadol after third molar surgery: A parallel, double-blind, randomized, placebo-controlled clinical trial

    Science.gov (United States)

    Isiordia-Espinoza, Mario-Alberto; Martinez-Rider, Ricardo; Perez-Urizar, Jose

    2016-01-01

    Background Preemptive analgesia is considered an alternative for treating the postsurgical pain of third molar removal. The aim of this study was to evaluate the preemptive analgesic efficacy of oral ketorolac versus intramuscular tramadol after a mandibular third molar surgery. Material and Methods A parallel, double-blind, randomized, placebo-controlled clinical trial was carried out. Thirty patients were randomized into two treatment groups using a series of random numbers: Group A, oral ketorolac 10 mg plus intramuscular placebo (1 mL saline solution); or Group B, oral placebo (similar tablet to oral ketorolac) plus intramuscular tramadol 50 mg diluted in 1 mL saline solution. These treatments were given 30 min before the surgery. We evaluated the time of first analgesic rescue medication, pain intensity, total analgesic consumption and adverse effects. Results Patients taking oral ketorolac had longer time of analgesic covering and less postoperative pain when compared with patients receiving intramuscular tramadol. Conclusions According to the VAS and AUC results, this study suggests that 10 mg of oral ketorolac had superior analgesic effect than 50 mg of tramadol when administered before a mandibular third molar surgery. Key words:Ketorolac, tramadol, third molar surgery, pain, preemptive analgesia. PMID:27475688

  2. Effects of Co-contraction of Both Transverse Abdominal Muscle and Pelvic Floor Muscle Exercises for Stress Urinary Incontinence: A Randomized Controlled Trial

    OpenAIRE

    Tajiri, Kimiko; Huo, Ming; Maruyama, Hitoshi

    2014-01-01

    [Purpose] The purpose of this study was to devise a new urinary incontinence exercise using co-contraction of both the transverse abdominal muscle (TA) and pelvic floor muscle (PFM) and examine the intervention effect in middle-aged women with stress urinary incontinence (SUI). [Subjects] The subjects were fifteen women with SUI who were divided into two groups: the TA and PFM co-contraction exercise group (n=9) and the control group (n=6). [Methods] Participants in the exercise group perform...

  3. Alterações cutâneas no Kwashiorkor: relato de caso de um homem adulto após cirurgia abdominal Cutaneous manifestations of kwashiorkor: a case report of an adult man after abdominal surgery

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    Danielle Mann

    2011-12-01

    Full Text Available Kwashiorkor é um tipo de desnutrição proteico-energética em que há deficiência dietética de proteína, embora a ingestão de calorias se mantenha adequada. As manifestações cutâneas incluem pele xerótica, com aspecto de esmalte descascado, típica coloração avermelhada a branco-acinzentada dos cabelos, o sinal da bandeira e edema mais evidente, nos membros inferiores e na face, dando aspecto de lua cheia. O presente artigo relata o caso de um paciente adulto, do sexo masculino, previamente submetido à duodenopancreatectomia para tratamento de pancreatite crônica associada ao pseudotumor em cabeça de pâncreas que evoluiu com alterações cutâneas de kwashiorkor após tuberculose pulmonar.Kwashiorkor is a type of protein-energy malnutrition where diet protein deficit is found, in spite of appropriate caloric intake. Cutaneous manifestations include xerosis, with abnormally dry skin that has a flaking enamel paint aspect, a typical red to gray-white hair color, the "flag sign" and more evident edema in lower limbs and face, giving it a full moon appearance. This article reports a case of a male adult patient who had undergone Whipple surgery for treatment of chronic pancreatitis associated with pseudotumor of the pancreatic head that progressed to cutaneous manifestations of kwashiorkor after pulmonary tuberculosis.

  4. Comparison of standard fusion with a "topping off" system in lumbar spine surgery: a protocol for a randomized controlled trial

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    Kaulhausen Thomas

    2011-10-01

    Full Text Available Abstract Background Fusion of lumbar spine segments is a well-established therapy for many pathologies. The procedure changes the biomechanics of the spine. Initial clinical benefits may be outweighed by ensuing damage to the adjacent segments. Various surgical devices and techniques have been developed to prevent this deterioration. "Topping off" systems combine rigid fusion with a flexible pedicle screw system to prevent adjacent segment disease (ASD. To date, there is no convincing evidence that these devices provide any patient benefits. Methods/Design The study is designed as a randomized, therapy-controlled trial in a clinical care setting at a university hospital. Patients presenting to the outpatient clinic with degenerative disc disease or spondylolisthesis will be assessed against study inclusion and exclusion criteria. After randomization, the control group will undergo conventional fusion. The intervention group will undergo fusion with a supplemental flexible pedicle screw system to protect the adjacent segment ("topping off". Follow-up examination will take place immediately after treatment during hospital stay, after 6 weeks, and then after 6, 12, 24 and 36 months. Subsequently, ongoing assessments will be performed annually. Outcome measurements will include quality of life and pain assessments using questionnaires (SF-36™, ODI, COMI. In addition, clinical and radiologic ASD, work-related disability, and duration of work disability will be assessed. Inpatient and 6-month mortality, surgery-related data (e.g., intraoperative complications, blood loss, length of incision, surgical duration, postoperative complications, adverse events, and serious adverse events will be documented and monitored throughout the study. Cost-effectiveness analysis will also be provided. Discussion New hybrid systems might improve the outcome of lumbar spine fusion. To date, there is no convincing published data on effectiveness or safety of these

  5. 氟比洛芬酯复合曲马多对腹部手术患者持续静脉镇痛的临床研究%Clinical Research of Flurbiprofen Axetil Combined Tramadol for Patient-control ed Intravenous Analgesia After Abdominal Surgeries

    Institute of Scientific and Technical Information of China (English)

    何江; 张欣宁; 许春雷; 诸月妮

    2014-01-01

    Objective To observe the efficacy and safety of flurbiprofen axetil combined tramadol ,used for postoperative patient-control ed intravenous analgesia in patients undergoing abdominal surgeries. Methods: EightyⅠ ~ Ⅱlevel of ASA patients undergoing abdominal surgeries were enrol ed in this study. Patients were randomly divided into flurbiprofen group (group F) and tramadol group (group T), 40 cases in each group. The patients in Group F received flurbiprofen axetil 50mg as initial dose, the analgesia pump added with flurbiprofen axetil 200mg, tramadol 400mg and thromboxane 5mg and diluted with saline to 100ml. The initial dose in group T was tramadol 100mg, analgesia pump added with tramadol 800mg and 5mg tropisetron and diluted with saline to l00ml. The two groups were set with the same PCA parameter (2ml/h, per-press 0.5ml, lockout time of15min). After postoperation of 1h,3h,6h,12h,24h and 48h, observed the patients and recorded the VAS scores, and statistics of pressing times and adverse reaction after 48h PCIA. The results of postoperative VAS score and postoperative 48h press times have no significant difference in group F and group T, but there are differences in adverse reactions occurred. The adverse reaction rate in group F was dearly lower than that of group T. Conclusion The usage of combination of Flurbiprofen axetil with Tramadol used in patients undergoing abdominal surgeries in PCIA, can reduce adverse reactions, and get a satisfactory analgesic effect. It is a safe, effective, and convenient analgesic method.%目的:观察氟比洛芬酯复合曲马多用于腹部手术患者持续静脉镇痛的有效性及安全性。方法选择ASA分级Ⅰ~Ⅱ级、择期行腹部手术的患者80例,随机分为氟比洛芬酯(F组)和曲马多组(T组),每组40例。F组首量为氟比洛芬酯50mg,镇痛泵内加入氟比洛芬酯200mg、曲马多400mg和托烷司烷5mg并用生理盐水稀释至100ml。T组首量为曲马多100mg

  6. Urgent Abdominal Re-Explorations

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    Peskersoy Mustafa

    2006-04-01

    Full Text Available Abstract Background Treatment of a number of complications that occur after abdominal surgeries may require that Urgent Abdominal Re-explorations (UARs, the life-saving and obligatory operations, are performed. The objectives of this study were to evaluate the reasons for performing UARs, outcomes of relaparotomies (RLs and factors that affect mortality. Methods Demographic characteristics; initial diagnoses; information from and complications of the first surgery received; durations and outcomes of UAR(s performed in patients who received early RLs because of complicated abdominal surgeries in our clinic between 01.01.2000 and 31.12.2004 were investigated retrospectively. Statistical analyses were done using the chi-square and Fisher exact tests. Results Early UAR was performed in 81 out of 4410 cases (1.8%. Average patient age was 50.46 (13–81 years with a male-to-female ratio of 60/21. Fifty one (62.96% patients had infection, 41 (50.61% of them had an accompanying serious disease, 24 (29.62% of them had various tumors and 57 (70.37% patients were operated under emergency conditions during first operation. Causes of urgent abdominal re-explorations were as follows: leakage from intestinal repair site or from anostomosis (n:34; 41.97%; hemorrhage (n:15; 18.51%; intestinal perforation (n:8; 9.87%; intraabdominal infection or abscess (n:8; 9.87%; progressive intestinal necrosis (n:7; 8.64%; stomal complications (n:5; 6.17%; and postoperative ileus (n:4; 4.93%. Two or more UARs were performed in 18 (22.22% cases, and overall mortality was 34.97% (n:30. Interval between the first laparotomy and UAR averaged as 6.95 (1–20 days, and average hospitalization period was 27.1 (3–78 days. Mortality rate was found to be higher among the patients who received multiple UARs. The most common (55.5% cause of mortality was sepsis/multiple organ failure (MOF. The rates for common mortality and sepsis/MOF-dependent mortality that occured following UAR were

  7. Prolonged conservative treatment or 'early' surgery in sciatica caused by a lumbar disc herniation: rationale and design of a randomized trial [ISRCT 26872154

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    Tans Joseph

    2005-02-01

    Full Text Available Abstract Background The design of a randomized multicenter trial is presented on the effectiveness of a prolonged conservative treatment strategy compared with surgery in patients with persisting intense sciatica (lumbosacral radicular syndrome. Methods/design Patients presenting themselves to their general practitioner with disabling sciatica lasting less than twelve weeks are referred to the neurology outpatient department of one of the participating hospitals. After confirmation of the diagnosis and surgical indication MRI scanning is performed. If a distinct disc herniation is discerned which in addition covers the clinically expected site the patient is eligible for randomization. Depending on the outcome of the randomization scheme the patient will either be submitted to prolonged conservative care or surgery. Surgery will be carried out according to the guidelines and between six and twelve weeks after onset of complaints. The experimental therapy consists of a prolonged conservative treatment under supervision of the general practitioner, which may be followed by surgical intervention in case of persisting or progressive disability. The main primary outcome measure is the disease specific disability of daily functioning. Other primary outcome measures are perceived recovery and intensity of legpain. Secondary outcome measures encompass severity of complaints, quality of life, medical consumption, absenteeism, costs and preference. The main research question will be answered at 12 months after randomization. The total follow-up period covers two years. Discussion Evidence is lacking concerning the optimal treatment of lumbar disc induced sciatica. This pragmatic randomized trial, focusses on the 'timing' of intervention, and will contribute to the decision of the general practictioner and neurologist, regarding referral of patients for surgery.

