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Sample records for undergoing noncardiac surgery

  1. Aspirin in patients undergoing noncardiac surgery

    DEFF Research Database (Denmark)

    Devereaux, P J; Mrkobrada, Marko; Sessler, Daniel I

    2014-01-01

    BACKGROUND: There is substantial variability in the perioperative administration of aspirin in patients undergoing noncardiac surgery, both among patients who are already on an aspirin regimen and among those who are not. METHODS: Using a 2-by-2 factorial trial design, we randomly assigned 10......,010 patients who were preparing to undergo noncardiac surgery and were at risk for vascular complications to receive aspirin or placebo and clonidine or placebo. The results of the aspirin trial are reported here. The patients were stratified according to whether they had not been taking aspirin before...... the study (initiation stratum, with 5628 patients) or they were already on an aspirin regimen (continuation stratum, with 4382 patients). Patients started taking aspirin (at a dose of 200 mg) or placebo just before surgery and continued it daily (at a dose of 100 mg) for 30 days in the initiation stratum...

  2. Clonidine in patients undergoing noncardiac surgery

    DEFF Research Database (Denmark)

    Devereaux, P J; Sessler, Daniel I; Leslie, Kate

    2014-01-01

    BACKGROUND: Marked activation of the sympathetic nervous system occurs during and after noncardiac surgery. Low-dose clonidine, which blunts central sympathetic outflow, may prevent perioperative myocardial infarction and death without inducing hemodynamic instability. METHODS: We performed a bli...

  3. Anaesthetic considerations in children with congenital heart disease undergoing non-cardiac surgery

    Directory of Open Access Journals (Sweden)

    Jagdish Menghraj Shahani

    2012-01-01

    Full Text Available The objective of this article is to provide an updated and comprehensive review on current perioperative anaesthetic management of paediatric patients with congenital heart disease (CHD coming for non-cardiac surgery. Search of terms such as "anaesthetic management," "congenital heart disease" and "non-cardiac surgery" was carried out in KKH eLibrary, PubMed, Medline and Google, focussing on significant current randomised control trials, case reports, review articles and editorials. Issues on how to tailor perioperative anaesthetic management on cases with left to right shunt, right to left shunt and complex heart disease are discussed in this article. Furthermore, the author also highlights special considerations such as pulmonary hypertension, neonates with CHD coming for extracardiac surgery and the role of regional anaesthesia in children with CHD undergoing non-cardiac operation.

  4. Comparison of neostigmine and sugammadex for hemodynamic parameters in cardiac patients undergoing noncardiac surgery.

    Science.gov (United States)

    Kizilay, Deniz; Dal, Didem; Saracoglu, Kemal T; Eti, Zeynep; Gogus, Fevzi Y

    2016-02-01

    The aim of this study is to compare the hemodynamic effects of neostigmine-atropine combination and sugammadex in patients with cardiac problems undergoing noncardiac surgery. Prospective randomized study. In the operating room. Ninety patients with a class 2 or 3 cardiovascular disease according to the New York Heart Association classification and aged between 18 and 75 years undergoing noncardiac surgery were randomized. Group N (n = 45) received 0.03 mg/kg IV neostigmine when T2 appeared as measured with a nerve muscle stimulator. When heart rate was 5 beats/min (±10 beats/min) lower than the heart rate before administration of the medication, 0.5 mg IV atropine sulfate was given. Group S (n = 45) received 3 mg/kg IV sugammadex when T2 appeared as measured with a nerve muscle stimulator. Heart rate, mean systolic and diastolic blood pressures, and electrocardiographic alterations including the QTc (QT Fredericia and QT Bazett) were recorded. There were no significant differences between and within the groups in terms of QTc values. Sugammadex group had a significant decrease on heart rate 1 minute after the medication when compared to the measurement before the medication (P Sugammadex group had lower systolic, diastolic, and mean blood pressures and heart rate when compared to neostigmine group (P sugammadex might be preferred as it provides more hemodynamic stability compared to neostigmine-atropine combination to reverse rocuronium-induced neuromuscular blockage in cardiac patients undergoing noncardiac surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Nitrates for the prevention of cardiac morbidity and mortality in patients undergoing non-cardiac surgery.

    Science.gov (United States)

    Zhao, Na; Xu, Jin; Singh, Balwinder; Yu, Xuerong; Wu, Taixiang; Huang, Yuguang

    2016-08-04

    Cardiac complications are not uncommon in patients undergoing non-cardiac surgery, especially in patients with coronary artery disease (CAD) or at high risk of CAD. Perioperative cardiac complications can lead to mortality and morbidity, as well as higher costs for patient care. Nitrates, which are among the most commonly used cardiovascular drugs, perform the function of decreasing cardiac preload while improving cardiac blood perfusion. Sometimes, nitrates are administered to patients undergoing non-cardiac surgery to reduce the incidence of cardiac complications, especially for patients with CAD. However, their effects on patients' relevant outcomes remain controversial. • To assess effects of nitrates as compared with other interventions or placebo in reducing cardiac risk (such as death caused by cardiac factors, angina pectoris, acute myocardial infarction, acute heart failure and cardiac arrhythmia) in patients undergoing non-cardiac surgery.• To identify the influence of different routes and dosages of nitrates on patient outcomes. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and the Chinese BioMedical Database until June 2014. We also searched relevant conference abstracts of important anaesthesiology or cardiology scientific meetings, the database of ongoing trials and Google Scholar.We reran the search in January 2016. We added three potential new studies of interest to the list of 'Studies awaiting classification' and will incorporate them into our formal review findings for the review update. We included randomized controlled trials (RCTs) comparing nitrates versus no treatment, placebo or other pharmacological interventions in participants (15 years of age and older) undergoing non-cardiac surgery under any type of anaesthesia. We used standard methodological procedures as expected by Cochrane. Two review authors selected trials, extracted data from included studies and assessed risk of bias. We

  6. Aspirin in Patients With Previous Percutaneous Coronary Intervention Undergoing Noncardiac Surgery

    DEFF Research Database (Denmark)

    Graham, Michelle M; Sessler, Daniel I; Parlow, Joel L

    2018-01-01

    Background: Uncertainty remains about the effects of aspirin in patients with prior percutaneous coronary intervention (PCI) having noncardiac surgery. Objective: To evaluate benefits and harms of perioperative aspirin in patients with prior PCI. Design: Nonprespecified subgroup analysis of a mul...

  7. Two acute kidney injury risk scores for critically ill cancer patients undergoing non-cardiac surgery.

    Science.gov (United States)

    Xing, Xue-Zhong; Wang, Hai-Jun; Huang, Chu-Lin; Yang, Quan-Hui; Qu, Shi-Ning; Zhang, Hao; Wang, Hao; Gao, Yong; Xiao, Qing-Ling; Sun, Ke-Lin

    2012-01-01

    Several risk scoures have been used in predicting acute kidney injury (AKI) of patients undergoing general or specific operations such as cardiac surgery. This study aimed to evaluate the use of two AKI risk scores in patients who underwent non-cardiac surgery but required intensive care. The clinical data of patients who had been admitted to ICU during the first 24 hours of ICU stay between September 2009 and August 2010 at the Cancer Institute, Chinese Academy of Medical Sciences & Peking Union Medical College were retrospectively collected and analyzed. AKI was diagnosed based on the acute kidney injury network (AKIN) criteria. Two AKI risk scores were calculated: Kheterpal and Abelha factors. The incidence of AKI was 10.3%. Patients who developed AKI had a increased ICU mortality of 10.9% vs. 1.0% and an in-hospital mortality of 13.0 vs. 1.5%, compared with those without AKI. There was a significant difference between the classification of Kheterpal's AKI risk scores and the occurrence of AKI (PAbelha's AKI risk scores and the occurrence of AKI (P=0.499). Receiver operating characteristic curves demonstrated an area under the curve of 0.655±0.043 (P=0.001, 95% confidence interval: 0.571-0.739) for Kheterpal's AKI risk score and 0.507±0.044 (P=0.879, 95% confidence interval: 0.422-0.592) for Abelha's AKI risk score. Kheterpal's AKI risk scores are more accurate than Abelha's AKI risk scores in predicting the occurrence of AKI in patients undergoing non-cardiac surgery with moderate predictive capability.

  8. Safety and efficacy of sugammadex for the reversal of rocuronium-induced neuromuscular blockade in cardiac patients undergoing noncardiac surgery

    NARCIS (Netherlands)

    Dahl, Vegard; Pendeville, Philippe E.; Hollmann, Markus W.; Heier, Tom; Abels, Esther Am; Blobner, Manfred

    2009-01-01

    Background and objective The present randomized, safety-assessor blinded, placebo-controlled trial was designed to assess safety and efficacy of sugammadex, a novel selective relaxant-binding agent, in patients with underlying cardiovascular disease undergoing noncardiac surgery. Methods Overall,

  9. β-Blocker-Associated Risks in Patients With Uncomplicated Hypertension Undergoing Noncardiac Surgery

    DEFF Research Database (Denmark)

    Jørgensen, Mads E; Hlatky, Mark A; Køber, Lars Valeur

    2015-01-01

    IMPORTANCE: Perioperative β-blocker strategies are important to reduce risks of adverse events. Effectiveness and safety may differ according to patients' baseline risk. OBJECTIVE: To determine the risk of major adverse cardiovascular events (MACEs) associated with long-term β-blocker therapy...... antihypertensive drugs (β-blockers, thiazides, calcium antagonists, or renin-angiotensin system [RAS] inhibitors) undergoing noncardiac surgery between 2005 and 2011. INTERVENTIONS: Various antihypertensive treatment regimens, chosen as part of usual care. MAIN OUTCOMES AND MEASURES: Thirty-day risk of MACEs...... (cardiovascular death, nonfatal ischemic stroke, nonfatal myocardial infarction) and all-cause mortality, assessed using multivariable logistic regression models and adjusted numbers needed to harm (NNH). RESULTS: The baseline characteristics of the 14,644 patients who received β-blockers (65% female, mean [SD...

  10. A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Gislason, Gunnar H; Hlatky, Mark A

    2014-01-01

    BACKGROUND: Heart failure is an established risk factor for poor outcomes in patients undergoing non-cardiac surgery, yet risk stratification remains a clinical challenge. We developed an index for 30-day mortality risk prediction in this particular group. METHODS AND RESULTS: All individuals...... with heart failure undergoing non-cardiac surgery between October 23 2004 and October 31 2011 were included from Danish administrative registers (n = 16 827). In total, 1787 (10.6%) died within 30 days. In a simple risk score based on the variables from the revised cardiac risk index, plus age, gender, acute...... by bootstrapping (1000 re-samples) provided c-statistic of 0.79. A more complex risk score based on stepwise logistic regression including 24 variables at P heart failure, this simple...

  11. Relationship Between Preoperative Anemia and In-Hospital Mortality in Children Undergoing Noncardiac Surgery.

    Science.gov (United States)

    Faraoni, David; DiNardo, James A; Goobie, Susan M

    2016-12-01

    The relationship between preoperative anemia and in-hospital mortality has not been investigated in the pediatric surgical population. We hypothesized that children with preoperative anemia undergoing noncardiac surgery may have an increased risk of in-hospital mortality. We identified all children between 1 and 18 years of age with a recorded preoperative hematocrit (HCT) in the 2012, 2013, and 2014 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) pediatric databases. The endpoint was defined as the incidence of in-hospital mortality. Children with preoperative anemia were identified based on their preoperative HCT. Demographic and surgical characteristics, as well as comorbidities, were considered potential confounding variables in a multivariable logistic regression analysis. A sensitivity analysis was performed using propensity-matched analysis. Among the 183,833 children included in the 2012, 2013, and 2014 ACS NSQIP database, 74,508 had a preoperative HCT recorded (41%). After exclusion of all children children were anemic, and 39,071 (76%) were nonanemic. The median preoperative HCT was 33% (interquartile range, 31-35) in anemic children, and 39% (interquartile range, 37-42) in nonanemic children (P anemia was associated with higher odds for in-hospital mortality (OR, 2.17; 95% CI, 1.48-3.19; P anemia was also associated with higher odds of in-hospital mortality (OR, 1.75; 95% CI, 1.15-2.65; P = .004). Our study demonstrates that children with preoperative anemia are at increased risk for in-hospital mortality. Further studies are needed to assess whether the correction of preoperative HCT, through the development of a patient blood management program, improves patient outcomes or simply reduces the need for transfusions.

  12. Risks of cardiovascular adverse events and death in patients with previous stroke undergoing emergency noncardiac, nonintracranial surgery

    DEFF Research Database (Denmark)

    Christiansen, Mia N.; Andersson, Charlotte; Gislason, Gunnar H.

    2017-01-01

    Background: The outcomes of emergent noncardiac, nonintracranial surgery in patients with previous stroke remain unknown. Methods: All emergency surgeries performed in Denmark (2005 to 2011) were analyzed according to time elapsed between previous ischemic stroke and surgery. The risks of 30-day...... mortality and major adverse cardiovascular events were estimated as odds ratios (ORs) and 95% CIs using adjusted logistic regression models in a priori defined groups (reference was no previous stroke). In patients undergoing surgery immediately (within 1 to 3 days) or early after stroke (within 4 to 14...... and general anesthesia less frequent in patients with previous stroke (all P Risks of major adverse cardiovascular events and mortality were high for patients with stroke less than 3 months (20.7 and 16.4% events; OR = 4.71 [95% CI, 4.18 to 5.32] and 1.65 [95% CI, 1.45 to 1.88]), and remained...

  13. Effect of perioperative beta blockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled, blinded multicentre trial

    DEFF Research Database (Denmark)

    Juul, Anne Benedicte; Wetterslev, Jørn; Gluud, Christian

    2006-01-01

    Objectives To evaluate the long term effects of perioperative blockade on mortality and cardiac morbidity in patients with diabetes undergoing major non-cardiac surgery. Design Randomised placebo controlled and blinded multicentre trial. Analyses were by intention to treat. Setting University...

  14. Preoperative evaluation of the adult patient undergoing non-cardiac surgery: guidelines from the European Society of Anaesthesiology

    NARCIS (Netherlands)

    de Hert, Stefan; Imberger, Georgina; Carlisle, John; Diemunsch, Pierre; Fritsch, Gerhard; Moppett, Iain; Solca, Maurizio; Staender, Sven; Wappler, Frank; Smith, Andrew

    2011-01-01

    The purpose of these guidelines on the preoperative evaluation of the adult non-cardiac surgery patient is to present recommendations based on available relevant clinical evidence. The ultimate aims of preoperative evaluation are two-fold. First, we aim to identify those patients for whom the

  15. Association of β-Blocker Therapy With Risks of Adverse Cardiovascular Events and Deaths in Patients With Ischemic Heart Disease Undergoing Noncardiac Surgery

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Mérie, Charlotte; Jørgensen, Mads Wissenberg

    2014-01-01

    IMPORTANCE: Clinical guidelines have been criticized for encouraging the use of β-blockers in noncardiac surgery despite weak evidence. Relevant clinical trials have been small and have not convincingly demonstrated an effect of β-blockers on hard end points (ie, perioperative myocardial infarction......, ischemic stroke, cardiovascular death, and all-cause death). OBJECTIVE: To assess the association of β-blocker treatment with major cardiovascular adverse events (MACE) and all-cause mortality in patients with ischemic heart disease undergoing noncardiac surgery. DESIGN, SETTING, PARTICIPANTS, AND EXPOSURE...... to calculate the 30-day risks of MACE (ischemic stroke, myocardial infarction, or cardiovascular death) and all-cause mortality associated with β-blocker therapy. MAIN OUTCOMES AND MEASURES: Thirty-day risk of MACE and all-cause mortality. RESULTS: Of 28,263 patients with ischemic heart disease undergoing...

  16. Perioperative hyperoxia and post-operative cardiac complications in adults undergoing non-cardiac surgery

    DEFF Research Database (Denmark)

    Petersen, C; Wetterslev, J; Meyhoff, C S

    2018-01-01

    BACKGROUND: Oxygen therapy is used liberally for all patients undergoing anaesthesia. Recent studies have raised concerns that it may not be without complications when arterial oxygen concentrations reach supranormal concentrations (hyperoxia). Studies of oxygen therapy have raised concerns......, potential risk of oxygen therapy. We will do a trial sequential analysis to assess the robustness of results as well as help estimate the required patient size for future clinical trials....

  17. Incidence of myocardial injury after non-cardiac surgery: Experience ...

    African Journals Online (AJOL)

    international study in 2012 investigated the mortality associated with ... Patients aged ≥45 years undergoing elective elevated-risk non-cardiac surgery were ..... 6 (2.5). 37 (4.7). 703 (4.6). 0.151. Vascular surgery, n (%). 18 (7.4). 788 (100).

  18. Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery.

    Science.gov (United States)

    Bradley, Katharine A; Rubinsky, Anna D; Sun, Haili; Bryson, Chris L; Bishop, Michael J; Blough, David K; Henderson, William G; Maynard, Charles; Hawn, Mary T; Tønnesen, Hanne; Hughes, Grant; Beste, Lauren A; Harris, Alex H S; Hawkins, Eric J; Houston, Thomas K; Kivlahan, Daniel R

    2011-02-01

    Patients who misuse alcohol are at increased risk for surgical complications. Four weeks of preoperative abstinence decreases the risk of complications, but practical approaches for early preoperative identification of alcohol misuse are needed. To evaluate whether results of alcohol screening with the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) questionnaire-up to a year before surgery-were associated with the risk of postoperative complications. This is a cohort study. Male Veterans Affairs (VA) patients were eligible if they had major noncardiac surgery assessed by the VA's Surgical Quality Improvement Program (VASQIP) in fiscal years 2004-2006, and completed the AUDIT-C alcohol screening questionnaire (0-12 points) on a mailed survey within 1 year before surgery. One or more postoperative complication(s) within 30 days of surgery based on VASQIP nurse medical record reviews. Among 9,176 eligible men, 16.3% screened positive for alcohol misuse with AUDIT-C scores ≥ 5, and 7.8% had postoperative complications. Patients with AUDIT-C scores ≥ 5 were at significantly increased risk for postoperative complications, compared to patients who drank less. In analyses adjusted for age, smoking, and days from screening to surgery, the estimated prevalence of postoperative complications increased from 5.6% (95% CI 4.8-6.6%) in patients with AUDIT-C scores 1-4, to 7.9% (6.3-9.7%) in patients with AUDIT-Cs 5-8, 9.7% (6.6-14.1%) in patients with AUDIT-Cs 9-10 and 14.0% (8.9-21.3%) in patients with AUDIT-Cs 11-12. In fully-adjusted analyses that included preoperative covariates potentially in the causal pathway between alcohol misuse and complications, the estimated prevalence of postoperative complications increased significantly from 4.8% (4.1-5.7%) in patients with AUDIT-C scores 1-4, to 6.9% (5.5-8.7%) in patients with AUDIT-Cs 5-8 and 7.5% (5.0-11.3%) among those with AUDIT-Cs 9-10. AUDIT-C scores of 5 or more up to a year before surgery were

  19. Noncardiac Surgery in Patients With Aortic Stenosis

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Jørgensen, Mads Emil; Martinsson, Andreas

    2014-01-01

    (MACE) and all-cause mortality were investigated in a contemporary Danish cohort. HYPOTHESIS: AS is not an independent risk factor for adverse outcomes in noncardiac surgery. METHODS: All patients with and without diagnosed AS who underwent noncardiac surgery in 2005 to 2011 were identified through......BACKGROUND: Past research has identified aortic stenosis (AS) as a major risk factor for adverse outcomes in noncardiac surgery; however, more contemporary studies have questioned the grave prognosis. To further our understanding of this, the risks of a 30-day major adverse cardiovascular event...... nationwide administrative registers. AS patients (n = 2823; mean age, 75.5 years, 53% female) were matched with patients without AS (n = 2823) on propensity score for AS and surgery type. RESULTS: In elective surgery, MACE (ie, nonfatal myocardial infarction, ischemic stroke, or cardiovascular death...

  20. Relationship between admission blood glucose level and prognosis in elderly patients without previously known diabetes who undergo emergency non-cardiac surgery.

    Science.gov (United States)

    Ma, Jinling; He, Lei; Wang, Xiujie; Gao, Meng; Zhao, Yuexiang; Liu, Jie

    2015-08-01

    Elevated blood glucose levels on admission are important as a marker for adverse events in patients who undergo surgery. This study aims to evaluate the relationship between admission glucose level and adverse outcome during the 30-day follow-up period in elderly patients without previously known diabetes who undergo emergency non-cardiac surgery. The primary and secondary end points were all-cause and major adverse cardiac event (MACE) mortalities, respectively, during the 30-day postoperative follow-up period. Higher 30-day all-cause (24.1 %) and MACE (13.7 %) mortalities were observed in patients with an admission glucose ≥ 11.1 mmol/L than in patients with admission glucose blood glucose level is an independent predictor for the development of the 30-day all-cause mortality [odds ratio (OR), 1.91; 95 % confidence interval (CI), 1.746-2.082; p blood glucose level ≥ 11.1 mmol/L has worse event-free survival than an admission blood glucose level <11.1 mmol/L.

  1. Effect of preoperative angina pectoris on cardiac outcomes in patients with previous myocardial infarction undergoing major noncardiac surgery (data from ACS-NSQIP).

    Science.gov (United States)

    Pandey, Ambarish; Sood, Akshay; Sammon, Jesse D; Abdollah, Firas; Gupta, Ena; Golwala, Harsh; Bardia, Amit; Kibel, Adam S; Menon, Mani; Trinh, Quoc-Dien

    2015-04-15

    The impact of preoperative stable angina pectoris on postoperative cardiovascular outcomes in patients with previous myocardial infarction (MI) who underwent major noncardiac surgery is not well studied. We studied patients with previous MI who underwent elective major noncardiac surgeries within the American College of Surgeons-National Surgical Quality Improvement Program (2005 to 2011). Primary outcome was occurrence of an adverse cardiac event (MI and/or cardiac arrest). Multivariable logistic regression models evaluated the impact of stable angina on outcomes. Of 1,568 patients (median age 70 years; 35% women) with previous MI who underwent major noncardiac surgery, 5.5% had postoperative MI and/or cardiac arrest. Patients with history of preoperative angina had significantly greater incidence of primary outcome compared to those without anginal symptoms (8.4% vs 5%, p = 0.035). In secondary outcomes, reintervention rates (22.5% vs 11%, p angina. In multivariable analyses, preoperative angina was a significant predictor for postoperative MI (odds ratio 2.49 [1.20 to 5.58]) and reintervention (odds ratio 2.40 [1.44 to 3.82]). In conclusion, our study indicates that preoperative angina is an independent predictor for adverse outcomes in patients with previous MI who underwent major noncardiac surgery, and cautions against overreliance on predictive tools, for example, the Revised Cardiac Risk Index, in these patients, which does not treat stable angina and previous MI as independent risk factors during risk prognostication. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Endothelial dysfunction after non-cardiac surgery

    DEFF Research Database (Denmark)

    Søndergaard, E S; Fonnes, S; Gögenur, I

    2015-01-01

    was to systematically review the literature to evaluate the association between non-cardiac surgery and non-invasive markers of endothelial function. METHODS: A systematic search was conducted in MEDLINE, EMBASE and Cochrane Library Database according to the PRISMA guidelines. Endothelial dysfunction was described only...... transplantation and vascular surgery respectively) had an improvement in endothelial dysfunction 1 month after surgery. CONCLUSION: Endothelial function changes in relation to surgery. Assessment of endothelial function by non-invasive measures has the potential to guide clinicians in the prevention or treatment...

  3. The usefulness of dipyridamole thallium-201 single photon emission computed tomography for predicting perioperative cardiac events in patients undergoing non-cardiac vascular surgery

    International Nuclear Information System (INIS)

    Chen, Tao; Kuwabara, Yasuo; Tsutsui, Hiroyuki; Sasaki, Masayuki; Nakagawa, Makoto; Koga, Hirofumi; Kaneko, Kouichirou; Komori, Kimihiro; Masuda, Kouji

    2002-01-01

    The aim of this study was to evaluate the usefulness of dipyridamole Tl-201 myocardium single photon emission computed tomography ( 201 Tl-SPECT) for predicting perioperative cardiac events in patients with arteriosclerosis obliterans (ASO) and abdominal aortic aneurysm (AAA) undergoing non-cardiac vascular surgery. Preoperative dipyridamole 201 Tl-SPECT imaging in association with clinical risk assessment was performed in 224 consecutive patients (97 ASO and 127 AAA). The patients were classified into three groups, including low-risk (n=173, 77%), intermediate-risk (n=39, 18%), and high-risk (n=12, 5%) groups according to the clinical risk stratification. The prevalence of reversible Tl-201 defect was significantly higher in the high-risk group than that in the low-risk group (83% vs. 14%, p 201 Tl-SPECT was the only variable to predict perioperative cardiac events by a stepwise logistic regression analysis (odds ratio 7.0, 95% confidence interval 1.7-28.0, p=0.007). It was also a significant predictor of perioperative cardiac events in a subgroup of low risk patients (odds ratio 11.6, 95% confidence interval 2.3-57.4, p=0.004). The sensitivity and specificity of the reversible defect for predicting perioperative cardiac events were 55.6% and 84.8% in all operated patients, and 57.1% and 89.7% in low risk patients, respectively. The preoperative dipyridamole 201 Tl-SPECT was useful for predicting perioperative cardiac events in patients with vascular diseases, even in patients identified as having a low risk based on the clinical risk assessment. (author)

  4. The usefulness of dipyridamole thallium-201 single photon emission computed tomography for predicting perioperative cardiac events in patients undergoing non-cardiac vascular surgery

    International Nuclear Information System (INIS)

    Chen Tao; Huang Gang

    2004-01-01

    The aim of this study was to evaluate the usefulness of dipyridamole Tl-201 myocardium single photon emission computed tomography (201Tl-SPECT) for predicting perioperative cardiac events in patients with arteriosclerosis obliterans (ASO) and abdominal aortic aneurysm (AAA) undergoing non-cardiac vascular surgery. Methods: Preoperative dipyridamole 201Tl-SPECT imaging in association with clinical risk assessment was performed in 224 consecutive patients (97 ASO and 127 AAA). Results: The patients were classified into three groups, including low-risk (n=173, 77%), intermediate-risk (n=39, 18%), and high-risk (n=12, 5%) groups according to the clinical risk stratification. The prevalence of reversible Tl-201 defect was significantly higher in the high-risk group than that in the low-risk group (83% vs. 14%, p<0.001). In 180 patients who underwent vascular surgery, 9 patients (5.0%) had perioperative cardiac events, including heart failure (n=l), unstable angina (n=2), and other cardiac events such as arrhythmias (n=6). The clinical variables including the clinical risk stratification did not significantly correlate with the perioperative cardiac events. In contrast, the reversible defect on 201Tl-SPECT was the only variable to predict perioperative cardiac events by a stepwise logistic regression analysis (odds ratio 7.0, 95% confidence interval l.7-28.0, p=0.007). It was also a significant predictor of perioperative cardiac events in a subgroup of low risk patients (odds ratio 11.6, 95% confidence interval 2.3-57.4, p=0.004). The sensitivity and specificity of the reversible defect for predicting perioperative cardiac events were 55.6% and 84.8% in all operated patients, and 57.1% and 89.7% in low risk patients, respectively. Conclusions: The preoperative dipyridamole 201Tl-SPECT was useful for predicting perioperative cardiac events in patients with vascular diseases, even in patients identified as having a low risk based on the clinical risk assessment. (authors)

  5. Aspirin and clonidine in non-cardiac surgery

    DEFF Research Database (Denmark)

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

    2014-01-01

    INTRODUCTION: Perioperative Ischaemic Evaluation-2 (POISE-2) is an international 2×2 factorial randomised controlled trial of low-dose aspirin versus placebo and low-dose clonidine versus placebo in patients who undergo non-cardiac surgery. Perioperative aspirin (and possibly clonidine) may reduce...... and preoperative chronic aspirin use. At the time of randomisation, a subpopulation agreed to a single measurement of serum creatinine between 3 and 12 months after surgery, and the authors will examine intervention effects on this outcome. ETHICS AND DISSEMINATION: The authors were competitively awarded a grant...

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

    DEFF Research Database (Denmark)

    Bangalore, Sripal; Wetterslev, Jørn; Pranesh, Shruthi

    2008-01-01

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

  7. Systemic hypertension and non-cardiac surgery.

    Science.gov (United States)

    Misra, Satyajeet

    2017-09-01

    Primary systemic hypertension affects 10%-25% of individuals presenting for surgery and anaesthesia and constitutes an important cause of cancellation of elective surgeries. Much of the fear stems from the fact that hypertension may lead to adverse perioperative outcomes. Although long-standing hypertension increases the risk of stroke, renal dysfunction or major adverse cardiovascular events, the same is usually not seen in the perioperative period if blood pressure is <180/110 mmHg and this has been the overriding theme in the recent guidelines on perioperative blood pressure management. Newer concepts include isolated systolic hypertension and pulse pressure hypertension that are increasingly used to stratify risk. The aim of this review is to focus on the adult patient with chronic primary systemic hypertension posted for elective non-cardiac surgery and outline the perioperative concerns.

  8. Sleep disturbances after non-cardiac surgery

    DEFF Research Database (Denmark)

    Rosenberg, Jacob

    2001-01-01

    . The sleep disturbances seem to be related to the magnitude of trauma and thereby to the surgical stress response and/or post-operative opioid administration. Post-operative sleep disturbances may contribute to the development of early post-operative fatigue, episodic hypoxaemia, haemodynamic instability......After major non-cardiac surgery sleep pattern is usually disturbed with initial suppression of rapid eye movement sleep with a subsequent rebound during the first post-operative week. Deep sleep is also suppressed for several days after the operation and subjective sleep quality is impaired...... and altered mental status, all with a potential negative effect on post-operative outcome. Minimizing surgical trauma and avoiding or minimizing use of opioids for pain relief may prevent or reduce post-operative sleep disturbances. Post-operative sleep pattern represents an important research field, since...

  9. Perioperative Myocardial Injury After Noncardiac Surgery: Incidence, Mortality, and Characterization.

    Science.gov (United States)

    Puelacher, Christian; Lurati Buse, Giovanna; Seeberger, Daniela; Sazgary, Lorraine; Marbot, Stella; Lampart, Andreas; Espinola, Jaqueline; Kindler, Christoph; Hammerer, Angelika; Seeberger, Esther; Strebel, Ivo; Wildi, Karin; Twerenbold, Raphael; du Fay de Lavallaz, Jeanne; Steiner, Luzius; Gurke, Lorenz; Breidthardt, Tobias; Rentsch, Katharina; Buser, Andreas; Gualandro, Danielle M; Osswald, Stefan; Mueller, Christian

    2018-03-20

    Perioperative myocardial injury (PMI) seems to be a contributor to mortality after noncardiac surgery. Because the vast majority of PMIs are asymptomatic, PMI usually is missed in the absence of systematic screening. We performed a prospective diagnostic study enrolling consecutive patients undergoing noncardiac surgery who had a planned postoperative stay of ≥24 hours and were considered at increased cardiovascular risk. All patients received a systematic screening using serial measurements of high-sensitivity cardiac troponin T in clinical routine. PMI was defined as an absolute high-sensitivity cardiac troponin T increase of ≥14 ng/L from preoperative to postoperative measurements. Furthermore, mortality was compared among patients with PMI not fulfilling additional criteria (ischemic symptoms, new ECG changes, or imaging evidence of loss of viable myocardium) required for the diagnosis of spontaneous acute myocardial infarction versus those that did. From 2014 to 2015 we included 2018 consecutive patients undergoing 2546 surgeries. Patients had a median age of 74 years and 42% were women. PMI occurred after 397 of 2546 surgeries (16%; 95% confidence interval, 14%-17%) and was accompanied by typical chest pain in 24 of 397 patients (6%) and any ischemic symptoms in 72 of 397 (18%). Crude 30-day mortality was 8.9% (95% confidence interval [CI], 5.7-12.0) in patients with PMI versus 1.5% (95% CI, 0.9-2.0) in patients without PMI ( P PMI not fulfilling any other of the additional criteria required for spontaneous acute myocardial infarction (280/397, 71%) versus those with at least 1 additional criterion (10.4%; 95% CI, 6.7-15.7, versus 8.7%; 95% CI, 4.2-16.7; P =0.684). PMI is a common complication after noncardiac surgery and, despite early detection during routine clinical screening, is associated with substantial short- and long-term mortality. Mortality seems comparable in patients with PMI not fulfilling any other of the additional criteria required for

  10. Non-cardiac surgery in patients with prosthetic heart valves: a 12 years experience.

    Science.gov (United States)

    Akhtar, Raja Parvez; Abid, Abdul Rehman; Zafar, Hasnain; Gardezi, Syed Javed Raza; Waheed, Abdul; Khan, Jawad Sajid

    2007-10-01

    To study patients with mechanical heart valves undergoing non-cardiac surgery and their anticoagulation management during these procedures. It was a cohort study. The study was conducted at the Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore and Department of Surgery, Services Institute of Medical Sciences, Lahore, from September 1994 to June 2006. Patients with mechanical heart valves undergoing non-cardiac surgical operation during this period, were included. Their anticoagulation was monitored and anticoagulation related complications were recorded. In this study, 507 consecutive patients with a mechanical heart valve replacement were followed-up. Forty two (8.28%) patients underwent non-cardiac surgical operations of which 24 (57.1%) were for abdominal and non-abdominal surgeries, 5 (20.8%) were emergency and 19 (79.2%) were planned. There were 18 (42.9%) caesarean sections for pregnancies. Among the 24 procedures, there were 7(29.1%) laparotomies, 7(29.1%) hernia repairs, 2 (8.3%) cholecystectomies, 2 (8.3%) hysterectomies, 1(4.1%) craniotomy, 1(4.1%) spinal surgery for neuroblastoma, 1(4.1%) ankle fracture and 1(4.1%) carbuncle. No untoward valve or anticoagulation related complication was seen during this period. Patients with mechanical valve prosthesis on life-long anticoagulation, if managed properly, can undergo any type of non-cardiac surgical operation with minimal risk.

  11. Non-cardiac surgery in patients with prosthetic heart valves: a 12 years experience

    International Nuclear Information System (INIS)

    Akhtar, R.P.; Khan, J.S.; Abid, A.R.; Gardezi, S.J.R.