  8. Abdominal wall hernia and pregnancy

    DEFF Research Database (Denmark)

    Jensen, K K; Henriksen, N A; Jorgensen, L N

    2015-01-01

    PURPOSE: There is no consensus as to the treatment strategy for abdominal wall hernias in fertile women. This study was undertaken to review the current literature on treatment of abdominal wall hernias in fertile women before or during pregnancy. METHODS: A literature search was undertaken in Pub......Med and Embase in combination with a cross-reference search of eligible papers. RESULTS: We included 31 papers of which 23 were case reports. In fertile women undergoing sutured or mesh repair, pain was described in a few patients during the last trimester of a subsequent pregnancy. Emergency surgery...... of incarcerated hernias in pregnant women, as well as combined hernia repair and cesarean section appears as safe procedures. No major complications were reported following hernia repair before or during pregnancy. The combined procedure of elective cesarean section and abdominal wall hernia repair was reported...

  9. Lesões abdominais por uso do fio guia em ensaios cirúrgicos do quadril: estudo em cadáver Abdominal injuries due to the use of guide wire in hip surgery experiments: cadaveric study

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    Anderson Freitas

    2010-01-01

    Full Text Available OBJETIVO: Avaliar a relação entre lesões abdominais e a introdução de fios guia em ensaios cirúrgicos do quadril, propor um sistema de escorização e conduta médica em função da distância percorrida pelo fio guia a partir da placa quadrilátera e a estrutura anatômica lesionada. MATERIAL E MÉTODOS: Utilizou-se 18 quadris de cadáveres, um fio de Steimann de 3.2 x 300 mm, um perfurador elétrico e um paquímetro. Introduziu-se o fio no centro do colo femoral por via de acesso lateral no quadril sob visualização direta. Por via de acesso abdominal mediana longitudinal estendida à região pélvica, observou-se a placa quadrilátera até o fio a transfixar. A partir deste ponto, prolongou-se a inserção por mais 140 mm, a fim de observar seu trajeto abdominal e descrever as lesões apresentadas em função da distância percorrida. RESULTADOS: Houve cinco (27% lesões de cólon sigmóide e uma (5% lesão transfixante do nervo obturador. Artérias e veias ilíacas comuns contra laterais ao quadril fixado não foram lesionadas. CONCLUSÃO: O fio guia não deve ultrapassar a placa quadrilátera. Medidas de prevenção são importantes no pré e intra-operatório e o escore e a conduta médica propostos neste estudo devem ser criteriosamente observados nos casos de lesão comprovada.OBJECTIVES: Evaluate the relationship between abdominal injuries and the introduction of guide wire in experimental hip surgery, to propose a scoring system and a medical management based on the distance traveled by the guide wire from the quadrilateral plate until the damaged anatomical structure. MATERIAL AND METHODS: 18 cadaveric hips, a Steimann pin of 3.2 x 300mm, an electric drill and a caliper were used. The wire was inserted in the center of the femoral neck through a lateral approach in the hip under direct visualization. Via median abdominal extended approach to the pelvic region, the quadrilateral plate was observed until the wire crossed it. From

  10. Implementation assessment of perioperatory antibiotic prophylaxis guidelines in pediatric abdominal surgery. Evaluación de la adherencia a la guía de profilaxis antibiótica perioperatoria en cirugía abdominal pediátrica

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    Luis Pedro Hernández Sosa

    2005-05-01

    Full Text Available Introduction: since the beginning of the 80s the term perioperative profilaxis is introduced, changing the previous criteria on antimicrobial profilaxis. This method helps to reduce the perioperative sepsis phenomenon and the medical cost, achieving more quality in pacient attention. In the surgical service area of the pediatric and universitary hospital ¨Paquito Gonzalez Cueto¨ a guide with good clinical practices in perioperative antibiotic profilaxis for abdominal surgery has been in use since the year 2000. Objective: To evaluate the following of this guide. Methods: a retrospective and descriptive study of a series of cases since february 2000 until february 2002. 235 pacients operated from abdominal affections were analized. The fallowing of the guide were tested by 4 questions, expressing the results in percentage lists. Conclussions: Despite the use of antibiotic profilaxis in more than 96% of the cases, there was a low percentage of global guide following (33,5%, since there were problems with the employed outline, dosis and moment of administration of the antibiotic, specially in surgery with high risk of developing infection of surgical injury.

    Fundamento: Desde los inicios de la década de los 80, se introduce el concepto de profilaxis perioperatoria que revoluciona los criterios anteriores de profilaxis antimicrobiana. Este método permite reducir los fenómenos de sepsis perioperatoria y de costo hospitalario para lograr una mayor calidad en la atención al paciente. En el Servicio de Cirugía del Hospital Pediátrico Universitario ¨Paquito González Cueto¨ se aplica desde febrero del 2000 una guía de buenas prácticas clínicas de profilaxis antibiótica perioperatoria para cirugía abdominal. Objetivo: Evaluar la adherencia a la guía de buenas prácticas clínicas de

  11. Laparoscopy to predict the result of primary cytoreductive surgery in advanced ovarian cancer patients (LapOvCa-trial: a multicentre randomized controlled study

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    Rutten Marianne J

    2012-01-01

    Full Text Available Abstract Background Standard treatment of advanced ovarian cancer is surgery and chemotherapy. The goal of surgery is to remove all macroscopic tumour, as the amount of residual tumour is the most important prognostic factor for survival. When removal off all tumour is considered not feasible, neoadjuvant chemotherapy (NACT in combination with interval debulking surgery (IDS is performed. Current methods of staging are not always accurate in predicting surgical outcome, since approximately 40% of patients will have more than 1 cm residual tumour after primary debulking surgery (PDS. In this study we aim to assess whether adding laparoscopy to the diagnostic work-up of patients suspected of advanced ovarian carcinoma may prevent unsuccessful primary debulking surgery for ovarian cancer. Methods Multicentre randomized controlled trial, including all gynaecologic oncologic centres in the Netherlands and their affiliated hospitals. Patients are eligible when they are planned for PDS after conventional staging. Participants are randomized between direct PDS or additional diagnostic laparoscopy. Depending on the result of laparoscopy patients are treated by PDS within three weeks, followed by six courses of platinum based chemotherapy or with NACT and IDS 3-4 weeks after three courses of chemotherapy, followed by another three courses of chemotherapy. Primary outcome measure is the proportion of PDS's leaving more than one centimetre tumour residual in each arm. In total 200 patients will be randomized. Data will be analysed according to intention to treat. Discussion Patients who have disease considered to be resectable to less than one centimetre should undergo PDS to improve prognosis. However, there is a need for better diagnostic procedures because the current number of debulking surgeries leaving more than one centimetre residual tumour is still high. Laparoscopy before starting treatment for ovarian cancer can be an additional diagnostic tool

  12. Fast-track surgery protocol in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer: a randomized controlled trial

    OpenAIRE

    Liu G; Jian F; Wang X; Chen L

    2016-01-01

    Guozheng Liu,1 Fengguo Jian,2 Xiuqin Wang,2 Lin Chen1 1Department of General Surgery, Chinese PLA General Hospital, Beijing, People’s Republic of China; 2Second Department of General Surgery, Changyi People’s Hospital, Shandong, People’s Republic of China Aim: To study the efficacy of the fast-track surgery (FTS) program combined with laparoscopic radical gastrectomy for elderly gastric cancer (GC) patients.Methods: Eighty-four elderly patients diagnosed with GC between Se...

  13. Fast-track surgery protocol in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer: a randomized controlled trial

    OpenAIRE

    Chen, Linpayi

    2016-01-01

    Guozheng Liu,1 Fengguo Jian,2 Xiuqin Wang,2 Lin Chen1 1Department of General Surgery, Chinese PLA General Hospital, Beijing, People’s Republic of China; 2Second Department of General Surgery, Changyi People’s Hospital, Shandong, People’s Republic of China Aim: To study the efficacy of the fast-track surgery (FTS) program combined with laparoscopic radical gastrectomy for elderly gastric cancer (GC) patients.Methods: Eighty-four elderly patients diagnosed with G...

  14. Randomized clinical trial comparing manual suture and different models of mechanical suture in the mimicking of bariatric surgery in swine

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    Fernandes MA

    2014-02-01

    Full Text Available Marcos AP Fernandes,1 Bruno MT Pereira,2 Sandra M Guimarães,1 Aline Paganelli,3 Carlos Manoel CT Pereira,1 Claudio Sergio Batista4 1Institute of Obesity and Advanced Video Laparoscopic Surgery of Petropolis, Rio de Janeiro, Brazil; 2Division of Trauma, University of Campinas, São Paulo, Brazil; 3Laboratório de Patologia Micron Cell Diagnóstico, Rio de Janeiro, Brazil; 4Department of Gynecology and Obstetrics, Faculty of Medicine of Petropolis, Rio de Janeiro, Brazil Context and objective: Variations in the ability of surgeons served as motivation for the development of devices that, overcoming individual differences, allow the techniques to be properly performed, and of which the end result was the best possible. Every technique must be reproduced reliably by the majority of surgeons for their results to be adopted and recognized as effective. The aim of this study was to compare the results, from the point of view of anatomic pathology, of manual sutures versus mechanical sutures using different models of linear mechanical staplers, in the procedure of gastroenteroanastomosis and enteroanastomosis in swine. Methods: Thirty-six healthy, adult, male Sus scrofa domesticus pigs, weighing between 20.7 and 25.5 kg, were used. The swine were randomly divided into four groups of nine pigs, according to the type of suture employed: group A, manual suture with Polysorb® 3-0 wire; group B, 80-shear linear stapler (Covidien® Gia 8038-S; group C, 75-shear linear stapler (Ethicon® Tlc 75; and group D, 75-shear linear stapler (Resource® Yq 75-3. A temporal study was established on the seventh postoperative day for histopathological analysis, and the degree of inflammation, fibrosis, and newly formed vessels, as well as the presence or absence of granulation tissue, foreign body granuloma, and necrosis were all evaluated qualitatively and semiquantitatively. The results were analyzed statistically. Results: Observations during the histopathological

  15. Abdominal compartment syndrome following abdominoplasty: A case report and review

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    Arash Izadpanah

    2014-01-01

    Full Text Available Abdominoplasty is among the most commonly performed aesthetic procedures in plastic surgery. Despite high complication rate, abdominal contouring procedures are expected to rise in popularity with the advent of bariatric surgery. Patients with a history of gastric bypass surgery have an elevated incidence of small bowel obstruction from internal herniation, which is associated with non-specific upper abdominal pain, nausea, and a decrease in appetite. Internal hernias, when subjected to elevated intra-abdominal pressures, have a high-risk of developing ischemic bowel. We present a case report of patient with previous laparoscopic Roux-en-y gastric bypass who developed acute ischemic bowel leading to abdominal compartment syndrome following abdominoplasty. To the best of our knowledge, this is the first reported case in the literature. We herein emphasise on the subtle symptoms and signs that warrant further investigations in prospective patients for an abdominal contouring procedure with a prior history of gastric bypass surgery.

  16. Effect of Nursing Intervention on Elderly Intestinal Function Recovery after Intra-abdominal Non-gastrointestinal Surgery Under General Anesthesia%术前胃肠道护理干预对老年全麻腹腔非胃肠道手术后肠功能恢复的影响研究

    Institute of Scientific and Technical Information of China (English)

    刘菁; 张芹; 汤琼; 李欣

    2012-01-01

    Objective To investigate the influence of gastrointestinal preoperative nursing intervention to the elderly recovery of intestinal function after anesthesia intra -abdominal non - gastrointestinal surgery. Methods A total of 120 elderly patients hospitalized in general surgical department for anesthesia abdominal non - gastrointestinal surgery from April 2010 to December 2011 were divided randomly into groups Study and control. Control group conducted conventional preoperative fasting and forbidden to drink; Study group performed, based on conventional measures, preoperative gastrointestinal tract ( GIT ) nursing and at 18 : 00 of the day before operation given oral compound polyethylene glycol electrolyte powder. Adverse reactions were observed in study group before operation and abdominal distension, bowel tones ( BT ), time of first anal exhaust compared between 2 groups after operation. Results Mild adverse reactions occurred in group study after taking preoperative oral compound polyethylene glycol electrolyte powder, such as nausea ( 5 cases ), vomiting ( 1 case ), feeling of repletion ( 6 cases ), etc. without abdominal pains, allergies and other serious complications. After operation, abdominal distension scored ( 1.2 + 1.3), BT e-mergence time was ( 18. 2 ±6. 0 ) h, anal exhaust time ( 29. 3 ±6. 2 ) h in study group, while in control group ( 2. 7 ± 1. 8 ), ( 23. 7 ± 10. 0 ) h, ( 37. 4 ±6. 1 ) h, respectively. The postoperative bowel function indicators of study group were superior to those of control group, the difference was significant ( P <0. 01 ). Conclusion Preoperative GIT nursing is conductive to recovery of elderly intestinal function after anesthesia intra - abdominal non - gastrointestinal surgery.%目的 探讨术前胃肠道护理干预对老年全麻腹腔非胃肠道手术患者术后肠功能恢复的影响.方法 选择2010年4月-2011年12月在我院普外科住院的120例全麻腹腔非胃肠道手术老年患者为研究对象,

  17. Assessment of a Standardized Pre-Operative Telephone Checklist Designed to Avoid Late Cancellation of Ambulatory Surgery: The AMBUPROG Multicenter Randomized Controlled Trial.

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    Sonia Gaucher

    Full Text Available To assess the impact of a standardized pre-operative telephone checklist on the rate of late cancellations of ambulatory surgery (AMBUPROG trial.Multicenter, two-arm, parallel-group, open-label randomized controlled trial.11 university hospital ambulatory surgery units in Paris, France.Patients scheduled for ambulatory surgery and able to be reached by telephone.A 7-item checklist designed to prevent late cancellation, available in five languages and two versions (for children and adults, was administered between 7 and 3 days before the planned date of surgery, by an automated phone system or a research assistant. The control group received standard management alone.Rate of cancellation on the day of surgery or the day before.The study population comprised 3900 patients enrolled between November 2012 and September 2013: 1950 patients were randomized to the checklist arm and 1950 patients to the control arm. The checklist was administered to 68.8% of patients in the intervention arm, 1002 by the automated phone system and 340 by a research assistant. The rate of late cancellation did not differ significantly between the checklist and control arms (109 (5.6% vs. 113 (5.8%, adjusted odds ratio [95% confidence interval] = 0.91 [0.65-1.29], (p = 0.57. Checklist administration revealed that 355 patients (28.0% had not undergone tests ordered by the surgeon or anesthetist, and that 254 patients (20.0% still had questions concerning the fasting state.A standardized pre-operative telephone checklist did not avoid late cancellations of ambulatory surgery but enabled us to identify several frequent causes.ClinicalTrials.gov NCT01732159.

  18. Assessment of a Standardized Pre-Operative Telephone Checklist Designed to Avoid Late Cancellation of Ambulatory Surgery: The AMBUPROG Multicenter Randomized Controlled Trial

    Science.gov (United States)

    Marchand-Maillet, Florence; Baron, Gabriel; Douard, Richard; Béthoux, Jean-Pierre

    2016-01-01

    Objectives To assess the impact of a standardized pre-operative telephone checklist on the rate of late cancellations of ambulatory surgery (AMBUPROG trial). Design Multicenter, two-arm, parallel-group, open-label randomized controlled trial. Setting 11 university hospital ambulatory surgery units in Paris, France. Participants Patients scheduled for ambulatory surgery and able to be reached by telephone. Intervention A 7-item checklist designed to prevent late cancellation, available in five languages and two versions (for children and adults), was administered between 7 and 3 days before the planned date of surgery, by an automated phone system or a research assistant. The control group received standard management alone. Main Outcome Measures Rate of cancellation on the day of surgery or the day before. Results The study population comprised 3900 patients enrolled between November 2012 and September 2013: 1950 patients were randomized to the checklist arm and 1950 patients to the control arm. The checklist was administered to 68.8% of patients in the intervention arm, 1002 by the automated phone system and 340 by a research assistant. The rate of late cancellation did not differ significantly between the checklist and control arms (109 (5.6%) vs. 113 (5.8%), adjusted odds ratio [95% confidence interval] = 0.91 [0.65–1.29], (p = 0.57)). Checklist administration revealed that 355 patients (28.0%) had not undergone tests ordered by the surgeon or anesthetist, and that 254 patients (20.0%) still had questions concerning the fasting state. Conclusions A standardized pre-operative telephone checklist did not avoid late cancellations of ambulatory surgery but enabled us to identify several frequent causes. Trial Registration ClinicalTrials.gov NCT01732159 PMID:26829478

  19. Safety and efficacy of recombinant activated factor VII: a randomized placebo-controlled trial in the setting of bleeding after cardiac surgery

    DEFF Research Database (Denmark)

    Gill, Ravi; Herbertson, Mike; Vuylsteke, Alain;

    2009-01-01

    BACKGROUND: Blood loss is a common complication of cardiac surgery. Evidence suggests that recombinant activated factor VII (rFVIIa) can decrease intractable bleeding in patients after cardiac surgery. Our objective was to investigate the safety and possible benefits of rFVIIa in patients who bleed...... after cardiac surgery. METHODS AND RESULTS: In this phase II dose-escalation study, patients who had undergone cardiac surgery and were bleeding were randomized to receive placebo (n=68), 40 microg/kg rFVIIa (n=35), or 80 microg/kg rFVIIa (n=69). The primary end points were the number of patients....../kg, 14%; P=0.25; 80 microg/kg, 12%; P=0.43). After randomization, significantly fewer patients in the rFVIIa group underwent a reoperation as a result of bleeding (P=0.03) or required allogeneic transfusions (P=0.01). CONCLUSIONS: On the basis of this preliminary evidence, rFVIIa may be beneficial for...

  20. Body Mass Index Is a Marker of Nutrition Preparation Sufficiency Before Surgery for Crohn's Disease From the Perspective of Intra-Abdominal Septic Complications

    Science.gov (United States)

    Zhang, Min; Gao, Xiang; Chen, Yuanhan; Zhi, Min; Chen, Huangwei; Tang, Jian; Su, Minli; Yao, Jiayin; Yang, Qingfan; Chen, Junrong; Hu, Pinjin; Liu, Huanliang

    2015-01-01

    Abstract Poor preoperative nutritional status for individuals with Crohn's disease (CD) is associated with intra-abdominal septic complications (IASCs). The present study aimed to investigate the association of the common nutrition indices serum albumin and body mass index (BMI) with IASCs. Sixty-four CD patients who had received elective intestinal operations were retrospectively investigated. Among these patients, 32 had received individualized fortified nutrition support. IASCs occurred in 7 patients (10.9%). Compared with non-IASC patients, IASC patients had a lower BMI (17.6 ± 2.7 vs 15.6 ± 1.3 kg/m2, P = 0.048). The area under the receiver operating characteristic curve according to the BMI-based IASC prediction was 0.772 (95% confidence interval [CI], 0.601–0.944; P = 0.020) with an optimum diagnostic cutoff value of 16.2 kg/m2. A BMI < 16.2 kg/m2 significantly increased the risk of developing an IASC (odds ratio [OR], 10.286; 95% CI, 1.158–91.386). Even after correction with the simplified CD activity index (CDAI), a low BMI level remained associated with IASCs (OR, 7.650; 95% CI, 0.808–72.427; P = 0.076). Serum albumin was not associated with IASCs. Although the fortified nutrition support group had an albumin level comparable to the control group, this group had a higher simplified CDAI score, a lower BMI level, and a comparable incidence rate of IASCs. Thus, BMI more accurately reflects the basic preoperative nutritional status of CD patients than serum albumin. BMI can aid in guiding preoperative nutrition support and judging the appropriate operation time for CD. PMID:26334908

  1. Topical diclofenac versus dexamethasone after strabismus surgery: A double-blind randomized clinical trial of anti-inflammatory effect and ocular hypertensive response

    OpenAIRE

    Khan Hayat; Amitava Abadan

    2007-01-01

    Background: Compared to steroids non-steroidal anti-inflammatory drugs offer comparable anti-inflammatory action without ocular side-effects. Aim: To compare the anti-inflammatory effect and effect on IOP (Goldmann) of topical diclofenac 0.1% with dexamethasone 0.1% after strabismus surgery. Design: Prospective, randomized, double-blind, single-center, clinical trial. Materials and Methods: Forty-three cases of constant horizontal strabismus, qualifying for standard un...