    2007-01-01

    To study patients with mechanical heart valves undergoing non-cardiac surgery and their anticoagulation management during these procedures. Patients with mechanical heart valves undergoing non-cardiac surgical operation during this period, were included. Their anticoagulation was monitored and anticoagulation related complications were recorded. In this study, 507 consecutive patients with a mechanical heart valve replacement were followed-up. Forty two (8.28%) patients underwent non-cardiac surgical operations of which 24 (57.1%) were for abdominal and non-abdominal surgeries, 5 (20.8%) were emergency and 19 (79.2%) were planned. There were 18 (42.9%) caesarean sections for pregnancies. Among the 24 procedures, there were 7(29.1%) laparotomies, 7(29.1%) hernia repairs, 2 (8.3%) cholecystectomies, 2 (8.3%) hysterectomies, 1(4.1%) craniotomy, 1(4.1%) spinal surgery for neuroblastoma, 1(4.1%) ankle fracture and 1(4.1%) carbuncle. No untoward valve or anticoagulation related complication was seen during this period. Patients with mechanical valve prosthesis on life-long anticoagulation, if managed properly, can undergo any type of noncardiac surgical operation with minimal risk. (author)

  12. Systematic review of near-infrared spectroscopy determined cerebral oxygenation during non-cardiac surgery

    Directory of Open Access Journals (Sweden)

    Henning Bay Nielsen

    2014-03-01

    Full Text Available Near-infrared spectroscopy (NIRS is used to monitor regional cerebral oxygenation (rScO2 during cardiac surgery but is less established during non-cardiac surgery. This systematic review aimed i to determine the non-cardiac surgical procedures that provoke a reduction in rScO2 and ii to evaluate whether an intraoperative reduction in rScO2 influences postoperative outcome. The PubMed and Embase database were searched from inception until April 30, 2013 and inclusion criteria were intraoperative NIRS determined rScO2 in adult patients undergoing non-cardiac surgery. The type of surgery and number of patients included were recorded. There was included 113 articles and evidence suggests that rScO2 is reduced during thoracic surgery involving single lung ventilation, major abdominal surgery, hip surgery, and laparascopic surgery with the patient placed in anti-Tredelenburg’s position. Shoulder arthroscopy in the beach chair and carotid endarterectomy with clamped internal carotid artery also cause pronounced cerebral desaturation. A >20% reduction in rScO2 coincides with indices of regional and global cerebral ischemia during carotid endarterectomy. Following thoracic surgery, major orthopedic and abdominal surgery the occurrence of postoperative cognitive dysfunction might be related to intraoperative cerebral desaturation. In conclusion, certain non-cardiac surgical procedures is associated with an increased risk for the occurrence of regional cerebral oxygenation. Evidence for an association between cerebral desaturation and postoperative outcome parameters other than cognitive dysfunction needs to be established.

  13. The peri-operative management of anti-platelet therapy in elective, non-cardiac surgery.

    Science.gov (United States)

    Alcock, Richard F; Naoum, Chris; Aliprandi-Costa, Bernadette; Hillis, Graham S; Brieger, David B

    2013-07-31

    Cardiovascular complications are important causes of morbidity and mortality in patients undergoing elective non-cardiac surgery, with adverse cardiac outcomes estimated to occur in approximately 4% of all patients. Anti-platelet therapy withdrawal may precede up to 10% of acute cardiovascular syndromes, with withdrawal in the peri-operative setting incompletely appraised. The aims of our study were to determine the proportion of patients undergoing elective non-cardiac surgery currently prescribed anti-platelet therapy, and identify current practice in peri-operative management. In addition, the relationship between management of anti-platelet therapy and peri-operative cardiac risk was assessed. We evaluated consecutive patients attending elective non-cardiac surgery at a major tertiary referral centre. Clinical and biochemical data were collected and analysed on patients currently prescribed anti-platelet therapy. Peri-operative management of anti-platelet therapy was compared with estimated peri-operative cardiac risk. Included were 2950 consecutive patients, with 516 (17%) prescribed anti-platelet therapy, primarily for ischaemic heart disease. Two hundred and eighty nine (56%) patients had all anti-platelet therapy ceased in the peri-operative period, including 49% of patients with ischaemic heart disease and 46% of patients with previous coronary stenting. Peri-operative cardiac risk score did not influence anti-platelet therapy management. Approximately 17% of patients undergoing elective non-cardiac surgery are prescribed anti-platelet therapy, the predominant indication being for ischaemic heart disease. Almost half of all patients with previous coronary stenting had no anti-platelet therapy during the peri-operative period. The decision to cease anti-platelet therapy, which occurred commonly, did not appear to be guided by peri-operative cardiac risk stratification. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  14. Simultaneous surgery in patients with both cardiac and noncardiac diseases

    Directory of Open Access Journals (Sweden)

    Yang Y

    2016-07-01

    Full Text Available Yang Yang,1 Feng Xiao,1 Jin Wang,1 Bo Song,1 Xi-Hui Li,1 Jian Li,2 Zhi-Song He,3 Huan Zhang,4 Ling Yin5 1Department of Cardiac Surgery, 2Department of Thoracic Surgery, 3Department of Urology Surgery, 4Department of General Surgery, 5Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, People’s Republic of China Background: To investigate the possibility and feasibility of simultaneous cardiac and noncardiac surgery.Methods: From August 2000 to March 2015, 64 patients suffering from cardiac and noncardiac diseases have been treated by simultaneous surgeries.Results: Two patients died after operations in hospital; thus, the hospital mortality rate was 3.1%. One patient with coronary heart disease, acute myocardial infarction, and a recurrence of bladder cancer accepted emergency simultaneous coronary artery bypass grafting (CABG, bladder cystectomy, and ureterostomy. He died of acute cerebral infarction complicated with multiple organ failure on the 153rd day after operation. The other patient with chronic constrictive pericarditis and right lung cancer underwent pericardial stripping and right lung lower lobectomy, which resulted in multiple organ failure, and the patient died on the tenth day postoperatively. The remaining 62 patients recovered and were discharged. The total operative morbidity was 17.2%: postoperative hemorrhage (n, % [1, 1.6%], pulmonary infection and hypoxemia (2, 3.1%, hemorrhage of upper digestive tract (1, 1.6%, incisional infection (3, 4.7%, subphrenic abscess (1, 1.6%, and postoperative acute renal failure and hemofiltration (3, 4.7%. Of the 62 patients discharged, 61 patients were followed up. Eleven patients died with 10 months to 10 years during the follow-up. The mean survival time is 116.2±12.4 months. The cumulative survival rate is 50.8%.Conclusion: Simultaneous surgeries in patients suffering from both cardiac and noncardiac benign or malignant diseases are safe and possible

  15. Benefits of quantitative gated SPECT in evaluation of perioperative cardiac risk in noncardiac surgery

    International Nuclear Information System (INIS)

    Watanabe, Koji; Ohsumi, Yukio; Abe, Hirohiko; Hattori, Masahito; Minatoguchi, Shinya; Fujiwara, Hisayoshi

    2007-01-01

    Gated single-photon emission computed tomography (G-SPECT) was used to evaluate cardiac risk associated with noncardiac surgery and determine the benefits and indications of this technique for this type of surgery. Patients scheduled to undergo noncardiac surgery under the supervision of anesthesiologists and subjected to preoperative cardiac evaluation using G-SPECT during the 26-month period between June 2000 and August 2002 were followed for the presence/absence of cardiac events (id est (i.e.), cardiac death, myocardial infarction, unstable angina, congestive heart failure, or fatal arrhythmia) during surgery and the postoperative period until discharged. Relationships between the occurrence of cardiac events and preoperative G-SPECT findings were evaluated. A total of 39 patients underwent G-SPECT; 6 of the 39 exhibited abnormal ejection fraction (left ventricular ejection fraction, left ventricular ejection fraction (LVEF)≤50%) and end-systolic volume (end-systolic volume (ESV)≥50 ml). Surgery was suspended for three of these six patients and cardiac events developed in the remaining three patients. Both abnormal perfusion images (PI) and abnormal wall thickening (WT) were observed in all six patients. All six patients exhibited abnormal LVEF and/or ESV. Three patients had either abnormal PI or WT, and a cardiac event occurred in one of them. Of the five patients who experienced cardiac events during or after surgery, two exhibited a short run of ventricular tachycardia requiring a continuous administering of antiarrhythmic drugs, whereas the remaining three patients exhibited cardiac failure requiring inotropic support following surgery. The results of this study indicate that the occurrence of perioperative cardiac events can be predicted by considering the severity of expected surgical stress and preoperative G-SPECT findings for LVEF, PI, and WT. We conclude that G-SPECT is quite useful for cardiac risk assessment in patients undergoing noncardiac

  16. Preoperative Prevention of Heart Failure in Noncardiac Surgery

    Directory of Open Access Journals (Sweden)

    V. V. Likhvantsev

    2016-01-01

    Full Text Available Congestive heart failure is consistently associated with adverse outcomes, and is characterized by a twofold increase in mortality in noncardiac surgery. In this regard, developing the methods aimed to prevent and treatacute heart failure (AHF in the intraoperative period remain a challenging problem.Objective. To evaluate the efficacy of preoperative levosimendan infusion in reduction both mortality and duration of treatment of elderly patients with reduced left ventricular ejection fraction in noncardiac surgery.Material and Methods. Design: Multicenter blind randomized placebocontrolled study. Patients: 81 patients operated on abdominal organs. The main endpoint of the study: The length of stay in the Intensive Care Unit (ICU and at the hospital were chosen as the primary endpoints. The secondary endpoints of the study were 30 day and annual mortality, the rate of acute myocardial infarction and stroke.Results. Levosimendan infusion at a rate of 0,05 μg/kg/min — 0,1 μg/kg/min to patients with low left ven tricular ejection fraction just before the surgery reduced the length of stay in ICU for 2 days and required hospital stay for 3 days. NTproBNP showed the best ratio of sensitivity/specificity in predicting 30day mortality in cumulative group: AUC=0,86 (90,77 to 0,93, P<0,0001. From other indicators the most informative were the Inotropes scoring, no change or decrease of a left ventricular ejection fraction, and cardiac index.Conclusion. To reduce perioperative mortality, the intravenous infusion of levosimendan at a rate of 0,05—0,1 μg/kg/min in elderly patients with low left ventricular ejection fraction is recommened as a preoperative preparation the day before the alleged noncardiac surgery.

  17. Design of a Randomized Placebo-Controlled Trial to Assess Dabigatran and Omeprazole in Patients with Myocardial Injury after Noncardiac Surgery (MANAGE)

    DEFF Research Database (Denmark)

    Duceppe, Emmanuelle; Yusuf, Salim; Tandon, Vikas

    2018-01-01

    BACKGROUND: Worldwide approximately 200 million adults undergo major surgery annually, of whom 8 million are estimated to suffer a myocardial injury after noncardiac surgery (MINS). There is currently no trial data informing the management of MINS. Antithrombotic agents such as direct oral antico...

  18. Incidence of myocardial injury after noncardiac surgery: Experience at Groote Schuur Hospital Cape Town South Africa

    Directory of Open Access Journals (Sweden)

    R Dyer

    2018-04-01

    Full Text Available Background. Myocardial injury after non-cardiac surgery (MINS is a newly recognised entity identified as an independent risk factor associated with increased 30-day all-cause mortality. MINS increases the risk of death in the perioperative period by ~10-fold. More than 80% of patients with MINS are asymptomatic, so the majority of diagnoses are missed. Awareness of MINS is therefore important for perioperative physicians.Objectives. To investigate the incidence of MINS after elective elevated-risk non-cardiac surgery at Groote Schuur Hospital, Cape Town, South Africa (SA.Methods. Patients aged ≥45 years undergoing elective elevated-risk non-cardiac surgery were enrolled via convenience sampling. The new fifth-generation high-sensitivity cardiac troponin T blood test was used postoperatively to identify MINS. Preoperative troponin levels were not measured.Results. Among 244 patients included in the study, the incidence of MINS was 4.9% (95% confidence interval (CI 2.8 - 8.5, which was not significantly different from that in a major international prospective observational study (VISION (8.0% (95% CI 7.5 - 8.4; p=0.080.Conclusions. Our SA cohort had a lower cardiovascular risk profile but a similar incidence of MINS to that described in international literature. The impact of MINS on morbidity and mortality is therefore likely to be proportionally higher in SA than in published international studies. The limited sample size and lower event rate weaken our conclusions. Larger studies are required to establish patient and surgical risk factors for MINS, allowing for revision of cardiovascular risk prediction models in SA. 

  19. The Surgical Mortality Probability Model: derivation and validation of a simple risk prediction rule for noncardiac surgery.

    Science.gov (United States)

    Glance, Laurent G; Lustik, Stewart J; Hannan, Edward L; Osler, Turner M; Mukamel, Dana B; Qian, Feng; Dick, Andrew W

    2012-04-01

    To develop a 30-day mortality risk index for noncardiac surgery that can be used to communicate risk information to patients and guide clinical management at the "point-of-care," and that can be used by surgeons and hospitals to internally audit their quality of care. Clinicians rely on the Revised Cardiac Risk Index to quantify the risk of cardiac complications in patients undergoing noncardiac surgery. Because mortality from noncardiac causes accounts for many perioperative deaths, there is also a need for a simple bedside risk index to predict 30-day all-cause mortality after noncardiac surgery. Retrospective cohort study of 298,772 patients undergoing noncardiac surgery during 2005 to 2007 using the American College of Surgeons National Surgical Quality Improvement Program database. The 9-point S-MPM (Surgical Mortality Probability Model) 30-day mortality risk index was derived empirically and includes three risk factors: ASA (American Society of Anesthesiologists) physical status, emergency status, and surgery risk class. Patients with ASA physical status I, II, III, IV or V were assigned either 0, 2, 4, 5, or 6 points, respectively; intermediate- or high-risk procedures were assigned 1 or 2 points, respectively; and emergency procedures were assigned 1 point. Patients with risk scores less than 5 had a predicted risk of mortality less than 0.50%, whereas patients with a risk score of 5 to 6 had a risk of mortality between 1.5% and 4.0%. Patients with a risk score greater than 6 had risk of mortality more than 10%. S-MPM exhibited excellent discrimination (C statistic, 0.897) and acceptable calibration (Hosmer-Lemeshow statistic 13.0, P = 0.023) in the validation data set. Thirty-day mortality after noncardiac surgery can be accurately predicted using a simple and accurate risk score based on information readily available at the bedside. This risk index may play a useful role in facilitating shared decision making, developing and implementing risk

  20. Major Cardiac Events After Non-cardiac Surgery.

    Science.gov (United States)

    Sousa, Gabriela; Lopes, Ana; Reis, Pedro; Carvalho, Vasco; Santos, Alice; Abelha, Fernando José

    2016-08-01

    Postoperative cardiovascular complications might be difficult to assess and are known to be associated with longer hospital stay and increased costs as well as higher morbidity and mortality rates. The aim of this study was to evaluate the predictors for major cardiac events (MCE) after non-cardiac surgery. The study included 4398 patients who were admitted to the Surgical Intensive Care Unit between January 1, 2006 and July 19, 2013. Acute physiology and chronic health evaluation II score and simplified acute physiology score (SAPS II) were calculated, and all variables entered as parameters were evaluated independently. Multivariate logistic regression analysis was performed to assess the independent factors for MCE. A total of 107 people experienced MCE. The independent predictors for postoperative MCE were higher fraction of inspired oxygen (FiO2) (odds ratio [OR] 38.97; 95 % confidence interval [CI] 10.81-140.36), history of ischemic heart disease (OR 3.38; 95 % CI 2.12-5.39), history of congestive heart disease (OR 2.39; 95 % CI 1.49-3.85), history of insulin therapy for diabetes (OR 2.93; 95 % CI 1.66-5.19), and increased SAPS II (OR 1.03; 95 % CI 1.01-1.05). Having a MCE was associated with a longer length of stay in the surgical intensive care unit (OR 1.01, 95 % CI 1.00-1.01). FiO2, ischemic heart disease, congestive heart disease, insulin therapy for diabetes, SAPS II, and length of stay in the surgical intensive care unit were independent predictors for MCE.

  1. Unanticipated hospital admission in pediatric patients with congenital heart disease undergoing ambulatory noncardiac surgical procedures.

    Science.gov (United States)

    Yuki, Koichi; Koutsogiannaki, Sophia; Lee, Sandra; DiNardo, James A

    2018-05-18

    An increasing number of surgical and nonsurgical procedures are being performed on an ambulatory basis in children. Analysis of a large group of pediatric patients with congenital heart disease undergoing ambulatory procedures has not been undertaken. The objective of this study was to characterize the profile of children with congenital heart disease who underwent noncardiac procedures on an ambulatory basis at our institution, to determine the incidence of adverse cardiovascular and respiratory adverse events, and to determine the risk factors for unscheduled hospital admission. This is a retrospective study of children with congenital heart disease who underwent noncardiac procedures on an ambulatory basis in a single center. Using the electronic preoperative anesthesia evaluation form, we identified 3010 patients with congenital heart disease who underwent noncardiac procedures of which 1028 (34.1%) were scheduled to occur on an ambulatory basis. Demographic, echocardiographic and functional status data, cardiovascular and respiratory adverse events, and reasons for postprocedure admission were recorded. Univariable analysis was conducted. The unplanned hospital admission was 2.7% and univariable analysis demonstrated that performance of an echocardiogram within 6 mo of the procedure and procedures performed in radiology were associated with postoperative admission. Cardiovascular adverse event incidence was 3.9%. Respiratory adverse event incidence was 1.8%. Ambulatory, noncomplex procedures can be performed in pediatric patients with congenital heart disease and good functional status with a relatively low unanticipated hospital admission rate. © 2018 John Wiley & Sons Ltd.