  2. Effect of erythropoietin on the incidence of acute kidney injury following complex valvular heart surgery: a double blind, randomized clinical trial of efficacy and safety

    OpenAIRE

    Kim, Ji-Ho; Shim, Jae-Kwang; Song, Jong-Wook; Song, Young; Kim, Hye-Bin; Kwak, Young-Lan

    2013-01-01

    Introduction Recombinant human erythropoietin (EPO) is known to provide organ protection against ischemia-reperfusion injury through its pleiotropic properties. The aim of this single-site, randomized, case-controlled, and double-blind study was to investigate the effect of pre-emptive EPO administration on the incidence of postoperative acute kidney injury (AKI) in patients with risk factors for AKI undergoing complex valvular heart surgery. Methods We studied ninety-eight patients with preo...

  3. Five-year follow up of a randomised controlled trial comparing subtotal with total abdominal hysterectomy

    DEFF Research Database (Denmark)

    Andersen, L L; Zobbe, V; Ottesen, B;

    2015-01-01

    OBJECTIVES: To compare the rates of urinary incontinence (UI) and other complications of subtotal abdominal hysterectomy (SAH) with total abdominal hysterectomy (TAH) at 5 years after surgery. DESIGN: Randomised clinical trial with central, computer-generated randomisation. SETTING: Danish multi-...

  4. Abdominal wound closure: current perspectives

    Directory of Open Access Journals (Sweden)

    Williams ZF

    2015-12-01

    Full Text Available Zachary F Williams, William W Hope Department of Surgery, South East Area Health Education Center, New Hanover Regional Medical Center, Wilmington, NC, USA Abstract: This review examines both early and late wound complications following laparotomy closure, with particular emphasis on technical aspects that reduce hernia formation. Abdominal fascial closure is an area of considerable variation within the field of general surgery. The formation of hernias following abdominal wall incisions continues to be a challenging problem. Ventral hernia repairs are among the most common surgeries performed by general surgeons, and despite many technical advances in the field, incisional hernia rates remain high. Much attention and research has been directed to the surgical management of hernias. Less focus has been placed on prevention of hernia formation despite its obvious importance. This review examines the effects of factors such as the type of incision, suture type and size, closure method, patient risk factors, and the use of prophylactic mesh. Keywords: incisional, abdominal, hernia, prevention, wound closure techniques 

  5. A COMPARATIVE STUDY OF THE EFFECT OF EPIDURAL BUPIVACAINE (0.125% VERSUS EPIDURAL BUPIVACAINE (0.125% AND BUTORPHANOL (2mg FOR POST-OPERATIVE PAIN RELIEF IN LOWER ABDOMINAL AND LOWER LIMB SURGERIES

    Directory of Open Access Journals (Sweden)

    Krishna

    2014-08-01

    Full Text Available BACKGROUND: Postoperative pain gives rise to various physiological and psychological phenomenons. Epidural analgesia with combination of local anesthetics and opioids provides better pain relief than local anesthetics alone in the postoperative period. Epidural opioids acting through the spinal cord receptors improve the quality and duration of analgesia along with dose-sparing effect with the local anesthetics. AIMS: The study was conducted to evaluate the efficacy of addition of opioids to local anesthetics for postoperative pain relief. METHODS: Fifty patients of American society of anesthesiology grade and physical status undergoing lower abdominal surgeries & lower limb surgeries in narayana general hospital, Nellore, were divided into two groups B and BB. Group B was given 0.125% bupivacaine alone and Group BB was given 0.125% bupivacaine plus 2mg of butorphanol postoperatively when the patients first complained of pain. Onset of Analgesia, duration of analgesia, visual analog scores and side effects were compared. RESULTS: The onset of analgesia in group B patients (10ml of 0.125% Bupivacaine was varied from 4-8 minutes (mean 5.2 minutes and duration of analgesia lasted for 2-4 hours (mean 2.98(p<0.0001 where as in group BB patients (2mg butorphanol + 0.125% bupivacaine the onset was 2-4 minutes (mean 2.69 and duration of analgesia lasted for 6-8 hours (mean 6.98 (p<0.0001.The Visual Analog Scores of Group B were in the range of 7 to 9 and Group BB were in the range of 5 to 6 (P<0.0001. CONCLUSION: This study concludes that addition of butorphanol (2mg to bupivacaine (0.125% gives more effective and prolonged duration of postoperative pain relief when administered epidurally, without significant side effects.

  6. The Hip Fracture Surgery in Elderly Patients (HIPELD study: protocol for a randomized, multicenter controlled trial evaluating the effect of xenon on postoperative delirium in older patients undergoing hip fracture surgery

    Directory of Open Access Journals (Sweden)

    Coburn Mark

    2012-09-01

    Full Text Available Abstract Background Strategies to protect the brain from postoperative delirium (POD after hip fracture are urgently needed. The development of delirium often is associated with the loss of independence, poor functional recovery, and increased morbidity, as well as increases in length of hospital stay, discharges to nursing facilities, and healthcare costs. We hypothesize that xenon may reduce the burden of POD, (i by avoiding the need to provide anesthesia with a drug that targets the γ-amino-butyric acid (GABAA receptor and (ii through beneficial anesthetic and organ-protective effects. Methods and design An international, multicenter, phase 2, prospective, randomized, blinded, parallel group and controlled trial to evaluate the incidence of POD, diagnosed with the Confusion Assessment Method (CAM, in older patients undergoing hip fracture surgery under general anesthesia with xenon or sevoflurane, for a period of 4 days post surgery (primary outcome is planned. Secondary objectives are to compare the incidence of POD between xenon and sevoflurane, to evaluate the incidence of POD from day 5 post surgery until discharge from hospital, to determine the time to first POD diagnosis, to evaluate the duration of POD, to evaluate the evolution of the physiological status of the patients in the postoperative period, to evaluate the recovery parameters, to collect preliminary data to evaluate the economical impact of POD in the postoperative period and to collect safety data. Patients are eligible if they are older aged (≥ 75 years and assigned to a planned hip fracture surgery within 48 h after the hip fracture. Furthermore, patients need to be willing and able to complete the requirements of this study including the signature of the written informed consent. A total of 256 randomized patients in the 10 participating centers will be recruited, that is, 128 randomized patients in each of the 2 study groups (receiving either xenon or sevoflurane

  7. Intra-operative intravenous fluid restriction reduces perioperative red blood cell transfusion in elective cardiac surgery, especially in transfusion-prone patients: a prospective, randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Georgopoulou Stavroula

    2010-02-01

    Full Text Available Abstract Background Cardiac surgery is a major consumer of blood products, and hemodilution increases transfusion requirements during cardiac surgery under CPB. As intraoperative parenteral fluids contribute to hemodilution, we evaluated the hypothesis that intraoperative fluid restriction reduces packed red-cell (PRC use, especially in transfusion-prone adults undergoing elective cardiac surgery. Methods 192 patients were randomly assigned to restrictive (group A, 100 pts, or liberal (group B, 92 pts intraoperative intravenous fluid administration. All operations were conducted by the same team (same surgeon and perfusionist. After anesthesia induction, intravenous fluids were turned off in Group A (fluid restriction patients, who only received fluids if directed by protocol. In contrast, intravenous fluid administration was unrestricted in group B. Transfusion decisions were made by the attending anesthesiologist, based on identical transfusion guidelines for both groups. Results 137 of 192 patients received 289 PRC units in total. Age, sex, weight, height, BMI, BSA, LVEF, CPB duration and surgery duration did not differ between groups. Fluid balance was less positive in Group A. Fewer group A patients (62/100 required transfusion compared to group B (75/92, p Conclusions Our data suggest that fluid restriction reduces intraoperative PRC transfusions without significantly increasing postoperative transfusions in cardiac surgery; this effect is more pronounced in transfusion-prone patients. Trial registration NCT00600704, at the United States National Institutes of Health.

  8. High Spinal Anesthesia Enhances Anti-Inflammatory Responses in Patients Undergoing Coronary Artery Bypass Graft Surgery and Aortic Valve Replacement: Randomized Pilot Study.

    Directory of Open Access Journals (Sweden)

    Trevor W R Lee

    Full Text Available Cardiac surgery induces many physiologic changes including major inflammatory and sympathetic nervous system responses. Here, we conducted a single-centre pilot study to generate hypotheses on the potential immune impact of adding high spinal anaesthesia to general anaesthesia during cardiac surgery in adults. We hypothesized that this strategy, previously shown to blunt the sympathetic response and improve pain management, could reduce the undesirable systemic inflammatory responses caused by cardiac surgery.This prospective randomized unblinded pilot study was conducted on 14 patients undergoing cardiac surgery for coronary artery bypass grafting and/or aortic valve replacement secondary to severe aortic stenosis. The primary outcome measures examined longitudinally were serum pro-inflammatory (IL-6, IL-1b, CCL2, anti-inflammatory (IL-10, TNF-RII, IL-1Ra, acute phase protein (CRP, PTX3 and cardiovascular risk (sST2 biomarkers.The kinetics of pro- and anti-inflammatory biomarker was determined following surgery. All pro-inflammatory and acute phase reactant biomarker responses induced by surgical stress were indistinguishable in intensity and duration between control groups and those who also received high spinal anaesthesia. Conversely, IL-10 levels were markedly elevated in both intensity and duration in the group receiving high spinal anesthesia (p = 0.005.This hypothesis generating pilot study suggests that high spinal anesthesia can alter the net inflammatory response that results from cardiac surgery. In appropriately selected populations, this may add incremental benefit by dampening the net systemic inflammatory response during the week following surgery. Larger population studies, powered to assess immune, physiologic and clinical outcomes in both acute and longer term settings, will be required to better assess potential benefits of incorporating high spinal anesthesia.ClinicalTrials.gov NCT00348920.

  9. Ultrasound guided pectoral nerve blockade versus thoracic spinal blockade for conservative breast surgery in cancer breast: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Hala M.S. ELdeen

    2016-01-01

    Conclusion: In conclusion, both Pecs and TSB provide effective intraoperative anesthesia and prolonged postoperative pain relief after breast surgery, but the Pecs block is technically simple and easy to learn with few contraindications, provides hemodynamic stability, and has a low complication rate and it is therefore a safe and effective technique in performing intraoperative anesthesia and controlling postoperative pain after unilateral conservative breast surgery.

  10. Local infiltration analgesia in urogenital prolapse surgery: a prospective randomized, double-blind, placebo-controlled study

    DEFF Research Database (Denmark)

    Kristensen, Billy B; Rasmussen, Yvonne H; Agerlin, Marianne;

    2011-01-01

    To evaluate the analgesic effect of high-volume infiltration analgesia in urogenital prolapse surgery and provide a detailed description of the infiltration technique.......To evaluate the analgesic effect of high-volume infiltration analgesia in urogenital prolapse surgery and provide a detailed description of the infiltration technique....

  11. Abdominal Aortic Aneurysms: Treatments

    Science.gov (United States)

    ... access catheters Vertebroplasty Women and vascular disease Women's health Social Media Facebook Twitter ... Abdominal Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists are vascular ...