  2. Surgery and Anesthesia Exposure Is Not a Risk Factor for Cognitive Impairment After Major Noncardiac Surgery and Critical Illness

    NARCIS (Netherlands)

    Hughes, Christopher G; Patel, Mayur B; Jackson, James C; Girard, Timothy D; Geevarghese, Sunil K; Norman, Brett C; Thompson, Jennifer L; Chandrasekhar, Rameela; Brummel, Nathan E; May, Addison K; Elstad, Mark R; Wasserstein, Mitzi L; Goodman, Richard B; Moons, Karel G; Dittus, Robert S; Ely, E Wesley; Pandharipande, Pratik P; MIND-ICU, BRAIN-ICU investigators

    OBJECTIVE: The aim of this study was to determine whether surgery and anesthesia exposure is an independent risk factor for cognitive impairment after major noncardiac surgery associated with critical illness. SUMMARY OF BACKGROUND DATA: Postoperative cognitive impairment is a prevalent individual

  3. Informed Consent and Cognitive Dysfunction After Noncardiac Surgery in the Elderly.

    Science.gov (United States)

    Hogan, Kirk J; Bratzke, Lisa C; Hogan, Kendra L

    2018-02-01

    Cognitive dysfunction 3 months after noncardiac surgery in the elderly satisfies informed consent thresholds of foreseeability in 10%-15% of patients, and materiality with new deficits observed in memory and executive function in patients with normal test performance beforehand. At present, the only safety step to avoid cognitive dysfunction after surgery is to forego surgery, thereby precluding the benefits of surgery with removal of pain and inflammation, and resumption of normal nutrition, physical activity, and sleep. To assure that consent for surgery is properly informed, risks of both cognitive dysfunction and alternative management strategies must be discussed with patients by the surgery team before a procedure is scheduled.

  4. Dabigatran in patients with myocardial injury after non-cardiac surgery (MANAGE)

    DEFF Research Database (Denmark)

    Devereaux, P J; Duceppe, Emmanuelle; Guyatt, Gordon

    2018-01-01

    BACKGROUND: Myocardial injury after non-cardiac surgery (MINS) increases the risk of cardiovascular events and deaths, which anticoagulation therapy could prevent. Dabigatran prevents perioperative venous thromboembolism, but whether this drug can prevent a broader range of vascular complications...... in patients with MINS is unknown. The MANAGE trial assessed the potential of dabigatran to prevent major vascular complications among such patients. METHODS: In this international, randomised, placebo-controlled trial, we recruited patients from 84 hospitals in 19 countries. Eligible patients were aged...

  5. High C-Reactive Protein Predicts Delirium Incidence, Duration, and Feature Severity After Major Noncardiac Surgery.

    Science.gov (United States)

    Vasunilashorn, Sarinnapha M; Dillon, Simon T; Inouye, Sharon K; Ngo, Long H; Fong, Tamara G; Jones, Richard N; Travison, Thomas G; Schmitt, Eva M; Alsop, David C; Freedman, Steven D; Arnold, Steven E; Metzger, Eran D; Libermann, Towia A; Marcantonio, Edward R

    2017-08-01

    To examine associations between the inflammatory marker C-reactive protein (CRP) measured preoperatively and on postoperative day 2 (POD2) and delirium incidence, duration, and feature severity. Prospective cohort study. Two academic medical centers. Adults aged 70 and older undergoing major noncardiac surgery (N = 560). Plasma CRP was measured using enzyme-linked immunosorbent assay. Delirium was assessed from Confusion Assessment Method (CAM) interviews and chart review. Delirium duration was measured according to number of hospital days with delirium. Delirium feature severity was defined as the sum of CAM-Severity (CAM-S) scores on all postoperative hospital days. Generalized linear models were used to examine independent associations between CRP (preoperatively and POD2 separately) and delirium incidence, duration, and feature severity; prolonged hospital length of stay (LOS, >5 days); and discharge disposition. Postoperative delirium occurred in 24% of participants, 12% had 2 or more delirium days, and the mean ± standard deviation sum CAM-S was 9.3 ± 11.4. After adjusting for age, sex, surgery type, anesthesia route, medical comorbidities, and postoperative infectious complications, participants with preoperative CRP of 3 mg/L or greater had a risk of delirium that was 1.5 times as great (95% confidence interval (CI) = 1.1-2.1) as that of those with CRP less than 3 mg/L, 0.4 more delirium days (P delirium (3.6 CAM-S points higher, P delirium (95% CI = 1.0-2.4) as those in the lowest quartile (≤127.53 mg/L), had 0.2 more delirium days (P delirium (4.5 CAM-S points higher, P delirium incidence, duration, and feature severity. CRP may be useful to identify individuals who are at risk of developing delirium. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  6. Assessment of cardiac risk before non-cardiac surgery: brain natriuretic peptide in 1590 patients.

    Science.gov (United States)

    Dernellis, J; Panaretou, M

    2006-11-01

    To evaluate the predictive value of brain natriuretic peptide (BNP) for assessment of cardiac risk before non-cardiac surgery. Consecutively treated patients (947 men, 643 women) whose BNP was measured before non-cardiac surgery were studied. Clinical and ECG variables were evaluated to identify predictors of postoperative cardiac events. Events occurred in 6% of patients: 21 cardiac deaths, 20 non-fatal myocardial infarctions, 41 episodes of pulmonary oedema and 14 patients with ventricular tachycardia. All of these patients had raised plasma BNP concentrations (best cut-off point 189 pg/ml). The only independent predictor of postoperative events was BNP (odds ratio 34.52, 95% confidence interval (CI) 17.08 to 68.62, p 300 pg/ml); postoperative event rates were 0%, 5%, 12% and 81%, respectively. In this population of patients evaluated before non-cardiac surgery, BNP is an independent predictor of postoperative cardiac events. BNP > 189 pg/ml identified patients at highest risk.

  7. The usefulness of myocardial SPECT for the preoperative cardiac risk evaluation in noncardiac surgery

    International Nuclear Information System (INIS)

    Lim, Seok Tae; Lee, Dong Soo; Kang, Won Jon; Chung, June Key; Lee, Myung Chul

    1999-01-01

    We investigated whether myocardial SPECT had additional usefulness to clinical, functional or surgical indices for the preoperative evaluation of cardiac risks in noncardiac surgery. 118 patients ( M: F=66: 52, 62.7±10.5 years) were studied retrospectively. Eighteen underwent vascular surgeries and 100 nonvascular surgeries. Rest Tl-201/ stress Tc-99m-MIBI SPECT was performed before operation and cardiac events (hard event: cardiac death and myocardial infarction; soft event: ischemic ECG change, congestive heat failure and unstable angina) were surveyed through perioperative periods (14.6±5.6 days). Clinical risk indices, functional capacity, surgery procedures and SPECT findings were tested for their predictive values of perioperative cardiac events. Peri-operative cardiac events occurred in 25 patients (3 hard events and 22 soft events). Clinical risk indices, surgical procedure risks and SPECT findings but functional capacity were predictive of cardiac events. Reversible perfusion decrease was a better predictor than persistent decrease. Multivariate analysis sorted out surgical procedure risk (p=0.0018) and SPECT findings (p=0.0001) as significant risk factors. SPECT could re-stratify perioperative cardiac risks in patients ranked with surgical procedures. We conclude that myocardial SPECT provides additional predictive value to surgical type risks as well as clinical indexes or functional capacity for the prediction of preoperative cardiac events in noncardiac surgery

  8. Predictors, Prognosis, and Management of New Clinically Important Atrial Fibrillation After Noncardiac Surgery: A Prospective Cohort Study.

    Science.gov (United States)

    Alonso-Coello, Pablo; Cook, Deborah; Xu, Shou Chun; Sigamani, Alben; Berwanger, Otavio; Sivakumaran, Soori; Yang, Homer; Xavier, Denis; Martinez, Luz Ximena; Ibarra, Pedro; Rao-Melacini, Purnima; Pogue, Janice; Zarnke, Kelly; Paniagua, Pilar; Ostrander, Jack; Yusuf, Salim; Devereaux, P J

    2017-07-01

    Despite the frequency of new clinically important atrial fibrillation (AF) after noncardiac surgery and its increased association with the risk of stroke at 30 days, there are limited data informing their prediction, association with outcomes, and management. We used the data from the PeriOperative ISchemic Evaluation trial to determine, in patients undergoing noncardiac surgery, the association of new clinically important AF with 30-day outcomes, and to assess management of these patients. We also aimed to derive a clinical prediction rule for new clinically important AF in this population. We defined new clinically important AF as new AF that resulted in symptoms or required treatment. We recorded an electrocardiogram 6 to 12 hours postoperatively and on the 1st, 2nd, and 30th days after surgery. A total of 211 (2.5% [8351 patients]; 95% confidence interval, 2.2%-2.9%) patients developed new clinically important AF within 30 days of randomization (8140 did not develop new AF). AF was independently associated with an increased length of hospital stay by 6.0 days (95% confidence interval, 3.5-8.5 days) and vascular complications (eg, stroke or congestive heart failure). The usage of an oral anticoagulant at the time of hospital discharge among patients with new AF and a CHADS2 score of 0, 1, 2, 3, and ≥4 was 6.9%, 10.2%, 23.0%, 9.4%, and 33.3%, respectively. Two independent predictors of patients developing new clinically important AF were identified (ie, age and surgery). The prediction rule included the following factors and assigned weights: age ≥85 years (4 points), age 75 to 84 years (3 points), age 65 to 74 years (2 points), intrathoracic surgery (3 points), major vascular surgery (2 points), and intra-abdominal surgery (1 point). The incidence of new AF based on scores of 0 to 1, 2, 3 to 4, and 5 to 6 was 0.5%, 1.0%, 3.1%, and 5.3%, respectively. Age and surgery are independent predictors of new clinically important AF in the perioperative setting. A

  9. Who is at increased risk for acute kidney injury following noncardiac surgery?

    Science.gov (United States)

    Murray, Patrick

    2009-01-01

    Abelha and colleagues evaluated the incidence and determinants of postoperative acute kidney injury (AKI) after major noncardiac surgery in patients with previously normal renal function. In this retrospective study of 1,166 patients with no previous renal insufficiency, who were admitted to a postsurgical intensive care unit (ICU) over a 2-year period, the incidence of AKI was 7.5%. Multivariate analysis identified American Society of Anesthesiologists physical status, Revised Cardiac Risk Index, high-risk surgery and congestive heart disease as preoperative AKI risk factors. AKI was an independent risk factor for hospital mortality (odds ratio = 3.12, 95% confidence interval = 1.41 to 6.93; P = 0.005), and was associated with higher severity of illness scores (Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation II), longer ICU length of stay, higher ICU mortality, increased hospital mortality and higher mortality at 6-month follow up. Although the study design excluded 121 patients with significant preoperative renal insufficiency by design, the relatively crude serum creatinine cut-offs used certainly permitted inclusion of numerous patients with preoperative renal impairment. Accordingly, the study design failed to quantify the impact of preoperative renal impairment on risk and outcomes of perioperative AKI in noncardiac surgery, and this should be a goal of such studies in the future. Nonetheless, the study is an important addition to the literature in an under-studied population of patients at high risk for AKI.

  10. Beta-blocker subtype and risks of perioperative adverse events following non-cardiac surgery

    DEFF Research Database (Denmark)

    Jørgensen, Mads E.; Sanders, Robert D.; Køber, Lars

    2017-01-01

    Aims Beta-blockers vary in pharmacodynamics and pharmacokinetic properties. It is unknown whether specific types are associated with increased perioperative risks. We evaluated perioperative risks associated with beta-blocker subtypes, overall and in patient subgroups. Methods and results We...... performed a Danish Nationwide cohort study, 2005-2011, of patients treated chronically with beta blocker (atenolol, bisoprolol, carvedilol, metoprolol, propranolol, or other) prior to non-cardiac surgery. Risks of 30-day all-cause mortality (ACM) and 30-day major adverse cardiovascular events (MACE) were...... in analyses stratified by age, surgery priority, duration of anaesthesia or surgery risk (all P for interaction >0.05). Conclusion Risks of ACM and MACE did not systematically differ by beta-blocker subtype. Findings may guide clinical practice and future trials....

  11. Trends in the Management of Patients With Left Ventricular Assist Devices Presenting for Noncardiac Surgery: A 10-Year Institutional Experience.

    Science.gov (United States)

    Stone, Marc; Hinchey, Joseph; Sattler, Christopher; Evans, Adam

    2016-09-01

    In our institution, the vast majority of patients presenting for noncardiac surgery (NCS) while supported by a left ventricular assist device (LVAD) are now cared for by noncardiac-trained anesthesiologists as the result of a decade of educational intervention to effect this transition. This represents a significant departure from the published experiences of other institutions. With institutional review board approval, we queried the database of our anesthesia record keeping system (CompuRecord) to determine various aspects of the perioperative management of these patients from July 1, 2003, through June 30, 2013, during which time 271 NCS procedures were performed on adult patients supported by LVADs. Over the entire study period (2003-2013), anesthetic care was provided by a cardiac anesthesiologist 47% of the time and by a noncardiac anesthesiologist 53% of the time. However, by the time period 2012-2013, 88% of the NCS procedures were staffed by a noncardiac anesthesiologist. Despite the prevalence of continuous flow devices in this series, the use of invasive blood pressure monitoring decreased dramatically by the later years of the study. Vasoactive and inotropic medications were rarely required intraoperatively. No intraoperative cardiac arrests, thromboembolic complications, or device malfunctions occurred. Our conclusion is that NCS procedures on LVAD-supported patients can be safely managed by educated noncardiac anesthesiologists. © The Author(s) 2015.

  12. Anaesthetic management of patients with congenital heart disease presenting for non-cardiac surgery.

    Directory of Open Access Journals (Sweden)

    Mohindra R

    2002-01-01

    Full Text Available The incidence of congenital heart disease is about one percent of all live births in the United States. Treatment is being performed at a younger age and these children are showing improved survival. It is not unusual for children with congenital heart disease to present for non-cardiac surgery. Their management depends on their age, type of lesion, extent of corrective procedure, the presence of complications and other congenital anomalies. Each patient needs a detailed pre-operative evaluation to understand the abnormal anatomy and physiology, and related anaesthetic implications. No anaesthetic agent is an absolute contraindication, although drugs beneficial for one lesion may be detrimental for another. Regional anaesthesia has also been safely used in children with congenital heart disease. However the anaesthesiologist must have a detailed understanding of the pathophysiology of the lesion and the pharmacology of drugs being used to be able to provide safe anaesthesia for children with congenital heart disease.

  13. Interarm systolic blood pressure difference is associated with myocardial injury after noncardiac surgery.

    Science.gov (United States)

    Belen, Erdal; Ozal, Ender; Bayyigit, Akif; Gunaydın, Senay; Helvacı, Aysen

    Myocardial injury after non-cardiac surgery (MINS) is closely related to increased cardiovascular mortality. To evaluate the relationship between MINS and interarm systolic blood pressure difference (IASBPD), which has previously been shown to correlate with the frequency of cardiovascular events and arterial arteriosclerotic processes. This observational, single-centre cohort study included 240 consecutive noncardiac surgery patients aged ≥ 45 years. Simultaneous blood pressure recordings were taken preoperatively and IASBPD was calculated. Patients' electrocardiography recordings and high sensitivity cardiac troponin T (hscTnT) levels were obtained for a period of three days postoperatively. Postoperatively, 27 (11.3%) patients were found to have MINS when hscTnT ≥ 14 ng/L was taken as a cut-off value. IASBPD > 10 mm Hg was found in 44 (18.3%) patients. When IASBPD was accepted to be a continuous variable, there was a higher IASBPD value in the MINS group (9.4 ± 5.0 vs. 4.5 ± 3.8, p 10 mm Hg and those not, exaggerate IASBPD was found to be more frequent in patients developing MINS (16 [59.3%] vs. 28 [13.1%], respectively, p 10 mm Hg to be independently associated with the development of MINS (OR: 30.82; CI: 9.14-103.98; p AUC = 0.79; 95% CI 0.71-0.87). Increased IASBPD is closely related to development of MINS. The preoperative measurement of blood pressure from both arms may be an important and easy to use clinical tool in determining cardiovascular risk.

  14. Williams Syndrome and Anesthesia for Non-cardiac Surgery: High Risk Can Be Mitigated with Appropriate Planning.

    Science.gov (United States)

    Brown, Morgan L; Nasr, Viviane G; Toohey, Rebecca; DiNardo, James A

    2018-03-23

    Patients with Williams syndrome are considered at high risk for anesthesia-related adverse events. At our institution, all William syndrome patients undergoing cardiac surgical, cardiac catheterization/interventional procedures, and cardiac imaging studies are cared for by cardiac anesthesiologists. All William syndrome patients undergoing non-cardiac surgical, interventional, or imaging studies are cared for by main operating room pediatric anesthesiologists with consultative input from a cardiac anesthesiologist. We reviewed our experience with 75 patients undergoing 202 separate anesthetics for 95 non-cardiac procedures and 107 cardiac procedures from 2012 to 2016. The mean age was 7.5 ± 7.0 years and the mean weight was 22.3 ± 17.0 kg. One hundred and eighty-seven patients had a general anesthetic (92.6%). Medications used included etomidate in 26.2%, propofol in 37.6%, isoflurane in 47.5%, and sevoflurane in 68.3%. Vasopressors and inotropes were required including calcium (22.8%), dopamine (10.4%), norepinephrine (17.3%), phenylephrine (35.1%), vasopressin (0.5%), and ephedrine (5.4%). The median length of stay after anesthesia was 2.8 days (range 0-32). No adverse events occurred in 89.6% of anesthetics. There were two cases of cardiac arrest, one of which required extracorporeal life support for resuscitation. Of the non-cardiac surgical procedures, 95.7% did not have a cardiovascular adverse event. Patients with Williams syndrome are at high risk for anesthesia, especially when undergoing cardiac procedures. The risk can be mitigated with appropriate planning and adherence to the hemodynamic goals for non-cardiac surgical procedures.

  15. [Severity of disease scoring systems and mortality after non-cardiac surgery].

    Science.gov (United States)

    Reis, Pedro Videira; Sousa, Gabriela; Lopes, Ana Martins; Costa, Ana Vera; Santos, Alice; Abelha, Fernando José

    2018-04-05

    Mortality after surgery is frequent and severity of disease scoring systems are used for prediction. Our aim was to evaluate predictors for mortality after non-cardiac surgery. Adult patients admitted at our surgical intensive care unit between January 2006 and July 2013 was included. Univariate analysis was carried using Mann-Whitney, Chi-square or Fisher's exact test. Logistic regression was performed to assess independent factors with calculation of odds ratio and 95% confidence interval (95% CI). 4398 patients were included. Mortality was 1.4% in surgical intensive care unit and 7.4% during hospital stay. Independent predictors of mortality in surgical intensive care unit were APACHE II (OR=1.24); emergent surgery (OR=4.10), serum sodium (OR=1.06) and FiO 2 at admission (OR=14.31). Serum bicarbonate at admission (OR=0.89) was considered a protective factor. Independent predictors of hospital mortality were age (OR=1.02), APACHE II (OR=1.09), emergency surgery (OR=1.82), high-risk surgery (OR=1.61), FiO 2 at admission (OR=1.02), postoperative acute renal failure (OR=1.96), heart rate (OR=1.01) and serum sodium (OR=1.04). Dying patients had higher scores in severity of disease scoring systems and longer surgical intensive care unit stay. Some factors influenced both surgical intensive care unit and hospital mortality. Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  16. Blood Transfusion and 30-Day Mortality in Patients With Coronary Artery Disease and Anemia Following Noncardiac Surgery.

    Science.gov (United States)

    Hollis, Robert H; Singletary, Brandon A; McMurtrie, James T; Graham, Laura A; Richman, Joshua S; Holcomb, Carla N; Itani, Kamal M; Maddox, Thomas M; Hawn, Mary T

    2016-02-01

    Although liberal blood transfusion thresholds have not been beneficial following noncardiac surgery, it is unclear whether higher thresholds are appropriate for patients who develop postoperative myocardial infarction (MI). To evaluate the association between postoperative blood transfusion and mortality in patients with coronary artery disease and postoperative MI following noncardiac surgery. Retrospective cohort study involving Veterans Affairs facilities from January 1, 2000, to December 31, 2012. A total of 7361 patients with coronary artery disease who underwent inpatient noncardiac surgery and had a nadir postoperative hematocrit between 20% and 30%. Patients with significant bleeding, including any preoperative blood transfusion or transfusion of greater than 4 units during the intraoperative or postoperative setting, were excluded. Mortality rates were compared using both logistic regression and propensity score matching. Patients were stratified by postoperative nadir hematocrit and the presence of postoperative MI. Initial postoperative blood transfusion. The 30-day postoperative mortality rate. Of the 7361 patients, 2027 patients (27.5%) received at least 1 postoperative blood transfusion. Postoperative mortality occurred in 267 (3.6%), and MI occurred in 271 (3.7%). Among the 5334 patients without postoperative blood transfusion, lower nadir hematocrit was associated with an increased risk for mortality (hematocrit of 20% to blood transfusion was associated with lower mortality, for those with hematocrit of 20% to 24% (odds ratio, 0.28; 95% CI, 0.13-0.64). In patients without postoperative MI, transfusion was associated with significantly higher mortality for those with hematocrit of 27% to 30% (odds ratio, 3.21; 95% CI, 1.85-5.60). These findings support a restrictive postoperative transfusion strategy in patients with stable coronary artery disease following noncardiac surgery. However, interventional studies are needed to evaluate the use of a more

  17. Utility of Ultraportable Echocardiography in the Preoperative Evaluation of Noncardiac Surgery.

    Science.gov (United States)

    Costa, Jean Allan; Almeida, Maria Lucia Pereira; Estrada, Tereza Cristina Duque; Werneck, Guilherme Lobosco; Rocha, Alexandre Marins; Rosa, Maria Luiza Garcia; Ribeiro, Mario Luiz; Mesquita, Claudio Tinoco

    2016-11-01

    The ultraportable echocardiogram machine, with relevant portability and easiness in performing diagnoses, when in experienced hands, may contribute to the reliability of preoperative evaluation in noncardiac surgeries. To assess cardiac function parameters in patients aged older than 60 years, candidates of elective noncardiac surgeries, classified as ASA1 or ASA 2 according to surgical risk. A total of 211 patients referred for elective surgeries, without suspicion of previous heart diseases, were included in the study. Assessment of patients was conducted by conventional echocardiogram using the ultraportable V Scan (GE) device right after the pre-anesthetic clinical evaluation. We assessed the clinical impact of echocardiography results by using a questionnaire addressed to the anesthetist. Mean age of patients was 68.9 ± 7.0 years, 154 were women. The most frequent surgeries were: a) facectomy - cataract - 18; b) inguinal hernia surgery - 18; c) Cholecystectomy - 16. We found 58 normal tests (27.5%), 70 (33.2%) with mild valve reflux, and 83 (39.3%) with relevant abnormality, such as increase in heart chamber size, global and/or segmental contractile dysfunction, significant valve dysfunction or other unspecified. Test results caused delay of surgical procedure for a more detailed cardiac evaluation in 20 (9.5%) patients, and change in anesthetic management in 7 (3.3%). There was a considerable clinical impact with the use of the ultraportable echocardiography, since one out of every ten patients evaluated had their clinical management changed due to the detection of previously unsuspected, significant heart diseases, with the potential for severe complications. O ecocardiógrafo ultraportátil, com importante mobilidade e facilidade diagnóstica em mãos experientes pode contribuir para a segurança na avaliação pré-operatória em cirurgias não cardíacas. Avaliar os parâmetros de função cardíaca nos pacientes com mais de 60 anos de idade, candidatos

  18. The Effect of Hypothyroidism on a Composite of Mortality, Cardiovascular and Wound Complications After Noncardiac Surgery: A Retrospective Cohort Analysis.

    Science.gov (United States)

    Komatsu, Ryu; You, Jing; Mascha, Edward J; Sessler, Daniel I; Kasuya, Yusuke; Turan, Alparslan

    2015-09-01

    We tested the hypothesis that hypothyroidism, as defined by thyroid-stimulating hormone (TSH) concentration, is associated with a severity-weighted composite of mortality and major cardiovascular and infectious complications after noncardiac surgery. In this retrospective cohort study, we evaluated adults at the Cleveland Clinic Main Campus between 2005 and 2012, who had had available TSH concentrations within the 6 months before noncardiac surgery. Patients were categorized as (1) hypothyroid (patients who had diagnosis of hypothyroidism any time prior to surgery and increased TSH value (> 5.5 mIU/L) within 6 months prior to surgery); (2) treated (hypothyroid diagnosis and normal TSH concentrations [0.4-5.5 mIU/L]); and (3) euthyroid (no hypothyroid diagnosis and normal TSH concentrations). We conducted pairwise comparisons among the 3 groups using inverse propensity score weighting to control for observed confounding variables. Average relative effect generalized estimating equation model was used for the primary outcome composite of in-hospital cardiovascular morbidity, surgical wound complication or infection, and mortality. Logistic regression and Cox proportional hazards regression were used for secondary outcomes of intraoperative vasopressor use and duration of hospitalization, respectively. We identified 800 hypothyroid patients (median TSH: 8.6 mIU/L [Q1, Q3: 6.5, 13.0]), 1805 treated patients (2.0 mIU/L [1.1, 3.2]), and 5612 euthyroid patients (1.7 mIU/L [1.1, 2.6]). There were no significant differences among the hypothyroid, treated, and euthyroid patients on the primary composite outcome (all P values ≥0.30). Hypothyroid patients were slightly more likely to receive vasopressor during surgery than either treated (odds ratio, 1.17; 99.2% confidence interval [CI], 1.01-1.36) or euthyroid (odds ratio, 1.12; 99.2% CI, 1.02-1.24) patients. Furthermore, hypothyroid patients were slightly but significantly less likely to be discharged at any given

  19. Preoperative B-type natriuretic peptides in patients undergoing ...

    African Journals Online (AJOL)

    Southern African Journal of Anaesthesia and Analgesia ... Preoperative B-type natriuretic peptides in patients undergoing noncardiac surgery: a cumulative ... Future investigation should focus on the clinical implications of these data and the ...

  20. Systematic review of near-infrared spectroscopy determined cerebral oxygenation during non-cardiac surgery

    DEFF Research Database (Denmark)

    Nielsen, Henning B

    2014-01-01

    and number of patients included were recorded. There was included 113 articles and evidence suggests that rScO2 is reduced during thoracic surgery involving single lung ventilation, major abdominal surgery, hip surgery, and laparoscopic surgery with the patient placed in anti-Tredelenburg's position....... Shoulder arthroscopy in the beach chair and carotid endarterectomy with clamped internal carotid artery (ICA) also cause pronounced cerebral desaturation. A >20% reduction in rScO2 coincides with indices of regional and global cerebral ischemia during carotid endarterectomy. Following thoracic surgery...

  1. Constipation Risk in Patients Undergoing Abdominal Surgery

    Science.gov (United States)

    Celik, Sevim; Atar, Nurdan Yalcin; Ozturk, Nilgun; Mendes, Guler; Kuytak, Figen; Bakar, Esra; Dalgiran, Duygu; Ergin, Sumeyra

    2015-01-01

    Background: Problems regarding bowel elimination are quite common in patients undergoing abdominal surgery. Objectives: To determine constipation risk before the surgery, bowel elimination during postoperative period, and the factors affecting bowel elimination. Patients and Methods: This is a cross-sectional study. It was conducted in a general surgery ward of a university hospital in Zonguldak, Turkey between January 2013 and May 2013. A total of 107 patients were included in the study, who were selected by convenience sampling. Constipation Risk Assessment Scale (CRAS), patient information form, medical and nursing records were used in the study. Results: The mean age of the patients was found to be 55.97 ± 15.74 (year). Most of the patients have undergone colon (37.4%) and stomach surgeries (21.5%). Open surgical intervention (83.2%) was performed on almost all patients (96.3%) under general anesthesia. Patients were at moderate risk for constipation with average scores of 11.71 before the surgery. A total of 77 patients (72%) did not have bowel elimination problem during postoperative period. The type of the surgery (P < 0.05), starting time for oral feeding after the surgery (P < 0.05), and mobilization (P < 0.05) were effective on postoperative bowel elimination. Conclusions: There is a risk for constipation after abdominal surgery. Postoperative practices are effective on the risk of constipation. PMID:26380107

  2. Hospital Blood Transfusion Patterns During Major Noncardiac Surgery and Surgical Mortality.

    Science.gov (United States)

    Chen, Alicia; Trivedi, Amal N; Jiang, Lan; Vezeridis, Michael; Henderson, William G; Wu, Wen-Chih

    2015-08-01

    We retrospectively examined intraoperative blood transfusion patterns at US veteran's hospitals through description of national patterns of intraoperative blood transfusion by indication for transfusion in the elderly; assessment of temporal trends in the use of intraoperative blood transfusion; and relationship of institutional use of intraoperative blood transfusion to hospital 30-day risk-adjusted postoperative mortality rates.Limited data exist on the pattern of intraoperative blood transfusion by indication for transfusion at the hospital level, and the relationship between intraoperative transfusion rates and institutional surgical outcomes.Using the Department of Veterans Affairs Surgical Quality Improvement Program database, we assigned 424,015 major noncardiac operations among elderly patients (≥65 years) in 117 veteran's hospitals, from 1997 to 2009, into groups based on indication for intraoperative blood transfusion according to literature and clinical guidelines. We then examined institutional variations and temporal trends in surgical blood use based on these indications, and the relationship between these institutional patterns of transfusion and 30-day postoperative mortality.Intraoperative transfusion occurred in 38,056/424,015 operations (9.0%). Among the 64,390 operations with an indication for transfusion, there was wide variation (median: 49.9%, range: 8.7%-76.2%) in hospital transfusion rates, a yearly decline in transfusion rates (average 1.0%/y), and an inverse relationship between hospital intraoperative transfusion rates and hospital 30-day risk-adjusted mortality (adjusted mortality of 9.8 ± 2.8% vs 8.3 ± 2.1% for lowest and highest tertiles of hospital transfusion rates, respectively, P = 0.02). In contrast, for the 225,782 operations with no indication for transfusion, there was little variation in hospital transfusion rates (median 0.7%, range: 0%-3.4%), no meaningful temporal change in transfusion (average 0.0%/y), and

  3. Axillary Temperature, as Recorded by the iThermonitor WT701, Well Represents Core Temperature in Adults Having Noncardiac Surgery.

    Science.gov (United States)

    Pei, Lijian; Huang, Yuguang; Mao, Guangmei; Sessler, Daniel I

    2018-03-01

    Core temperature can be accurately measured from the esophagus or nasopharynx during general anesthesia, but neither site is suitable for neuraxial anesthesia. We therefore determined the precision and accuracy of a novel wireless axillary thermometer, the iThermonitor, to determine its suitability for use during neuraxial anesthesia and in other patients who are not intubated. We enrolled 80 adults having upper abdominal surgery with endotracheal intubation. Intraoperative core temperature was measured in distal esophagus and was estimated at the axilla with a wireless iThermonitor WT701 (Raiing Medical, Boston MA) at 5-minute intervals. Pairs of axillary and reference distal esophageal temperatures were compared and summarized using linear regression and repeated-measured Bland-Altman methods. We a priori determined that the iThermonitor would have clinically acceptable accuracy if most estimates were within ±0.5°C of the esophageal reference, and suitable precision if the limits of agreement were within ±0.5°C. There were 3339 sets of paired temperatures. Axillary and esophageal temperatures were similar, with a mean difference (esophageal minus axillary) of only 0.14°C ± 0.26°C (standard deviation). The Bland-Altman 95% limits of agreement were reasonably narrow, with the estimated upper limit at 0.66°C and the lower limit at -0.38°C, thus ±0.52°C, indicating good agreement across the range of mean temperatures from 34.9°C to 38.1°C. The absolute difference was within 0.5°C in 91% of the measurements (95% confidence interval, 88%-93%). Axillary temperature, as recorded by the iThermonitor WT701, well represents core temperature in adults having noncardiac surgery and thus appears suitable for clinical use.

  4. Myocardial injury after non-cardiac surgery: Time to shed the ...

    African Journals Online (AJOL)

    A literature search on MINS in the perioperative period was conducted using MEDLINE ... of age and the need to spend a night in hospital following surgery, .... Table 4. Postoperative troponin surveillance recommendations from the Canadian.

  5. Myocardial injury after surgery is a risk factor for weaning failure from mechanical ventilation in critical patients undergoing major abdominal surgery.