  12. Differential analgesic effects of low-dose epidural morphine and morphine-bupivacaine at rest and during mobilization after major abdominal surgery

    DEFF Research Database (Denmark)

    Dahl, J B; Rosenberg, J; Hansen, B L;

    1992-01-01

    In a double-blind, randomized study, epidural infusions of low-dose morphine (0.2 mg/h) combined with low-dose bupivacaine (10 mg/h) were compared with epidural infusions of low-dose morphine (0.2 mg/h) alone for postoperative analgesia at rest and during mobilization and cough in 24 patients after...... mobilization from the supine into the sitting position 12 and 30 h after surgical incision and during cough 8, 12, and 30 h after surgical incision (P less than 0.05). We conclude, that low-dose epidural bupivacaine potentiates postoperative low-dose epidural morphine analgesia during mobilization and cough...

  13. Acute spontaneous isolated dissection of abdominal aorta

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    Ali Akbar beigi

    2009-09-01

    Full Text Available

    • Aortic dissection occurs when the layers of the aorta separate as a result of extra luminal cavity of blood through an intimal tear. Dissection limited to the abdominal aorta is rare. Unfortunately, the appropriate management of dissecting aneurysm of abdominal aorta is not documented yet. A 43 years old man was admitted to Al-zahra hospital in Isfahan with sudden onset of periumbilical abdominal pain. CT scan confirmed infrarenal dissection of abdominal aorta. Performing laparotomy, aorta was repaired using bifurcate collagen-coated Dacron graft. Surgical intervention with synthetic graft is recommended in patients with dissecting aortic aneurysm of infrarenal segments where the extent of dissection is limited and accessible.
    • Keywords: Aneurysm, Aortic dissection, Aortic aneurysm abdominal surgery.

  14. A fibromatosis case mimicking abdominal aorta aneurysm.

    Science.gov (United States)

    Tasdemir, Arzu; Kahraman, Cemal; Tasdemir, Kutay; Mavili, Ertugrul

    2013-01-01

    Retroperitoneal fibrosis is a rare fibrosing reactive process that may be confused with mesenteric fibromatosis. Abdominal aorta aneurysm is rare too and mostly develops secondary to Behcet's disease, trauma, and infection or connective tissue diseases. Incidence of aneurysms occurring as a result of atherosclerotic changes increases in postmenopausal period. Diagnosis can be established with arteriography, tomography, or magnetic resonance imaging associated with clinical findings. Tumors and cysts should be considered in differential diagnosis. Abdominal ultrasound and contrast-enhanced computerized tomography revealed an infrarenal abdominal aorta aneurysm in a 41-year-old woman, but, on surgery, retroperitoneal fibrosis surrounding the aorta was detected. We present this interesting case because retroperitoneal fibrosis encircling the abdominal aorta can mimic abdominal aorta aneurysm radiologically.

  15. Chylous Ascites after Abdominal Aortic Aneurysm Repair.

    Science.gov (United States)

    Ohki, Shinichi; Kurumisawa, Soki; Misawa, Yoshio

    2016-01-01

    A 73-year-old man was transferred for treatment of abdominal aortic aneurysm. He had no history of abdominal surgeries. Grafting between the infra-renal abdominal aorta and the bilateral common iliac arteries was performed. Proximal and distal cross clamps were applied for grafting. He developed chylous ascites on the 5th post-operative day, 2 days after initiation of oral intake. Fortunately, he responded to treatment with total parenteral hyper-alimentation for 10 days, followed by a low-fat diet. There was no recurrence of ascites. PMID:27087873

  16. Damage control surgery for severe thoracoabdominal injuries dominated by abdominal trauma%损伤控制手术在以腹部损伤为主的严重胸腹联合伤中的应用

    Institute of Scientific and Technical Information of China (English)

    周正武; 韩圣瑾; 丁锐; 吴文涛

    2013-01-01

    目的:探讨损伤控制手术(DCO)在治疗以腹部损伤为主的严重胸腹联合伤中的应用.方法:回顾性分析2008年3月-2011年6月收治的71例严重胸腹联合伤患者的临床资料,其中,行损伤控制手术41例,另外30例患者行一期确定性手术.结果:损伤控制手术组患者复苏后乳酸水平,pH值,体温,凝血酶原时间(PT)与一期确定性手术组的患者无统计学差异(均P>0.05).71例患者均治愈后安全出院,但损伤控制手术组患者粘连性肠梗阻、感染的发生率明显低于一期确定性手术组(均P<0.05).结论:在正确掌握适应证的前提下,损伤控制性手术对于严重胸腹部损伤患者是理想的治疗策略.%Objective: To investigate the utilization of damage control operation (DCO) in treatment of the severe thoracoabdominal injuries dominated by abdominal trauma.Methods: The clinical data of 71 patients with severe thoracoabdominal wounds admitted from March 2008 to June 2011 were retrospectively analyzed. Of the patients, 41 cases received DCO procedure, and another 30 cases underwent primary definitive surgery.Results: There were no significant differences in the lactate levels, pH value, body temperature, and prothrombin time (PT) between the DCO patients after resuscitation and patients undergoing primary definitive surgery (all P>0.05). All of the 71 patients were cured and discharged from hospital, while the patients receiving DCO had significantly lower incidence of adhesive ileus and infection compared with those undergoing primary definitive surgery (both P<0.05).Conclusion: DCO is a better treatment strategy for patients with severe thoracoabdominal injuries under the condition of a correct understanding of its indications.

  17. Effect of melatonin on depressive symptoms and anxiety in patients undergoing breast cancer surgery: a randomized, double-blind, placebo-controlled trial.

    Science.gov (United States)

    Hansen, Melissa V; Andersen, Lærke T; Madsen, Michael T; Hageman, Ida; Rasmussen, Lars S; Bokmand, Susanne; Rosenberg, Jacob; Gögenur, Ismail

    2014-06-01

    Depression, anxiety and sleep disturbances are known problems in patients with breast cancer. The effect of melatonin as an antidepressant in humans with cancer has not been investigated. We investigated whether melatonin could lower the risk of depressive symptoms in women with breast cancer in a three-month period after surgery and assessed the effect of melatonin on subjective parameters: anxiety, sleep, general well-being, fatigue, pain and sleepiness. Randomized, double-blind, placebo-controlled trial undertaken from July 2011 to December 2012 at a department of breast surgery in Copenhagen, Denmark. Women, 30-75 years, undergoing surgery for breast cancer and without signs of depression on Major Depression Inventory (MDI) were included 1 week before surgery and received 6 mg oral melatonin or placebo for 3 months. The primary outcome was the incidence of depressive symptoms measured by MDI. The secondary outcomes were area under the curve (AUC) for the subjective parameters. 54 patients were randomized to melatonin (n = 28) or placebo (n = 26) and 11 withdrew from the study (10 placebo group and 1 melatonin group, P = 0.002). The risk of developing depressive symptoms was significantly lower with melatonin than with placebo (3 [11 %] of 27 vs. 9 [45 %] of 20; relative risk 0.25 [95 % CI 0.077-0.80]), giving a NNT of 3.0 [95 % CI 1.7-11.0]. No significant differences were found between AUC for the subjective parameters. No differences in side effects were found (P = 0.78). Melatonin significantly reduced the risk of depressive symptoms in women with breast cancer during a three-month period after surgery. PMID:24756186

  18. 悬吊式与气腹腹腔镜手术治疗老年结直肠癌的对比研究%The comparative study between gasless laparoscopic surgery with abdominal wall lifting and traditional laparoscopic surgery for colorectal cancer in aged patients

    Institute of Scientific and Technical Information of China (English)

    傅健; 张建立; 孙振青; 王政坤; 刘希春; 邱志刚

    2013-01-01

    Objective:To compare and analyze the effect of gasless laparoscopic surgery with abdominal wall lifting and traditional laparoscopic surgery for colorectal cancer in aged patients. Methods: Forty aged patients with colorectal cancer underwent either gasless laparoscopic surgery with abdominal wall lifting (n =20,gasless group) or traditional laparoscopic surgery (n = 20,pneumoper-itoneum group) from Jun. 2010 to Jun. 2012. The operating time, blood loss, harvested lymph nodes, intraoperative unexpected injury, postoperative exhaust time, complications and pain score were compared between groups. Results; Thirty-seven operations were successfully performed, and 1 case was converted to open surgery in pneumoperitoneum group and 2 in gasless group. Each group had 1 case of ureteral injury and 1 case of anastomotic stoma fistula. And 1 case of postoperative vagina-rectum fistula was observed in gasless group. No significant difference was observed in the operating time,blood loss,total harvested lymph nodes,postoperative exhaust time,complications or pain score between the 2 groups (P > 0. 05 ) . Conclusions: Gasless laparoscopic operations for colorectal cancer with abdominal wall lifting are safe and feasible. It is better than traditional laparoscopic operations in aged patients and those with poor cardio-pul-monary function with advantages of no pneumoperitoneum complications.%目的:对比分析悬吊式腹腔镜手术与传统腹腔镜手术治疗老年结直肠癌的可行性及临床疗效.方法:回顾分析2010年6月至2012年6月为40例老年患者行腹腔镜结直肠癌手术的临床资料,分别采用悬吊式免气腹法(悬吊组,n=20)及气腹法(气腹组,n =20),对比分析两组患者手术时间、出血量、淋巴结清扫数量、术后排气时间、术后疼痛评分、术中意外损伤、术后并发症情况.结果:37例成功施行腹腔镜手术,气腹组中转1例,悬吊组中转2例.术中两组各有1例损伤输尿管;术后

  19. Control effect of blood glucose control optimization on stress hyperglycemia of patients after abdominal surgery%血糖控制优化方案对肝胆胰外科术后患者应激性高血糖控制的效果

    Institute of Scientific and Technical Information of China (English)

    杨金旭; 石泽亚; 蔡益民; 周煦; 潘小季; 周丽娟; 张娟; 李玉莲; 刘小明

    2013-01-01

    Objective To study the clinical effect of blood glucose control optimization on stress hyperglycemia of patients after abdominal surgery.Methods Totals of 86 cases of serious patients who had suffered from abdominal surgery from January to June 2012 and suffered from postoperative stress hyperglycemia were selected and randomly divided into the control group and the observation group,with 43 cases in each group.In both groups,50 U neutral insulin was added into 48.75 ml of 0.9% sodium chloride injection,and venous transfusion was done by micro pump to control blood glucose between 7.8 and 10.0 mmol/L.Blood glucose control optimization and traditional methods were respectively used in the observation group and the control group.Results Compared to the control group,blood glucose of patients in the observation group reached the target value more quickly.The time was (4.54 ± 1.51) h in the observation group and (8.64 ± 2.68) h in the control group,and the difference was statistically significant (t =2.84,P < 0.05).The hyperglycemic index was (0.86 ± 0.24) in the observation group and (1.97± 0.94) in the control group,and the difference was statistically significant (t =2.95,P < 0.05).The incidence of adverse events such as hypoglycemia,severe hypoglycemia and 50% glucose rescue was lower in the observation group than in the control group,and the differences were statistically significant (x2 =6.541,4.195,14.577,respectively; P < 0.05).The incidence rate of abdominal infection,incisional wound infection and pulmonary infection were also lower in the observation group than in the control group,and the differences were statistically significant (x2 =5.108,6.198,3.957,respectively; P < 0.05).Conclusions Blood glucose control optimization on patients after abdominal surgery can control patients' blood sugar better,quicker and safer,as well as reduce the incidence of adverse events including hypoglycemia,abdominal infection and so on.%目的 探讨肝胆胰