    Directory of Open Access Journals (Sweden)

    Shu Li

    Full Text Available Myocardial injury after noncardiac surgery (MINS is a newly proposed concept that is common among adults undergoing noncardiac surgery and associated with substantial mortality. We analyzed whether MINS was a risk factor for weaning failure in critical patients who underwent major abdominal surgery.This retrospective study was conducted in the Department of Critical Care Medicine of Peking University People's Hospital. The subjects were all critically ill patients who underwent major abdominal surgery between January 2011 and December 2013. Clinical and laboratory parameters during the perioperative period were investigated. Backward stepwise regression analysis was performed to evaluate MINS relative to the rate of weaning failure. Age, hypertension, chronic renal disease, left ventricular ejection fraction before surgery, Acute Physiologic and Chronic Health Evaluation II score, pleural effusion, pneumonia, acute kidney injury, duration of mechanical ventilation before weaning and the level of albumin after surgery were treated as independent variables.This study included 381 patients, of whom 274 were successfully weaned. MINS was observed in 42.0% of the patients. The MINS incidence was significantly higher in patients who failed to be weaned compared to patients who were successfully weaned (56.1% versus 36.5%; P<0.001. Independent predictive factors of weaning failure were MINS, age, lower left ventricular ejection fraction before surgery and lower serum albumin level after surgery. The MINS odds ratio was 4.098 (95% confidence interval, 1.07 to 15.6; P = 0.04. The patients who were successfully weaned had shorter hospital stay lengths and a higher survival rate than those who failed to be weaned.MINS is a risk factor for weaning failure from mechanical ventilation in critical patients who have undergone major abdominal surgery, independent of age, lower left ventricular ejection fraction before surgery and lower serum albumin levels after

  6. Is perioperative beta-blockade effective and safe in patients undergoing noncardiac surgery?

    Directory of Open Access Journals (Sweden)

    Andrés Armstrong

    2016-12-01

    Full Text Available Resumen El betabloqueo en pacientes sometidos a cirugía no cardíaca ha sido ampliamente recomendado como una forma de disminuir los eventos adversos cardiovasculares durante el periodo perioperatorio. Sin embargo, los estudios han mostrado resultados discordantes. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en múltiples bases de datos, identificamos 22 revisiones sistemáticas que en conjunto incluyen 131 estudios, entre ellos 112 estudios aleatorizados. Extrajimos los datos, realizamos un metanálisis y preparamos tablas de resumen de los resultados utilizando el método GRADE. Concluimos que el uso perioperatorio de betabloqueadores en pacientes sometidos a cirugía no cardíaca, si bien probablemente disminuye el riesgo de infarto miocárdico, aumenta el riesgo de accidente cerebrovascular y la mortalidad total.

  7. Case series: Dexmedetomidine and ketamine for anesthesia in patients with uncorrected congenital cyanotic heart disease presenting for non-cardiac surgery

    Directory of Open Access Journals (Sweden)

    Rakhee Goyal

    2013-01-01

    Full Text Available The number of patients with uncorrected congenital cyanotic heart disease is less but at times some may present for non-cardiac surgery with a high anesthetic risk. Some of these may even be adults with compromised cardiopulmonary physiology posing greater challenges to the anesthesiologist. The authors have used a combination of dexmedetomidine and ketamine for anesthesia for non cardiac surgery in five patients with cyanotic heart disease and right to left shunt (3-Eisenmenger′s syndrome, 2-Tetralogy of Fallot. The sympathoinhibitory effects of dexmedetomidine were balanced with the cardiostimulatory effects of ketamine, thereby maintaining good cardiovascular stability. The analgesia was good and there was no postoperative agitation.This drug combination was effective and safe for patients with cyanotic heart disease for non cardiac surgeries.

  8. Alpha-2 adrenergic agonists for the prevention of cardiac complications among adults undergoing surgery.

    Science.gov (United States)

    Duncan, Dallas; Sankar, Ashwin; Beattie, W Scott; Wijeysundera, Duminda N

    2018-03-06

    The surgical stress response plays an important role on the pathogenesis of perioperative cardiac complications. Alpha-2 adrenergic agonists attenuate this response and may help prevent postoperative cardiac complications. To determine the efficacy and safety of α-2 adrenergic agonists for reducing mortality and cardiac complications in adults undergoing cardiac surgery and non-cardiac surgery. We searched CENTRAL (2017, Issue 4), MEDLINE (1950 to April Week 4, 2017), Embase (1980 to May 2017), the Science Citation Index, clinical trial registries, and reference lists of included articles. We included randomized controlled trials that compared α-2 adrenergic agonists (i.e. clonidine, dexmedetomidine or mivazerol) against placebo or non-α-2 adrenergic agonists. Included trials had to evaluate the efficacy and safety of α-2 adrenergic agonists for preventing perioperative mortality or cardiac complications (or both), or measure one or more relevant outcomes (i.e. death, myocardial infarction, heart failure, acute stroke, supraventricular tachyarrhythmia and myocardial ischaemia). Two authors independently assessed trial quality, extracted data and independently performed computer entry of abstracted data. We contacted study authors for additional information. Adverse event data were gathered from the trials. We evaluated included studies using the Cochrane 'Risk of bias' tool, and the quality of the evidence underlying pooled treatment effects using GRADE methodology. Given the clinical heterogeneity between cardiac and non-cardiac surgery, we analysed these subgroups separately. We expressed treatment effects as pooled risk ratios (RR) with 95% confidence intervals (CI). We included 47 trials with 17,039 participants. Of these studies, 24 trials only included participants undergoing cardiac surgery, 23 only included participants undergoing non-cardiac surgery and eight only included participants undergoing vascular surgery. The α-2 adrenergic agonist studied

  9. Plasma fibronectin in patients undergoing major surgery

    International Nuclear Information System (INIS)

    Sallam, M.H.M.

    2003-01-01

    Plasma fibronectin in patients undergoing major surgery had been determined before and after operation. The study was done on 15 patients and 15 normal healthy individuals. The study revealed that patients subjected to major operation, their fibronectin level was normal before operation followed by reduction one day post-operation. After one week, fibronectin level raised again nearly to the pre-operations levels. The probable mechanisms of fibronectin in healing processes were discussed. Fibronectin (FN) is a family of structurally and immunologically related high molecular weight glycoproteins that are present in many cell surfaces, in extracellular fluids, in connective tissues and in most membranes. Interaction with certain discrete extracellular substances, such as a glucosaminoglycans (e.g. heparin), fibrin and collagen and with cell surface structure seem to account for many of its biological activities, among which are regulation of adhesion, spreading and locomotion (Mosesson and amrani, 1980). The concentration of Fn in human plasma decreases after extensive destruction such as that occurs in major surgery, burns or other trauma. This decrease has been generally though to be due to increased consumption of soluble plasma Fn in opsonization of particulate and soluble debris from circulation by the reticuloendothelial (RE) system. Fn rapidly appears in injury areas, in experimentally induced blisters, wounded and epithelium tissues (Petersen et al., 1985). Fn accumulates at times of increased vascular permeability and it is produced by cell of blood vessels in response to injury

  10. Concomitant atrial fibrillation surgery for people undergoing cardiac surgery

    Science.gov (United States)

    Huffman, Mark D; Karmali, Kunal N; Berendsen, Mark A; Andrei, Adin-Cristian; Kruse, Jane; McCarthy, Patrick M; Malaisrie, S C

    2016-01-01

    Background People with atrial fibrillation (AF) often undergo cardiac surgery for other underlying reasons and are frequently offered concomitant AF surgery to reduce the frequency of short- and long-term AF and improve short- and long-term outcomes. Objectives To assess the effects of concomitant AF surgery among people with AF who are undergoing cardiac surgery on short-term and long-term (12 months or greater) health-related outcomes, health-related quality of life, and costs. Search methods Starting from the year when the first “maze” AF surgery was reported (1987), we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (March 2016), MEDLINE Ovid (March 2016), Embase Ovid (March 2016), Web of Science (March 2016), the Database of Abstracts of Reviews of Effects (DARE, April 2015), and Health Technology Assessment Database (HTA, March 2016). We searched trial registers in April 2016. We used no language restrictions. Selection criteria We included randomised controlled trials evaluating the effect of any concomitant AF surgery compared with no AF surgery among adults with preoperative AF, regardless of symptoms, who were undergoing cardiac surgery for another indication. Data collection and analysis Two review authors independently selected studies and extracted data. We evaluated the risk of bias using the Cochrane ‘Risk of bias’ tool. We included outcome data on all-cause and cardiovascular-specific mortality, freedom from atrial fibrillation, flutter, or tachycardia off antiarrhythmic medications, as measured by patient electrocardiographic monitoring greater than three months after the procedure, procedural safety, 30-day rehospitalisation, need for post-discharge direct current cardioversion, health-related quality of life, and direct costs. We calculated risk ratios (RR) for dichotomous data with 95% confidence intervals (CI) using a fixed-effect model when heterogeneity was low (I2 ≤ 50%) and random

  11. Do patients fear undergoing general anesthesia for oral surgery?

    Science.gov (United States)

    Elmore, Jasmine R; Priest, James H; Laskin, Daniel M

    2014-01-01

    Many patients undergoing major surgery have more fear of the general anesthesia than the procedure. This appears to be reversed with oral surgery. Therefore, patients need to be as well informed about this aspect as the surgical operation.

  12. The safety of addition of nitrous oxide to general anaesthesia in at-risk patients having major non-cardiac surgery (ENIGMA-II): a randomised, single-blind trial.

    Science.gov (United States)

    Myles, Paul S; Leslie, Kate; Chan, Matthew T V; Forbes, Andrew; Peyton, Philip J; Paech, Michael J; Beattie, W Scott; Sessler, Daniel I; Devereaux, P J; Silbert, Brendan; Schricker, Thomas; Wallace, Sophie

    2014-10-18

    Nitrous oxide is commonly used in general anaesthesia but concerns exist that it might increase perioperative cardiovascular risk. We aimed to gather evidence to establish whether nitrous oxide affects perioperative cardiovascular risk. We did an international, randomised, assessor-blinded trial in patients aged at least 45 years with known or suspected coronary artery disease having major non-cardiac surgery. Patients were randomly assigned via automated telephone service, stratified by site, to receive a general anaesthetic with or without nitrous oxide. Attending anaesthetists were aware of patients' group assignments, but patients and assessors were not. The primary outcome measure was a composite of death and cardiovascular complications (non-fatal myocardial infarction, stroke, pulmonary embolism, or cardiac arrest) within 30 days of surgery. Our modified intention-to-treat population included all patients randomly assigned to groups and undergoing induction of general anaesthesia for surgery. This trial is registered at ClinicalTrials.gov, number NCT00430989. Of 10,102 eligible patients, we enrolled 7112 patients between May 30, 2008, and Sept 28, 2013. 3543 were assigned to receive nitrous oxide and 3569 were assigned not to receive nitrous oxide. 3483 patients receiving nitrous oxide and 3509 not receiving nitrous oxide were assessed for the primary outcome. The primary outcome occurred in 283 (8%) patients receiving nitrous oxide and in 296 (8%) patients not receiving nitrous oxide (relative risk 0·96, 95% CI 0·83–1·12; p=0·64). Surgical site infection occurred in 321 (9%) patients assigned to nitrous oxide, and in 311 (9%) patients in the no-nitrous oxide group (p=0·61), and severe nausea and vomiting occurred in 506 patients (15%) assigned to nitrous oxide and 378 patients (11%) not assigned to nitrous oxide (pnitrous oxide use in major non-cardiac surgery. Nitrous oxide did not increase the risk of death and cardiovascular complications or

  13. Dynamic muscle O2 saturation response is impaired during major non-cardiac surgery despite goal-directed haemodynamic therapy.

    Science.gov (United States)

    Feldheiser, A; Hunsicker, O; Kaufner, L; Köhler, J; Sieglitz, H; Casans Francés, R; Wernecke, K-D; Sehouli, J; Spies, C

    2016-03-01

    Near-infrared spectroscopy combined with a vascular occlusion test (VOT) could indicate an impairment of microvascular reactivity (MVR) in septic patients by detecting changes in dynamic variables of muscle O2 saturation (StO2). However, in the perioperative context the consequences of surgical trauma on dynamic variables of muscle StO2 as indicators of MVR are still unknown. This study is a sub-analysis of a randomised controlled trial in patients with metastatic primary ovarian cancer undergoing debulking surgery, during which a goal-directed haemodynamic algorithm was applied using oesophageal Doppler. During a 3 min VOT, near-infrared spectroscopy was used to assess dynamic variables arising from changes in muscle StO2. At the beginning of surgery, values of desaturation and recovery slope were comparable to values obtained in healthy volunteers. During the course of surgery, both desaturation and recovery slope showed a gradual decrease. Concomitantly, the study population underwent a transition to a surgically induced systemic inflammatory response state shown by a gradual increase in norepinephrine administration, heart rate, and Interleukin-6, with a peak immediately after the end of surgery. Higher rates of norepinephrine and a higher heart rate were related to a faster decline in StO2 during vascular occlusion. Using near-infrared spectroscopy combined with a VOT during surgery showed a gradual deterioration of MVR in patients treated with optimal haemodynamic care. The deterioration of MVR was accompanied by the transition to a surgically induced systemic inflammatory response state. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Preoperative autologous plateletpheresis in patients undergoing open heart surgery.

    OpenAIRE

    Tomar Akhlesh; Tempe Deepak; Banerjee A; Hegde R; Cooper A; Khanna S

    2003-01-01

    Blood conservation is an important aspect of care provided to the patients undergoing cardiac operations with cardiopulmonary bypass (CPB). It is even more important in patients with anticipated prolonged CPB, redo cardiac surgery, patients having negative blood group and in patients undergoing emergency cardiac surgery. In prolonged CPB the blood is subjected to more destruction of important coagulation factors, in redo surgery the separation of adhesions leads to increased bleeding and diff...

  15. INTESTINAL MALROTATION IN PATIENTS UNDERGOING BARIATRIC SURGERY.

    Science.gov (United States)

    Vidal, Eduardo Arevalo; Rendon, Francisco Abarca; Zambrano, Trino Andrade; García, Yudoco Andrade; Viteri, Mario Ferrin; Campos, Josemberg Marins; Ramos, Manoela Galvão; Ramos, Almino Cardoso

    Intestinal malrotation is a rare congenital anomaly. In adults is very difficult to recognize due to the lack of symptoms. Diagnosis is usually incidental during surgical procedures or at autopsy. To review the occurrence and recognition of uneventful intestinal malrotation discovered during regular cases of bariatric surgeries. Were retrospectively reviewed the medical registry of 20,000 cases undergoing bariatric surgery, from January 2002 to January 2016, looking for the occurrence of intestinal malrotation and consequences in the intraoperative technique and immediate evolution of the patients. Five cases (0,025%) of intestinal malrotation were found. All of them were males, aging 45, 49, 37,52 and 39 years; BMI 35, 42, 49, 47 and 52 kg/m2, all of them with a past medical history of morbid obesity. The patient with BMI 35 kg/m2 suffered from type 2 diabetes also. All procedures were completed by laparoscopic approach, with no conversions. In one patient was not possible to move the jejunum to the upper abdomen in order to establish the gastrojejunostomy and a sleeve gastrectomy was performed. In another patient was not possible to fully recognize the anatomy due to bowel adhesions and a single anastomosis gastric bypass was preferred. No leaks or bleeding were identified. There were no perioperative complications. All patients were discharged 72 h after the procedure and no immediate 30-day complications were reported. Patients with malrotation can successfully undergo laparoscopic bariatric surgery. May be necessary changes in the surgical original strategy regarding the malrotation. Surgeons must check full abdominal anatomical condition prior to start the division of the stomach. Má-rotação intestinal é rara anomalia congênita em adultos de difícil reconhecimento devido à falta de sintomas. O diagnóstico é feito geralmente incidentalmente durante procedimentos cirúrgicos ou durante autópsia. Verificar a ocorrência e reconhecimento não eventual

  16. Cerebral monitoring during neonatal surgery for non-cardiac congenital anomalies: a first step to improve outcome?

    NARCIS (Netherlands)

    Stolwijk, L.J.

    2017-01-01

    Monitoring the newborn brain during surgery Cerebral monitoring in newborns, who require surgery in the first month of life, is important to protect the brain. The newborn brain is vulnerable during neonatal surgery. Newborn babies with a congenital anomaly requiring surgery in the first month of

  17. Goal directed fluid therapy decreases postoperative morbidity but not mortality in major non-cardiac surgery: a meta-analysis and trial sequential analysis of randomized controlled trials.

    Science.gov (United States)

    Som, Anirban; Maitra, Souvik; Bhattacharjee, Sulagna; Baidya, Dalim K

    2017-02-01

    Optimum perioperative fluid administration may improve postoperative outcome after major surgery. This meta-analysis and systematic review has been aimed to determine the effect of dynamic goal directed fluid therapy (GDFT) on postoperative morbidity and mortality in non-cardiac surgical patients. Meta-analysis of published prospective randomized controlled trials where GDFT based on non-invasive flow based hemodynamic measurement has been compared with a standard care. Data from 41 prospective randomized trials have been included in this study. Use of GDFT in major surgical patients does not decrease postoperative hospital/30-day mortality (OR 0.70, 95 % CI 0.46-1.08, p = 0.11) length of post-operative hospital stay (SMD -0.14; 95 % CI -0.28, 0.00; p = 0.05) and length of ICU stay (SMD -0.12; 95 % CI -0.28, 0.04; p = 0.14). However, number of patients having at least one postoperative complication is significantly lower with use of GDFT (OR 0.57; 95 % CI 0.43, 0.75; p infection (p = 0.002) and postoperative hypotension (p = 0.04) are also decreased with used of GDFT as opposed to a standard care. Though patients who received GDFT were infused more colloid (p infection, abdominal complications and postoperative hypotension is reduced.