  20. Cosmetic outcome of skin adhesives versus transcutaneous sutures in laparoscopic port-site wounds: a prospective randomized controlled trial

    OpenAIRE

    Buchweitz, Olaf; Frye, Christian; Moeller, Claus Peter; Nugent, Wolfgang; Krueger, Eckart; Nugent, Andreas; Biel, Peter; Juergens, Sven

    2015-01-01

    Background In an elective laparoscopic surgery, the cosmetic outcome becomes increasingly important. We conducted a study to evaluate the cosmetic outcome 3 months after a laparoscopic procedure and compared skin adhesive (SA) versus transcutaneous suture (TS). Methods A randomized, controlled, prospective study was conducted at a single study centre in Hamburg, Germany. Seventy-seven patients undergoing laparoscopic surgery with two lower abdominal port sites met the study requirements. It w...

  1. RANDOMIZED DOUBLE BLIND STUDY COMPARING ONDANSETRON, PALONOSETRON & GRANISETRON TO PREVENT POST OPERATIVE NAUSEA & VOMITING AFTER LAPAROSCOPIC SURGERIES UNDER GENERAL ANAESTHESIA

    Directory of Open Access Journals (Sweden)

    Rajendra

    2015-11-01

    Full Text Available The aim of the study is to compare the efficacy of intravenously administered 5-HT3 receptor antagonists namely Ondansetron, Palonosetron and Granisetron given as prophylaxis for postoperative nausea and vomiting in patients undergoing laparoscopic surgeries under general anaesthesia. A single dose of palonosetron (0.75 µg when given prophylactically results in a significantly lower incidence of PONV after laparoscopic surgeries than ondansetron (4mg and granisetron (2.5mg during the first 24 hours

  2. Transumbilical Single-port Laparoscopic Surgery Combined with 2-mm Trocar for Abdominal Undescended Testis%经脐单一切口腹腔镜联合2mm trocar治疗腹腔型隐睾

    Institute of Scientific and Technical Information of China (English)

    江春; 黄健; 林天歆; 韩金利; 黄海; 许可慰; 谢文练; 姚友生

    2011-01-01

    目的 探讨经脐单一切口腹腔镜联合2 mm trocar治疗腹腔型隐睾的应用价值. 方法 2009年11月~2011年1月,采用经脐单一切口腹腔镜联合2 mm trocar治疗11例腹腔型隐睾.脐下缘1.5 cm弧形切口,置入自制多通道trocar,置入5 mm腹腔镜和操作器械1把,脐与耻骨联合连线中点处直接穿刺置人2 mm trocar,置入2 mm腹腔镜抓钳,进行手术.结果 10例11侧成功将隐睾下降固定于阴囊;1例1侧行隐睾切除术.手术时间30~70 min,平均45 min.无手术并发症发生.10例随访3 ~14个月,平均8.8月,未发现下降的睾丸萎缩. 结论 经脐单一切口腹腔镜联合2 mm trocar治疗操作不复杂的腹腔型隐睾可行.%Objective To evaluate transumbilical single-port laparoscopic orchiopexy combined with 2-mm trocar for abdominal undescended testis. Methods From November 2009 to January 2011 , we performed transumbilical single-port laparoscopic orchiopexy combined with 2-mm trocar on 11 patient with nonpalpable undescended testis. A domestic multichannel port was inserted through a 1. 5-cm umbilical incision, and a 2-mm trocar was inserted at the middle point between the pubis and umbilicus. A 5-mm laparoscope, 5-mm instrument and a 2-mm laparoscopic forceps were applied in the procedure. Results The operations, including 10 cases of orchiopexy, and 1 case of orchidectomy because of testicular hypoplasia, were completed successfully within a mean of 45 min (30-70 min). Ten patients were followed up for 3-14 months with a mean of 8. 8 months, during which no testicular atrophy was found. Conclusions Transumbilical single-port laparoscopic surgery combined with 2-mm trocar is feasible for uncomplicated abdominal undescended tesits.

  3. Valeriana officinalis L. for conscious sedation of patients submitted to impacted lower third molar surgery: A randomized, double-blind, placebo-controlled split-mouth study

    Directory of Open Access Journals (Sweden)

    Marcos Luciano Pimenta Pinheiro

    2014-01-01

    Full Text Available Introduction: Anxiety is one of the components of patient stress in the dental office and is recognized as one of the main factors that negatively affect treatment. The control of anxiety can be performed through conscious sedation, for which benzodiazepine is the drug of choice in dental practice, however present side-effects. Objective: The objective of the following study is to evaluate the efficacy of Valeriana officinalis L. (Valerian for control of anxiety during the third molar surgery. Materials and Methods: A single oral dose of either Valerian (100 mg or placebo was randomly administered 1 h before each surgical procedure to 20 volunteers between 17 and 31 years of age. Anxiety level was assessed by physiological parameters (blood pressure and heart rate [HR] and the observation of signs. Descriptive analysis, Chi-square test, Friedman test, Wilcoxon test and effect size test were performed (P < 0.05. Results: According to the researcher′s (80% and surgeon′s (75% evaluations, the patients treated with Valerian were calmer and more relaxed during surgery. Valerian had a greater effect on the maintenance of systolic blood pressure and HR after surgery. Conclusion: Valerian was more effective at controlling anxiety than a placebo when used for the conscious sedation of adult patients submitted to impacted lower third molar surgery.

  4. Pregabalin as a perioperative strategy for pain management in patients undergoing cosmetic surgery. A randomized, double-blind, and placebo-controlled study

    Directory of Open Access Journals (Sweden)

    Lorena Duque

    2008-11-01

    Full Text Available BACKGROUND: Preoperative Gabapentin has demonstrated to be as analgesic strategy in the control of perioperative pain. Pregabalin -an analogue of Gabapentin- has only a few trials demonstrating its effectiveness on this clinical setting. We wanted to assess the effectiveness of pregabalin given not only as a single dose in the preoperative period, but also continuing its administration 75 mg bid up to the fourth day after surgery. METHODS: Previous consent by the Ethical Committee of the University, we enrolled 110 patients undergoing ambulatory liposuction. They were randomized and blindedallocated to receive Pregabalin (75 mg bid versus placebo, starting 12 hours before surgery up to the fourth day after surgery. We use the postoperative pain intensity by numerical rating scale, pain intensity by categorical pain scale and tramadol-ibuprofen request as primary outcomes. RESULTS: We had 9 dropouts during the recruitment and follow up. 24 hours after surgery we had 18/51 (35.3% versus 16/50 (32% (p=0.7. We also found no difference in opioid request at the same time point, being 6.3 mg morphine equivalents in the pregabalin versus 6.7 mg in the Placebo Group. Subsequent evaluations at 48, 72 and 96 hours demonstrated no difference between groups for analgesic request and pain intensity. CONCLUSION: Perioperative use of Pregabalin (75 mg bid does not offer benefit as analgesic strategy in terms of pain intensity and opioid requirement in patients undergoing cosmetic liposuction.

  5. Initial serum lactate level as predictor of morbidity after major abdominal surgery%腹部大手术后首次动脉血乳酸浓度对患者并发症的预测价值

    Institute of Scientific and Technical Information of China (English)

    李声华; 刘芬; 张应天; 赵文辉

    2008-01-01

    Objective To evaluate the value of immediate postoperative arterial lactate level to predict morbidity after major abdominal surgery. Methods 139 patients,73 males and 66 females, aged (64 ±14)(26-87), who underwent major abdominal surgery had their levels of arterial lactate, blood routine, blood gas and electrolytes measured after they were sent to the ICU. The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and the simplified acute physiology score Ⅱ (SAPS Ⅱ ) levels in the first 24-hour postoperative period were calculated Multivariate logistic regression analysis was utilized to examine the independent relationship of the initial lactate, blood gas values, and anion gap with the morbidity. Results Sixty-one cases of postoperative complications were recorded in the 47 patients (34%). The median initial lactate level of the patients with postoperative complications was 1.7 retool/L, significantly higher than that of the patients without complication (1.2mmol/L,P=0.001). Multivariate analysis showed that lactate level (odds ratio:1.81, 95% confidence interval:1.14-2.89;P=0.013)and Simplified Acute Physiology Score Ⅱ (SAPS Ⅱ (odds rstio:l.14;95% confidence interval:1.08-1.21, P < 0.001) were significantly predictive of postoperative morbidity. The optimal value of lactate to discriminate between the patients who did or did not develop postoperative complications was 2.7 mmol/L as associated with the highest sum of sensitivity and specificity (29.8% and 95.7% respectively). The lactate level more than 2.7 mmol/L was associated with 9.3-fold-higher odds for postoperative complications (95% confidence interval:2.9-30. 4, P< 0.001 ). After adjustment for SAP Ⅱ, the lactate level 2.7 mmol/L remained strongly associated with morbidity (odds ratio:5.9; 95% confidence interval:1.6-21.7; P=0.007). Conclusion Initial serum lactate level is significantly associated with postoperative complications and can

  6. [Intestinal occlusion and abdominal compartment syndrome (ACS)].

    Science.gov (United States)

    Stagnitti, Franco

    2009-01-01

    Intestinal occlusion is defined as an independent predictive factor of intra-abdominal hypertension (IAH) which represents an independent predictor of mortality. Baggot in 1951 classified patients operated with intestinal occlusion as being at risk for IAH ("abdominal blow-out"), recommending them for open abdomen surgery proposed by Ogilvie. Abdominal surgery provokes IAH in 44.7% of cases with mortality which, in emergency, triples with respect to elective surgery (21.9% vs 6.8%). In particular, IAH is present in 61.2% of ileus and bowel distension and is responsible for 52% of mortality (54.8% in cases with intra-abdominal infection). These patients present with an increasing intra-abdominal pressure (IAP) which, over 20-25 mmHg, triggers an Abdominal Compartment Syndrome (ACS) with altered functions in some organs arriving at Multiple Organ Dysfunction Syndrome (MODS). The intestine normally covers 58% of abdominal volume but when there is ileus distension, intestinal pneumatosis develops (third space) which can occupy up to 90% of the entire cavity. At this moment, Gastro Intestinal Failure (GIF) can appear, which is a specific independent risk factor of mortality, motor of "Organ Failure". The pathophysiological evolution has many factors in 45% of cases: intestinal pneumatosis is associated with mucosal and serous edema, capillary leakage with an increase in extra-cellular volume and peritoneal fluid collections (fourth space). The successive loss of the mucous barrier permits a bacterial translocation which includes bacteria, toxins, pro-inflammatory factors and oxygen free radicals facilitating the passage from an intra-abdominal to inter-systemic vicious cyrcle. IAH provokes the raising of the diaphragm, and vascular and visceral compressions which induce hypertension in the various spaces with compartmental characteristics. These trigger hypertension in the renal, hepatic, pelvic, thoracic, cardiac, intracranial, orbital and lower extremity areas, giving

  7. The effect of ranitidine on postoperative infectious complications following emergency colorectal surgery: a randomized, placebo-controlled, double-blind trial

    DEFF Research Database (Denmark)

    Moesgaard, F; Jensen, L S; Christiansen, P M;

    1998-01-01

    OBJECTIVE AND DESIGN: To study the potential effect of ranitidine on postoperative infectious complications following emergency colorectal surgery. A randomized, placebo-controlled, double-blind trial was carried out in three university clinics and two county hospitals in Denmark. PATIENTS AND...... i.v. placebo (group II). All patients were given 1.5 g metronidazole plus 3.0 g cefuroxime at the time of surgery. Patients with perforation of the colon or rectum were given metronidazole and cefuroxime for further 3 days. All patients were assessed daily until discharge from the hospital. Thirty...... < 0.05). Wound infection, intraabdominal abscess, septicemia, and pneumonia were 12.9%, 5.2%, 3.8% and 14%, respectively in group I. In group II, the infectious complications were 16.1%, 6.8%, 6.9% and 22%, respectively. Twelve patients (13.8%) in the placebo group developed more than one complication...

  8. Surgery for adult coarctation with the ascending-abdominal aorta bypass procedure%升主动脉-腹主动脉转流术治疗成人主动脉缩窄

    Institute of Scientific and Technical Information of China (English)

    刘巍; 孙立忠; 王晓龙; 程卫平; 朱俊明; 刘永民; 陈雷; 乔志钰; 里程楠

    2011-01-01

    Objective To explore the surgical effects and follow-up results in treating adult aortic coarctation patients using ascending aorta-abdominal aorta vascular prosthesis bypass and summarize the clinical experiences. Methods From May 2008 to July 2009, ascending aorta-abdominal aorta vascular prosthesis bypass surgery was performed in nine patients with adult aortic coarctation, among which, four were male, and five were female, with the average age of 42.6 years old. All patients had upper extremity hypertension, the systolic blood pressure difference between their upper extremities and lower extremities was 55 - 100 mm Hg, mean (70.2 ± 15. 6) mm Hg. Among which, seven cases showed descending aorta aneurysmal dilatation at coarctation segment distal end, with the wall thinning; two cases showed long segment stenosis; three cases showed aortic wall near coarctation segment was calcified. All cases belonged to complex aortic coarctation. All patients underwent radial artery and dorsalis pedis artery puncture manometry, the surgical effects were evaluated according to mean pressure difference changes between radial artery and dorsalis pedis artery before and after operations. Results All patients were cured and dispertension has been significantly improved, before operation, the mean pressure difference between radial artery and dorsalis pedis artery was 36 - 63 mm Hg, mean [(48.2 ± 5.6 ) mm Hg]; 24 hours after operation, the mean pressure difference between radial artery and dorsalis pedis artery was 0 - 13 mm Hg, mean [(6.2 ± 1.6) mm Hg], significantly reduced ( P <per extremity hypertension disappeared, no need for oral antihypertensive drugs, the mean pressure differences between upper extremities and lower extremities after operations were all less than 20 mm Hg, thoracoabodominal aorta main vessels multi-slice CT examination three months after operation showed that bypass vascular prosthesis was unobetructed, two cases showed that autologous artery at aortic

  9. Topical diclofenac versus dexamethasone after strabismus surgery: A double-blind randomized clinical trial of anti-inflammatory effect and ocular hypertensive response

    Directory of Open Access Journals (Sweden)

    Khan Hayat

    2007-01-01

    Full Text Available Background: Compared to steroids non-steroidal anti-inflammatory drugs offer comparable anti-inflammatory action without ocular side-effects. Aim: To compare the anti-inflammatory effect and effect on IOP (Goldmann of topical diclofenac 0.1% with dexamethasone 0.1% after strabismus surgery. Design: Prospective, randomized, double-blind, single-center, clinical trial. Materials and Methods: Forty-three cases of constant horizontal strabismus, qualifying for standard uniocular recession-resection surgery on two horizontal rectus muscles were randomized to either the dexamethasone or diclofenac group. They were excluded if they had previous ocular surgery, recently used anti-inflammatory drugs and had a neurological, systemic or an ocular inflammatory condition. In addition all received ciprofloxacin 0.3% four times daily. Assessment was done on the first postoperative day and at two and four weeks. The inflammatory characteristics graded from nil (0 to severe (3 were: discomfort, chemosis, injection, discharge and drop-intolerance. Their sum provided the total inflammatory score (TIS. Results: Dexamethasone group (n=21 was comparable in age, gender, preoperative IOP, strabismus, anesthesia administered and baseline IOP, to diclofenac (n=22. There were no significant differences in the inflammatory characteristics and TIS. The dexamethasone group had IOP significantly higher at two weeks (95% CI 0.17 to 3.25 and four weeks (95% CI 1.09 to 4.24 compared to diclofenac group and the net change of IOP at four weeks (95% CI 0.60 to 3.14. Compared to the baseline IOP. Conclusion: Topical diclofenac is comparable to dexamethasone in providing anti-inflammatory and analgesic effect with the advantage of significantly lesser IOP rise and should be preferred after strabismus surgery.

  10. Superior subconjunctival anesthesia versus retrobulbar anesthesia for manual small-incision cataract surgery in a residency training program: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Kongsap P

    2012-11-01

    Full Text Available Pipat KongsapDepartment of Ophthalmology, Prapokklao Hospital, Chanthaburi, Thailand; Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandPurpose: To evaluate the effectiveness of subconjunctival anesthesia as compared to retrobulbar anesthesia for pain control during manual small-incision cataract surgery (MSICS performed by third-year residents.Design: A randomized, controlled trial.Patients and methods: A total of 150 patients undergoing routine cataract surgery were randomly assigned to receive either subconjunctival anesthesia (group 1, n = 75 or retrobulbar anesthesia (group 2, n = 75. Third-year residents performed MSICS using the modified Blumenthal technique. Subconjunctival anesthesia was administered by injecting 2% xylocaine with adrenalin into the superior conjunctiva, and retrobulbar anesthesia by injecting 2 mL of 2% xylocaine with adrenalin into the retrobulbar space. We studied the following variables: intraoperative pain score rated on a 100-point visual analog scale (VAS, operative time, and injection and operative complications.Results: A mean age of 69 vs 70 years, an operative time of 47.1 (SD, 9.9 min vs 47.7 (10.9 min, and a median (interquartile range pain score of 40 (range, 20–70 vs 40 (range, 20–50 were observed in the subconjunctival and the retrobulbar groups, respectively. The injection complication of subconjunctival hemorrhage was significantly higher in the subconjunctival group (25.3% compared to the retrobulbar group (1.3%. The operative complication rate between groups was not different (P > 0.05.Conclusion: Both, superior subconjunctival anesthesia and retrobulbar anesthesia were effective during MSICS when used in a residency training program.Keywords: subconjunctival anesthesia, retrobulbar anesthesia, cataract surgery, small-incision cataract surgery, visual analog scale, pain score

  11. Hot topics in the perioperative nutritional support therapy in abdominal surgery%腹部外科围术期营养支持治疗的热点问题

    Institute of Scientific and Technical Information of China (English)

    韦军民

    2015-01-01

    营养不良在腹部外科较为常见,对患者的恢复产生影响,合理的营养支持治疗可改善患者预后.患者入院24 h内应行营养风险筛查,对于存在营养风险和营养不良的患者,需制订营养支持治疗计划,并选择合适的时机和途径行营养支持治疗.术前整夜禁食对绝大多数腹部外科患者是没有必要的,应允许摄入浓度很低的流质饮食至麻醉前2h.外科患者如术前存在重度营养不良,应行7~10 d营养支持治疗.术后需要行营养支持治疗的患者,首选肠内营养支持治疗,但对肠内营养支持治疗不可行或达不到目标量的60%患者,应辅以肠外营养支持治疗.对于无严重伴发疾病的患者,通常没有必要行个体化营养支持治疗.ω-3多不饱和脂肪酸、谷氨酰胺等药理营养素对腹部外科大手术、危重患者有益,临床上可酌情使用.%Malnutrition is common in the abdominal surgery and affects the recovery of patients.Reasonable nutritional support therapy can improve the prognosis of patients.The nutritional risk screening should be apphed to patients within 24 hours of admission.Patients with the nutritional risk and malnutrition should receive the nutritional support by selecting a good timing and way based on the nutritional support planning.Preoperative fasting all night for the majority of patients is not necessary,patients should be allowed to intake low-concentration liquid diet at hour 2 before anesthesia.Patients with preoperative severe malnutrition should be given 7-10 days of nutritional support therapy.The enteral nutritional therapy was preferred to patients needing postoperative nutritional support therapy,while parenteral nutrition therapy should be supplied to patients with infeasible enteral nutrition or expected target of 60% for enteral nutrition.Individual nutritional support therapy is not necessary for patients without severe concomitant disease.Pharmacological nutrients such as

  12. Causes of pulmonary infections under general anesthesia for elderly patients after abdominal surgery%老年患者全身麻醉腹部手术后并发肺部感染的原因分析

    Institute of Scientific and Technical Information of China (English)