  18. Clostridium difficile colitis in patients undergoing lumbar spine surgery.

    Science.gov (United States)

    Skovrlj, Branko; Guzman, Javier Z; Silvestre, Jason; Al Maaieh, Motasem; Qureshi, Sheeraz A

    2014-09-01

    Retrospective database analysis. To investigate incidence, comorbidities, and impact on health care resources of Clostridium difficile infection after lumbar spine surgery. C. difficile colitis is reportedly increasing in hospitalized patients and can have a negative impact on patient outcomes. No data exist on estimates of C. difficile infection rates and its consequences on patient outcomes and health care resources among patients undergoing lumbar spine surgery. The Nationwide Inpatient Sample was examined from 2002 to 2011. Patients were included for study based on International Classification of Diseases, Ninth Revision, Clinical Modification, procedural codes for lumbar spine surgery for degenerative diagnoses. Baseline patient characteristics were determined and multivariable analyses assessed factors associated with increased incidence of C. difficile and risk of mortality. The incidence of C. difficile infection in patients undergoing lumbar spine surgery is 0.11%. At baseline, patients infected with C. difficile were significantly older (65.4 yr vs. 58.9 yr, Pinfection. Small hospital size was associated with decreased odds (odds ratio [OR], 0.5; Pinfection. Uninsured (OR, 1.62; Pinfection. C. difficile increased hospital length of stay by 8 days (Pdifficile infection after lumbar spine surgery carries a 36.4-fold increase in mortality and costs approximately $10,658,646 per year to manage. These data suggest that great care should be taken to avoid C. difficile colitis in patients undergoing lumbar spine surgery because it is associated with longer hospital stays, greater overall costs, and increased inpatient mortality. 3.

  19. Medical Crowdfunding for Patients Undergoing Orthopedic Surgery.

    Science.gov (United States)

    Durand, Wesley M; Johnson, Joseph R; Eltorai, Adam E M; Daniels, Alan H

    2018-01-01

    Crowdfunding for medical expenses is growing in popularity. Through several websites, patients create public campaign profiles to which donors can contribute. Research on medical crowdfunding is limited, and there have been no studies of crowdfunding in orthopedics. Active medical crowdfunding campaigns for orthopedic trauma, total joint arthroplasty, and spine surgery were queried from a crowdfunding website. The characteristics and outcomes of crowdfunding campaigns were abstracted and analyzed. For this study, 444 campaigns were analyzed, raising a total of $1,443,528. Among the campaigns that received a donation, mean amount raised was $4414 (SE, $611). Multivariate analysis showed that campaigns with unspecified location (odds ratio, 0.26; P=.0008 vs West) and those for total joint arthroplasty (odds ratio, 0.35; P=.0003 vs trauma) had significantly lower odds of receipt of any donation. Description length was associated with higher odds of donation receipt (odds ratio, 1.13 per +100 characters; Pcrowdfunding may be disproportionately available to patients with specific diagnoses, those from specific regions, those who are able to craft a lengthy descriptive narrative, and those with access to robust digital social networks. Clinicians are likely to see a greater proportion of patients turning to crowdfunding as it grows in popularity. Patients may ask physicians for information about crowdfunding or request testimonials to support campaigns. Surgeons should consider their response to such requests individually. These findings shed light on the dynamics of medical crowdfunding and support robust personal and professional deliberation. [Orthopedics. 2018; 41(1):e58-e63.]. Copyright 2017, SLACK Incorporated.

  20. Risk of Adverse Cardiac and Bleeding Events Following Cardiac and Noncardiac Surgery in Patients With Coronary Stent: How Important Is the Interplay Between Stent Type and Time From Stenting to Surgery?

    Science.gov (United States)

    Saia, Francesco; Belotti, Laura Maria Beatrice; Guastaroba, Paolo; Berardini, Alessandra; Rossini, Roberta; Musumeci, Giuseppe; Tarantini, Giuseppe; Campo, Gianluca; Guiducci, Vincenzo; Tarantino, Fabio; Menozzi, Alberto; Varani, Elisabetta; Santarelli, Andrea; Tondi, Stefano; De Palma, Rossana; Rapezzi, Claudio; Marzocchi, Antonio

    2016-01-01

    Epidemiology and consequences of surgery in patients with coronary stents are not clearly defined, as well as the impact of different stent types in relationship with timing of surgery. Among 39 362 patients with previous coronary stenting enrolled in a multicenter prospective registry and followed for 5 years, 13 128 patients underwent 17 226 surgical procedures. The cumulative incidence of surgery at 30 days, 6 months, 1 year, and 5 years was 3.6%, 9.4%, 14.3%, and 40.0%, respectively, and of cardiac and noncardiac surgery was 0.8%, 2.1%, 2.6%, and 4.0% and 1.3%, 5.1%, 9.1%, and 31.7%, respectively. We assessed the incidence and the predictors of cardiac death, myocardial infarction, and serious bleeding event within 30 days from surgery. Cardiac death occurred in 438 patients (2.5%), myocardial infarction in 256 (1.5%), and serious bleeding event in 1099 (6.4%). Surgery increased 1.58× the risk of cardiac death during follow-up. Along with other risk factors, the interplay between stent type and time from percutaneous coronary intervention to surgery was independently associated with cardiac death/myocardial infarction. In comparison with bare-metal stent implanted >12 months before surgery, old-generation drug-eluting stent was associated with higher risk of events at any time point. Conversely, new-generation drug-eluting stent showed similar safety as bare-metal stent >12 months and between 6 and 12 months and appeared trendly safer between 0 and 6 months. Surgery is frequent in patients with coronary stents and carries a considerable risk of ischemic and bleeding events. Ischemic risk is inversely related with time from percutaneous coronary intervention to surgery and is influenced by stent type. © 2015 American Heart Association, Inc.

  1. Impact of multimodal preoperative preparation program on children undergoing surgery

    Directory of Open Access Journals (Sweden)

    Priya Reshma Aranha

    2017-01-01

    Full Text Available Background: The advanced era of technological development in child health care has resulted in more pediatric procedures being performed in various settings. Millions of children undergo surgery every year which is a stressful event. Many nonpharmacological strategies are being used to manage the preoperative fear and anxiety in children. The current study aims to assess the effectiveness of multimodal preoperative preparation program (MPPP on children undergoing surgery in terms of its effect on the psychophysiological parameters. Objective: The aim of this study is to assess the effectiveness of MPPP on the psychophysiological parameters of children undergoing surgery. Materials and Methods: A quasi-experimental study was conducted in a selected multi-specialty hospital. Using the purposive sampling technique, a total of 110 children aged 8–12 years were assigned to nonintervention (n = 55 and intervention (n = 55 groups, respectively. The MPPP was administered to the intervention group. The children in the nonintervention group received the routine preoperative care. Child's fear and anxiety was assessed on admission, prior to shifting the child to operation theater (OT, 24 and 48 h after surgery, whereas child's pulse, respiration, blood pressure (BP, and oxygen saturation was assessed on admission, prior to shifting the child to OT, 6, 12, 24, and 48 h after surgery and pain was assessed at 24 and 48 h after surgery. Results: The mean fear and anxiety scores of children were significantly lower in the intervention group than that of nonintervention group (P 0.05. This study also found that there is a significant association between the psychophysiological parameters of children with the selected demographic variables (P < 0.05. A positive correlation was found between the psychological and physiological parameters of children undergoing surgery. Conclusion: The MPPP is effective on psychophysiological parameters of children undergoing

  2. Troponin elevations after non-cardiac, non-vascular surgery are predictive of major adverse cardiac events and mortality

    DEFF Research Database (Denmark)

    Ekeloef, S; Alamili, M; Devereaux, P J

    2016-01-01

    -analysis was conducted in January 2016 according to the Meta-analysis Of Observational Studies in Epidemiology guidelines. Both interventional and observational studies measuring troponin within the first 4 days after surgery were eligible. A systematic search was performed in PubMed, EMBASE, Scopus, and the Cochrane...

  3. Cerebroprotective effect of piracetam in patients undergoing open heart surgery.

    Science.gov (United States)

    Holinski, Sebastian; Claus, Benjamin; Alaaraj, Nour; Dohmen, Pascal Maria; Neumann, Konrad; Uebelhack, Ralf; Konertz, Wolfgang

    2011-01-01

    Reduction of cognitive function is a possible side effect after the use of cardiopulmonary bypass (CPB) during cardiac surgery. Since it has been proven that piracetam is cerebroprotective in patients undergoing coronary bypass surgery, we investigated the effects of piracetam on the cognitive performance of patients undergoing open heart surgery. Patients scheduled for elective open heart surgery were randomized to the piracetam or placebo group in a double-blind study. Patients received 12 g of piracetam or placebo at the beginning of the operation. Six neuropsychological subtests from the Syndrom Kurz Test and the Alzheimer's Disease Assessment Scale were performed preoperatively and on day 3, postoperatively. To assess the overall cognitive function and the degree of cognitive decline across all tests after the surgery, we combined the six test-scores by principal component analysis. A total of 88 patients with a mean age of 67 years were enrolled into the study. The mean duration of CPB was 110 minutes. Preoperative clinical parameters and overall cognitive functions were not significantly different between the groups. The postoperative combined score of the neuropsychological tests showed deterioration of cognitive function in both groups (piracetam: preoperative 0.19 ± 0.97 vs. postoperative -0.97 ± 1.38, p piracetam did not perform better than those taking placebo, and both groups had the same decline of overall cognitive function (p = 0.955). Piracetam had no cerebroprotective effect in patients undergoing open heart surgery. Unlike the patients who underwent coronary surgery, piracetam did not reduce the early postoperative decline of neuropsychological abilities in heart valve patients.

  4. Emotional state and coping style among gynecologic patients undergoing surgery.

    Science.gov (United States)

    Matsushita, Toshiko; Murata, Hinako; Matsushima, Eisuke; Sakata, Yu; Miyasaka, Naoyuki; Aso, Takeshi

    2007-02-01

    The aim of the present study was to investigate changes in emotional state and the relationship between emotional state and demographic/clinical factors and coping style among gynecologic patients undergoing surgery. Using the Japanese version of the Profile of Mood States (POMS), 90 patients (benign disease: 32, malignancy: 58) were examined on three occasions: before surgery, before discharge, and 3 months after discharge. They were also examined using the Coping Inventory for Stressful Situations (CISS) on one occasion before discharge. The scores for the subscales depression, anger, and confusion were the highest after discharge while those for anxiety were the highest before surgery. The average scores of the POMS subscales for all subjects were within the normal range. With regard to the relationship between these emotional states and other factors, multiple regressions showed that the principal determinants of anxiety before surgery were religious belief, psychological symptoms during hospitalization and emotion-oriented (E) coping style; further, it was found that depression after discharge could be explained by chemotherapy, duration of hospitalization, and E coping style. The principal determinants of anger after discharge and vigor before surgery were length of education and E coping style, and severity of disease, chemotherapy, E coping style and task-oriented coping style, respectively. Those of post-discharge fatigue and confusion were length of education, psychological symptoms, and E coping style. In summary it is suggested that the following should be taken into account in patients undergoing gynecologic surgery: anxiety before surgery, depression, anger, and confusion after surgery, including coping styles.

  5. Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery.

    Science.gov (United States)

    Myles, Paul S; Smith, Julian A; Forbes, Andrew; Silbert, Brendan; Jayarajah, Mohandas; Painter, Thomas; Cooper, D James; Marasco, Silvana; McNeil, John; Bussières, Jean S; McGuinness, Shay; Byrne, Kelly; Chan, Matthew T V; Landoni, Giovanni; Wallace, Sophie

    2017-01-12

    Tranexamic acid reduces the risk of bleeding among patients undergoing cardiac surgery, but it is unclear whether this leads to improved outcomes. Furthermore, there are concerns that tranexamic acid may have prothrombotic and proconvulsant effects. In a trial with a 2-by-2 factorial design, we randomly assigned patients who were scheduled to undergo coronary-artery surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary outcome was a composite of death and thrombotic complications (nonfatal myocardial infarction, stroke, pulmonary embolism, renal failure, or bowel infarction) within 30 days after surgery. Of the 4662 patients who were enrolled and provided consent, 4631 underwent surgery and had available outcomes data; 2311 were assigned to the tranexamic acid group and 2320 to the placebo group. A primary outcome event occurred in 386 patients (16.7%) in the tranexamic acid group and in 420 patients (18.1%) in the placebo group (relative risk, 0.92; 95% confidence interval, 0.81 to 1.05; P=0.22). The total number of units of blood products that were transfused during hospitalization was 4331 in the tranexamic acid group and 7994 in the placebo group (Ptranexamic acid group and in 2.8% of the patients in the placebo group (P=0.001), and seizures occurred in 0.7% and 0.1%, respectively (P=0.002 by Fisher's exact test). Among patients undergoing coronary-artery surgery, tranexamic acid was associated with a lower risk of bleeding than was placebo, without a higher risk of death or thrombotic complications within 30 days after surgery. Tranexamic acid was associated with a higher risk of postoperative seizures. (Funded by the Australian National Health and Medical Research Council and others; ATACAS Australia New Zealand Clinical Trials Registry number, ACTRN12605000557639 .).

  6. Time Elapsed After Ischemic Stroke and Risk of Adverse Cardiovascular Events and Mortality Following Elective Noncardiac Surgery

    DEFF Research Database (Denmark)

    Jørgensen, Mads E; Torp-Pedersen, Christian; Gislason, Gunnar H

    2014-01-01

     = 7137) and without (n = 474,046) prior stroke were 54.4 (95% CI, 49.1-59.9) vs 4.1 (95% CI, 3.9-4.2) per 1000 patients. Compared with patients without stroke, ORs for MACE were 14.23 (95% CI, 11.61-17.45) for stroke less than 3 months prior to surgery, 4.85 (95% CI, 3.32-7.08) for stroke 3 to less than...... dependency of risk may warrant attention in future guidelines....

  7. Age-specific performance of the revised cardiac risk index for predicting cardiovascular risk in elective noncardiac surgery

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Wissenberg, Mads; Jørgensen, Mads Emil

    2015-01-01

    , II, III, and IV. Multivariable odds ratio estimates were as follows: ischemic heart disease 3.30 (95% confidence interval, 2.96-3.69), high-risk surgery 2.70 (2.46-2.96), congestive heart failure 2.65 (2.29-3.06), cerebrovascular disease 10.02 (9.08-11.05), insulin therapy 1.62 (1.......37-1.93), and kidney disease 1.45 (1.33-1.59). Modeling RCRI classes as a continuous variable, C statistic was highest among age group 56 to 65 years (0.772) and lowest for those aged >85 years (0.683). Sensitivity of RCRI class >I (ie, having ≥ 1 risk factor) for capturing major adverse cardiovascular events was 59...

  8. Effect of intravenous paracetamol on postoperative morphine requirements in neonates and infants undergoing major noncardiac surgery: a randomized controlled trial

    NARCIS (Netherlands)

    Ceelie, Ilse; de Wildt, Saskia N.; van Dijk, Monique; van den Berg, Margreeth M. J.; van den Bosch, Gerbrich E.; Duivenvoorden, Hugo J.; de Leeuw, Tom G.; Mathôt, Ron; Knibbe, Catherijne A. J.; Tibboel, Dick

    2013-01-01

    Continuous morphine infusion as standard postoperative analgesic therapy in young infants is associated with unwanted adverse effects such as respiratory depression. To determine whether intravenous paracetamol (acetaminophen) would significantly (>30%) reduce morphine requirements in neonates and

  9. Prevalence of alcohol misuse among men and women undergoing major noncardiac surgery in the Veterans Affairs health care system

    DEFF Research Database (Denmark)

    Bradley, Katharine A; Rubinsky, Anna D; Sun, Haili

    2012-01-01

    Patients who screen positive for alcohol misuse on the Alcohol Use Disorder Identification Test Consumption Questionnaire (AUDIT-C ≥5 points) have significantly increased postoperative complications. Severe alcohol misuse (AUDIT-C ≥9 points) is associated with increased postoperative health care...

  10. Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery

    DEFF Research Database (Denmark)

    Bradley, Katharine A; Rubinsky, Anna D; Sun, Haili

    2011-01-01

    Patients who misuse alcohol are at increased risk for surgical complications. Four weeks of preoperative abstinence decreases the risk of complications, but practical approaches for early preoperative identification of alcohol misuse are needed....

  11. Pre- and/or Intra-Operative Prescription of Diuretics, but Not Renin-Angiotensin-System Inhibitors, Is Significantly Associated with Acute Kidney Injury after Non-Cardiac Surgery: A Retrospective Cohort Study.