    张燕; 刘欢欢; 杨平山

    2012-01-01

    OBJECTIVE To analyze the causes of pulmonary infections under general anesthesia for elderly patients after abdominal surgery, explore measures for prevention of infections so as to reduce the hospital infection rate of the elderly patients. METHODS A total of 16 patients with postoperative pulmonary infections among the 226 cases of elderly patients who underwent abdominal surgery under general anesthesia from Aug 2009 to Jun 2011 were analyzed retrospectively. The causes of the infections, infection rate and pathogenic bacteria were observed. RESULTS Of 226 cases of patients,the postoperative pulmonary infections occurred in 16 cases with the infection rate of 7. 1 %, the main risk factors for infections mainly included the invasive procedures, postoperative pain, the use of antibiotics, and upper respiratory diseases; all of the 16 patients with pulmonary infections underwent tracheal intubation, suffered from postoperative pain, and empirically used antibiotics after operation; the result of the sputum culture for 16 cases of patients with pulmonary infections indicated that there were 16 strains of pathogens cultured, including gram-negative bacteria (56. 3%), gram-positive bacteria (31. 3%), and fungi (12.5%); the main pathogenic bacteria causing infections were Pseudomonas aeruginosa , Escherichia coli, and Staphylococcus aureus. CONCLUSION The operations should be strictly in accordance with procedures, the strict quality control of the steps of the invasive operation should be carried out so as to eliminate various susceptible factors, which is also crucial to the reduction of the pulmonary infections.%目的 分析老年患者全身麻醉腹部手术后并发肺部感染的原因,探讨预防感染的措施,以降低老年患者的医院感染率.方法 医院2009年8月-2011年6月226例全身麻醉腹部手术的老年患者的资料进行回顾性分析,其中16例并发肺部感染,调查发生感染的原因、感染率及感染病原菌.结果 226

  13. Reconstruction of chest, abdominal walls and perineum

    OpenAIRE

    Vijaykumar D; Vijayaraghavan Sundeep

    2007-01-01

    The structural integrity of the chest and abdominal walls and perineum is frequently altered by cancer extirpation. Advances in reconstructive surgery and the availability of innovative techniques have helped the cancer surgeon to proceed with radical excisions with minimum morbidity. The ability to harvest flaps from distant sites and the availability of good prosthetic materials have now become part of the routine armamentarium of the plastic surgeon engaged in reconstructive surgery of the...

  14. 腹部外科手术切口感染的危险因素及对策%Risk factors and strategy for surgical incision infection in department of abdominal surgery

    Institute of Scientific and Technical Information of China (English)

    马红丽

    2011-01-01

    目的 探讨影响腹部外科手术切口感染的危险因素.方法 通过回顾性调查,以为诊断标准,分析各调查因素对切口感染率的影响,筛选出手术切口感染的主要危险因素.结果 2009年1月1日-10月30日医院实行腹部外科手术共1216例,发生切口感染48例,感染率为3.95%,其中Ⅰ类切口感染率为0.78%,Ⅱ、Ⅲ类切口感染率为6.25%;性别、年龄、肥胖、糖尿病、切口分类、手术性质、手术时间均是普通外科切口感染的危险因素.结论 加强对危险因素的监测与调控有利于降低腹部外科手术切口感染的发病率.%OBJECTIVE To study the risk factors of surgical wound infection among the patients in department of abodominal surgery.METHODS The factors on surgical wound infection were investigated by retrospective study.The diagnosis standard was based on the Diagnosis Standard of Hospital Infection published by Ministry of Health.RESULTS There were 1216 cases with abodominal operation from Jan 1, 2009 to Oct 30, 2009 and 48 cases suffered incision infection with the infection rate 3.95%.The infection rate in type Ⅰ operation was 0.78%, and the infection rate in type Ⅱ and Ⅲ was 6.25%.Gender, age, obesity, diabetes, classification of incision, character of operation and operation time were the risk factors of surgical wound infection among patients in department of abdominal surgery.CONCLUSION Strengthening the monitor and regulation to the risk factors could reduce the surgical wound infection rate.

  15. Comparison of analgesic efficacy of flupirtine maleate and ibuprofen in gynaecological ambulatory surgeries: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Vanita Ahuja

    2015-01-01

    Full Text Available Background and Aims: Flupirtine maleate is a centrally acting, non-opioid analgesic with unique muscle relaxant properties as compared to common analgesics. The aim of this study was to compare post-operative analgesic efficacy of flupirtine maleate and ibuprofen in patients undergoing gynaecological ambulatory surgeries. Methods: This prospective, randomised controlled study was conducted in 60 women of American Society of Anesthesiologists physical status I/II, 18-70 years of age and scheduled to undergo gynaecological ambulatory surgeries. The participants were randomised to receive either 100 mg oral flupirtine maleate (group flupirtine, n = 30 or 800 mg oral ibuprofen (group ibuprofen, n = 30, 1 h prior to surgery and then every 8 h for 48 h. Verbal Numerical Rating Scale (VNRS on movement was assessed at 0, 2, 4, 6 and 8 h following surgery. Following discharge from hospital, the patients were interviewed telephonically at 12, 24 and 48 h post-operatively. VNRS was statistically analysed using Mann-Whitney test. Results: VNRS on movement was statistically reduced at 2 h after surgery (P = 0.04 in group flupirtine as compared to group ibuprofen. The analgesic efficacy was similar in both the groups at 4, 6, 8, 12, 24 and 48 h after surgery. The satisfaction scores at 24 and 48 h post-operatively were superior in group flupirtine as compared to group ibuprofen (P < 0.001. Conclusion: Analgesic efficacy of flupirtine maleate was comparable with ibuprofen in patients in ambulatory gynaecological patients up to 48 h postoperatively with superior satisfaction scores.

  16. Effect of melatonin and gabapentin on anxiety and pain associated with retrobulbar eye block for cataract surgery: A randomized double-blind study

    Directory of Open Access Journals (Sweden)

    Marzieh-Beigom Khezri

    2013-01-01

    Full Text Available Objectives: To compare the effect of melatonin and gabapentin on anxiety, pain, sedation scores, and satisfaction of surgeon in patients of cataract surgery. Materials and Methods: One hundred thirty patients aged between 35 and 85 years scheduled for cataract surgery were randomly allocated to three study groups to receive melatonin (6 mg, gabapentin (600 mg or placebo 90 min before arrival in the operating room. Pain, anxiety, and sedation scores during block and surgery as well as the surgeon′s satisfaction with the surgery were assessed. Results: Anxiety scores decreased significantly in melatonin and gabapentin groups compared to the placebo group after premedication and extended to early postoperative period. The level of anxiety showed no statistically significant difference between melatonin and gabapentin groups at any time of measurement. There were significant differences between the pain scores during retrobulbar placement in gabapentin versus placebo (95% CI 3 to 4; P = 0.001 and melatonin (95% CI 3 to 4; P = 0.040 groups. Also, there were significant differences between the sedation scores during retrobulbar placement in gabapentin and placebo groups (95% CI 2 to 2.5; P = 0.046. The difference in sedation scores during retrobulbar placement in melatonin versus gabapentin and placebo groups was not significant. Neither the intraoperative pain scores nor the postoperative pain scores were different between the three groups. The surgeon reported similar quality of operation conditions during surgery for the three study groups. Conclusion: The level of anxiety was significantly lower with both anxiolytic drugs compared to placebo. Furthermore, gabapentin decreased the pain and improved the sedation scores only during retrobulbar placement compared to the placebo.

  17. 损伤控制外科在闭合性胰腺创伤中的应用%Damage control surgery for pancreatic injuries after blunt abdominal trauma

    Institute of Scientific and Technical Information of China (English)

    赵振国; 李幼生; 王剑; 李刚; 王凯; 胥子玮; 郑磊; 李宁; 黎介寿

    2012-01-01

    Objective To summarize the management of pancreatic injuries after blunt abdominal trauma.Methods The clinical data of 42 patients with blunt pancreatic injury admitted from January 2001to December 2010 was analyzed retrospectively.There were 38 male and 4 female patients,aging from 13 to 65 ycars with a mean of 31 years.The organ injury scaling of Committee of the American Association for the Surgery of Trauma (AAST grade):grade Ⅰ in 3 patients,grade Ⅱ in 12 patients,grade Ⅲ in 9 patients,grade Ⅳ in 13 patients and grade Ⅴ in 5 patients.The mean injury severity score was 27 ± 21.Patients above AAST grade Ⅱ underwent peritoneal drainage and "three neostomy" (gastrostomy,jejunostomy and gallbladder) according to damage control theory.Results Thirty-eight patients got abdominal CT scanning with a positive rate of 79.9% (30/38).Forty patients underwent surgical procedures,and 2 patients with non-operative management.The surgical procedures include peritoneal drainage and "three neostomy" in 32patients,pancreas suture or pancreatic tail resection in 6 patients,pancreatoduodenectomy or caudal pancreaticojejunostomy in 2 patients.Forty patients (95.2%) survived,2 patients (4.8% ) died and 16patients (38.1% ) had complications such as pancreatic fistula,pulmonary infection.Conclusions Abdominal CT scanning will benefit the preoperative diagnosis of blunt pancreatic trauma. Although the survival rate of patients with blunt pancreatic trauma might be improved by using the damage control surgery,the management of damage control surgery also needs to be modified because of the high rate of complications.%目的 总结闭合性胰腺创伤的外科治疗经验.方法 回顾性分析2001年1月至2010年12月收治的42例闭合性胰腺创伤患者的临床资料.其中男性38例,女性4例;年龄13~65岁,平均年龄31岁.根据美国创伤外科协会脏器损伤委员会(AAST)的器官损伤分级:Ⅰ级3例,Ⅱ级12例,Ⅲ级9例,Ⅳ级13

  18. Postoperative abdominal complications after cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Dong Guohua

    2012-10-01

    Full Text Available Abstract Background To summarize the diagnostic and therapeutic experiences on the patients who suffered abdominal complications after cardiovascular surgery with cardiopulmonary bypass(CPB. Methods A total of 2349 consecutive patients submitted to cardiovascular surgery with CPB in our hospital from Jan 2004 to Dec 2010 were involved. The clinical data of any abdominal complication, including its incidence, characters, relative risks, diagnostic measures, medical or surgical management and mortality, was retrospectively analyzed. Results Of all the patients, 33(1.4% developed abdominal complications postoperatively, including 11(33.3% cases of paralytic ileus, 9(27.3% of gastrointestinal haemorrhage, 2(6.1% of gastroduodenal ulcer perforation, 2(6.1% of acute calculus cholecystitis, 3(9.1% of acute acalculus cholecystitis, 4(12.1% of hepatic dysfunction and 2(6.1% of ischemia bowel diseases. Of the 33 patients, 26 (78.8% accepted medical treatment and 7 (21.2% underwent subsequent surgical intervention. There were 5(15.2% deaths in this series, which was significantly higher than the overall mortality (2.7%. Positive history of peptic ulcer, advanced ages, bad heart function, preoperative IABP support, prolonged CPB time, low cardiac output and prolonged mechanical ventilation are the risk factors of abdominal complications. Conclusions Abdominal complications after cardiovascular surgery with CPB have a low incidence but a higher mortality. Early detection and prompt appropriate intervention are essential for the outcome of the patients.

  19. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing tota