    Science.gov (United States)

    Tagawa, Miho; Ogata, Ai; Hamano, Takayuki

    2015-01-01

    Pre- and/or intra-operative use of diuretics, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin II receptor blockers (ARB) constitutes a potentially modifiable risk factor for postoperative acute kidney injury (AKI). It has been studied whether use of these drugs predicts AKI after cardiac surgery. The objective of this study was to examine whether administration of these agents was independently associated with AKI after non-cardiac surgery. This was a retrospective observational study. Inclusion criteria were adult patients (age ≥ 18) who underwent non-cardiac surgery under general anesthesia from 2007 to 2009 at Kyoto Katsura Hospital. Exclusion criteria were urological surgery, missing creatinine values, and preoperative dialysis. The exposures of interest were pre- and/or intra-operative use of diuretics or ACE-I/ARB. Outcome variables were postoperative AKI as defined by the AKI Network (increase in creatinine ≥ 0.3 mg/dL or 150% within 48 hours, or urine output 6 hours). Multivariable logistic regression analyses were conducted and adjusted for potential confounders. Propensity scores (PS) for receiving diuretics or ACE-I/ARB therapy were estimated and PS adjustment, PS matching, and inverse probability weighting were performed. There were 137 AKI cases (5.0%) among 2,725 subjects. After statistical adjustment for patient and surgical characteristics, odds (95% CI) of postoperative AKI were 2.07 (1.10-3.89) (p = 0.02) and 0.89 (0.56-1.42) (p = 0.63) in users of diuretics and ACE-I/ARB, respectively, compared with non-users. PS adjustment, PS matching, and inverse probability weighting yielded similar results. The effect size of diuretics was significantly greater in the patients with lower propensity for diuretic use (p for interaction diuretics, but not ACE-I/ARB, was independently associated with postoperative AKI after non-cardiac surgery, especially in patients with low propensity for diuretic use. It might be reasonable to withhold

  12. Functional capacity and mental state of patients undergoing cardiac surgery

    Directory of Open Access Journals (Sweden)

    Bruna Corrêa

    Full Text Available Abstract Introduction: Cardiovascular diseases are a serious public health problem in Brazil. Myocardial revascularization surgery (MRS as well as cardiac valve replacement and repair are procedures indicated to treat them. Thus, extracorporeal circulation (ECC is still widely used in these surgeries, in which patients with long ECC times may have greater neurological deficits. Neurological damage resulting from MRS can have devastating consequences such as loss of independence and worsening of quality of life. Objective: To assess the effect of cardiac surgery on a patient’s mental state and functional capacity in both the pre- and postoperative periods. Methods: We conducted a cross-sectional study with convenience sampling of subjects undergoing MRS and valve replacement. Participants were administered the Mini-Mental State Exam (MMSE and the Duke Activity Status Index (DASI in the pre- and postoperative periods, as well as before their hospital discharge. Results: This study assessed nine patients (eight males aged 62.4 ± 6.3 years with a BMI of 29.5 ± 2.3 kg/m2. There was a significant decrease in DASI scores and VO2 from preoperative to postoperative status (p = 0.003 and p = 0.003, respectively. Conclusion: This study revealed a loss of cognitive and exercise capacity after cardiac surgery. A larger sample however is needed to consolidate these findings.

  13. Quantifying risk of transfusion in children undergoing spine surgery.

    Science.gov (United States)

    Vitale, Michael G; Levy, Douglas E; Park, Maxwell C; Choi, Hyunok; Choe, Julie C; Roye, David P

    2002-01-01

    The risks and costs of transfusion are a great concern in the area of pediatric spine surgery, because it is a blood-intensive procedure with a high risk for transfusion. Therefore, determining the predictors of transfusion in this patient population is an important first step and has the potential to improve upon the current approaches to reducing transfusion rates. In this study, we reveal several predictors of transfusion in a pediatric patient population undergoing spine surgery. In turn, we present a general rule of thumb ("rule of two's") for gauging transfusion risk, thus enhancing the surgeon's approach to avoiding transfusion in certain clinical scenarios. This study was conducted to determine the main factors of transfusion in a population of pediatric patients undergoing scoliosis surgery. The goal was to present an algorithm for quantifying the true risk of transfusion for various patient groups that would highlight patients "at high risk" for transfusion. This is especially important in light of the various risks associated with undergoing a transfusion, as well as the costs involved in maintaining and disposing of exogenous blood materials. This is a retrospective review of a group of children who underwent scoliosis surgery between 1988 and 1995 at an academic institution. A total of 290 patients were analyzed in this study, of which 63 were transfused and 227 were not. No outcomes measures were used in this study. A retrospective review of 290 patients presenting to our institution for scoliosis surgery was conducted, with a focus on socioclinical data related to transfusion risk. Univariate analysis and logistic regression were used to quantify the determinants of transfusion risk. Univariate analysis identified many factors that were associated with the risk of transfusion. However, it is clear that several of these factors are dependent on each other, obscuring the true issues driving transfusion need. We used multivariate analysis to control for

  14. Performance of PROMIS for Healthy Patients Undergoing Meniscal Surgery.

    Science.gov (United States)

    Hancock, Kyle J; Glass, Natalie; Anthony, Chris A; Hettrich, Carolyn M; Albright, John; Amendola, Annunziato; Wolf, Brian R; Bollier, Matthew

    2017-06-07

    The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed as an extensive question bank with multiple health domains that could be utilized for computerized adaptive testing (CAT). In the present study, we investigated the use of the PROMIS Physical Function CAT (PROMIS PF CAT) in an otherwise healthy population scheduled to undergo surgery for meniscal injury with the hypotheses that (1) the PROMIS PF CAT would correlate strongly with patient-reported outcome instruments that measure physical function and would not correlate strongly with those that measure other health domains, (2) there would be no ceiling effects, and (3) the test burden would be significantly less than that of the traditional measures. Patients scheduled to undergo meniscal surgery completed the PROMIS PF CAT, Knee injury and Osteoarthritis Outcome Score (KOOS), Marx Knee Activity Rating Scale, Short Form-36 (SF-36), and EuroQol-5 Dimension (EQ-5D) questionnaires. Correlations were defined as high (≥0.7), high-moderate (0.61 to 0.69), moderate (0.4 to 0.6), moderate-weak (0.31 to 0.39), or weak (≤0.3). If ≥15% respondents to a patient-reported outcome measure obtained the highest or lowest possible score, the instrument was determined to have a significant ceiling or floor effect. A total of 107 participants were analyzed. The PROMIS PF CAT had a high correlation with the SF-36 Physical Functioning (PF) (r = 0.82, p ceiling effects, with 0% of the participants achieving the lowest and highest score, respectively. The PROMIS PF CAT correlates strongly with currently used patient-reported outcome measures of physical function and demonstrates no ceiling effects for patients with meniscal injury requiring surgery. It may be a reasonable alternative to more burdensome patient-reported outcome measures.

  15. Preoperative autologous plateletpheresis in patients undergoing open heart surgery.

    Science.gov (United States)

    Tomar, Akhlesh S; Tempe, Deepak K; Banerjee, Amit; Hegde, Radhesh; Cooper, Andrea; Khanna, S K

    2003-07-01

    Blood conservation is an important aspect of care provided to the patients undergoing cardiac operations with cardiopulmonary bypass (CPB). It is even more important in patients with anticipated prolonged CPB, redo cardiac surgery, patients having negative blood group and in patients undergoing emergency cardiac surgery. In prolonged CPB the blood is subjected to more destruction of important coagulation factors, in redo surgery the separation of adhesions leads to increased bleeding and difficulty in achieving the haemostasis and in patients with negative blood group and emergency operations, the availability of sufficient blood can be a problem. Harvesting the autologous platelet rich plasma (PRP) can be a useful method of blood conservation in these patients. The above four categories of patients were prospectively studied, using either autologous whole blood donation or autologous platelet rich plasma (PRP) harvest in the immediate pre-bypass period. Forty two patients were included in the study and randomly divided into two equal groups of 21 each, control group (Group I) in which one unit of whole blood was withdrawn, and PRP group (Group II) where autologous plateletpheresis was utilised. After reversal of heparin, autologous whole blood was transfused in the control group and autologous PRP was transfused in the PRP group. The chest tube drainage and the requirement of homologous blood and blood products were recorded. Average PRP harvest was 643.33 +/- 133.51 mL in PRP group and the mean whole blood donation was 333.75 +/- 79.58 mL in the control group. Demographic, preoperative and intra operative data showed no statistically significant differences between the two groups. The PRP group patients drained 26.44% less (pblood products (pconservation in terms of better haemostasis, and less requirement of blood and blood products in the postoperative period as compared with the autologous whole blood donation. This technique can be especially useful in the

  16. Levosimendan in Patients with Left Ventricular Dysfunction Undergoing Cardiac Surgery.

    Science.gov (United States)

    Mehta, Rajendra H; Leimberger, Jeffrey D; van Diepen, Sean; Meza, James; Wang, Alice; Jankowich, Rachael; Harrison, Robert W; Hay, Douglas; Fremes, Stephen; Duncan, Andra; Soltesz, Edward G; Luber, John; Park, Soon; Argenziano, Michael; Murphy, Edward; Marcel, Randy; Kalavrouziotis, Dimitri; Nagpal, Dave; Bozinovski, John; Toller, Wolfgang; Heringlake, Matthias; Goodman, Shaun G; Levy, Jerrold H; Harrington, Robert A; Anstrom, Kevin J; Alexander, John H

    2017-05-25

    Levosimendan is an inotropic agent that has been shown in small studies to prevent or treat the low cardiac output syndrome after cardiac surgery. In a multicenter, randomized, placebo-controlled, phase 3 trial, we evaluated the efficacy and safety of levosimendan in patients with a left ventricular ejection fraction of 35% or less who were undergoing cardiac surgery with the use of cardiopulmonary bypass. Patients were randomly assigned to receive either intravenous levosimendan (at a dose of 0.2 μg per kilogram of body weight per minute for 1 hour, followed by a dose of 0.1 μg per kilogram per minute for 23 hours) or placebo, with the infusion started before surgery. The two primary end points were a four-component composite of death through day 30, renal-replacement therapy through day 30, perioperative myocardial infarction through day 5, or use of a mechanical cardiac assist device through day 5; and a two-component composite of death through day 30 or use of a mechanical cardiac assist device through day 5. A total of 882 patients underwent randomization, 849 of whom received levosimendan or placebo and were included in the modified intention-to-treat population. The four-component primary end point occurred in 105 of 428 patients (24.5%) assigned to receive levosimendan and in 103 of 421 (24.5%) assigned to receive placebo (adjusted odds ratio, 1.00; 99% confidence interval [CI], 0.66 to 1.54; P=0.98). The two-component primary end point occurred in 56 patients (13.1%) assigned to receive levosimendan and in 48 (11.4%) assigned to receive placebo (adjusted odds ratio, 1.18; 96% CI, 0.76 to 1.82; P=0.45). The rate of adverse events did not differ significantly between the two groups. Prophylactic levosimendan did not result in a rate of the short-term composite end point of death, renal-replacement therapy, perioperative myocardial infarction, or use of a mechanical cardiac assist device that was lower than the rate with placebo among patients with a

  17. Controlled invasive mechanical ventilation strategies in obese patients undergoing surgery.

    Science.gov (United States)

    Maia, Lígia de Albuquerque; Silva, Pedro Leme; Pelosi, Paolo; Rocco, Patricia Rieken Macedo

    2017-06-01

    The obesity prevalence is increasing in surgical population. As the number of obese surgical patients increases, so does the demand for mechanical ventilation. Nevertheless, ventilatory strategies in this population are challenging, since obesity results in pathophysiological changes in respiratory function. Areas covered: We reviewed the impact of obesity on respiratory system and the effects of controlled invasive mechanical ventilation strategies in obese patients undergoing surgery. To date, there is no consensus regarding the optimal invasive mechanical ventilation strategy for obese surgical patients, and no evidence that possible intraoperative beneficial effects on oxygenation and mechanics translate into better postoperative pulmonary function or improved outcomes. Expert commentary: Before determining the ideal intraoperative ventilation strategy, it is important to analyze the pathophysiology and comorbidities of each obese patient. Protective ventilation with low tidal volume, driving pressure, energy, and mechanical power should be employed during surgery; however, further studies are required to clarify the most effective ventilation strategies, such as the optimal positive end-expiratory pressure and whether recruitment maneuvers minimize lung injury. In this context, an ongoing trial of intraoperative ventilation in obese patients (PROBESE) should help determine the mechanical ventilation strategy that best improves clinical outcome in patients with body mass index≥35kg/m 2 .

  18. Preoperative autologous plateletpheresis in patients undergoing open heart surgery.

    Directory of Open Access Journals (Sweden)

    Tomar Akhlesh

    2003-01-01

    Full Text Available Blood conservation is an important aspect of care provided to the patients undergoing cardiac operations with cardiopulmonary bypass (CPB. It is even more important in patients with anticipated prolonged CPB, redo cardiac surgery, patients having negative blood group and in patients undergoing emergency cardiac surgery. In prolonged CPB the blood is subjected to more destruction of important coagulation factors, in redo surgery the separation of adhesions leads to increased bleeding and difficulty in achieving the haemostasis and in patients with negative blood group and emergency operations, the availability of sufficient blood can be a problem. Harvesting the autologous platelet rich plasma (PRP can be a useful method of blood conservation in these patients. The above four categories of patients were prospectively studied, using either autologous whole blood donation or autologous platelet rich plasma (PRP harvest in the immediate pre-bypass period. Forty two patients were included in the study and randomly divided into two equal groups of 21 each, control group (Group I in which one unit of whole blood was withdrawn, and PRP group (Group II where autologous plateletpheresis was utilised. After reversal of heparin, autologous whole blood was transfused in the control group and autologous PRP was transfused in the PRP group. The chest tube drainage and the requirement of homologous blood and blood products were recorded. Average PRP harvest was 643.33 +/- 133.51 mL in PRP group and the mean whole blood donation was 333.75 +/- 79.58 mL in the control group. Demographic, preoperative and intra operative data showed no statistically significant differences between the two groups. The PRP group patients drained 26.44% less (p<0.001 and required 38.5% less homologous blood and blood products (p<0.05, in the postoperative period. Haemoglobin levels on day zero (day of operation and day three were statistically not different between the two groups. We

  19. Red blood cell transfusion for people undergoing hip fracture surgery.

    Science.gov (United States)

    Brunskill, Susan J; Millette, Sarah L; Shokoohi, Ali; Pulford, E C; Doree, Carolyn; Murphy, Michael F; Stanworth, Simon

    2015-04-21

    The incidence of hip fracture is increasing and it is more common with increasing age. Surgery is used for almost all hip fractures. Blood loss occurs as a consequence of both the fracture and the surgery and thus red blood cell transfusion is frequently used. However, red blood cell transfusion is not without risks. Therefore, it is important to identify the evidence for the effective and safe use of red blood cell transfusion in people with hip fracture. To assess the effects (benefits and harms) of red blood cell transfusion in people undergoing surgery for hip fracture. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (31 October 2014), the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2014, Issue 10), MEDLINE (January 1946 to 20 November 2014), EMBASE (January 1974 to 20 November 2014), CINAHL (January 1982 to 20 November 2014), British Nursing Index Database (January 1992 to 20 November 2014), the Systematic Review Initiative's Transfusion Evidence Library, PubMed for e-publications, various other databases and ongoing trial registers. Randomised controlled trials comparing red blood cell transfusion versus no transfusion or an alternative to transfusion, different transfusion protocols or different transfusion thresholds in people undergoing surgery for hip fracture. Three review authors independently assessed each study's risk of bias and extracted data using a study-specific form. We pooled data where there was homogeneity in the trial comparisons and the timing of outcome measurement. We used GRADE criteria to assess the quality (low, moderate or high) of the evidence for each outcome. We included six trials (2722 participants): all compared two thresholds for red blood cell transfusion: a 'liberal' strategy to maintain a haemoglobin concentration of usually 10 g/dL versus a more 'restrictive' strategy based on symptoms of anaemia or a lower haemoglobin concentration, usually 8 g/dL. The exact

  20. Epidemiological evaluation of hepatic trauma victims undergoing surgery

    Directory of Open Access Journals (Sweden)

    Mitre Kalil

    Full Text Available Objective : to evaluate the epidemiological variables and diagnostic and therapeutic modalities related to hepatic trauma patients undergoing laparotomy in a public referral hospital in the metropolitan region of Vitória-ES. Methods : we conducted a retrospective study, reviewing charts of trauma patients with liver injuries, whether isolated or in association with other organs, who underwent exploratory laparotomy, from January 2011 to December 2013. Results : We studied 392 patients, 107 of these with liver injury. The male: female ratio was 6.6 : 1 and the mean age was 30.12 years. Penetrating liver trauma occurred in 78.5% of patients, mostly with firearms. Associated injuries occurred in 86% of cases and intra-abdominal injuries were more common in penetrating trauma (p <0.01. The most commonly used operative technique was hepatorrhaphy and damage control surgery was applied in 6.5% of patients. The average amounts of blood products used were 6.07 units of packed red blood cells and 3.01 units of fresh frozen plasma. The incidence of postoperative complications was 29.9%, the most frequent being infectious, including pneumonia, peritonitis and intra-abdominal abscess. The survival rate of patients suffering from blunt trauma was 60%, and penetrating trauma, 87.5% (p <0.05. Conclusion : despite technological advances in diagnosis and treatment, mortality rates in liver trauma remain high, especially in patients suffering from blunt trauma in relation to penetrating one.

  1. Cardiac effects of noncardiac neoplasms

    International Nuclear Information System (INIS)

    Schoen, F.J.; Berger, B.M.; Guerina, N.G.

    1984-01-01

    Clinically significant cardiovascular abnormalities may occur as secondary manifestations of noncardiac neoplasms. The principal cardiac effects of noncardiac tumors include the direct results of metastases to the heart or lungs, the indirect effects of circulating tumor products (causing nonbacterial thrombotic endocarditis, myeloma-associated amyloidosis, pheochromocytoma-associated cardiac hypertrophy and myofibrillar degeneration, and carcinoid heart disease), and the undesired cardiotoxicities of chemotherapy and radiotherapy. 89 references

  2. The efficacy of a smoking cessation programme in patients undergoing elective surgery - a randomised clinical trial

    DEFF Research Database (Denmark)

    Azodi, O. Sadr; Lindstrom, D.; Adami, J.

    2009-01-01

    It is known that smokers constitute an important risk group of patients undergoing surgery. It is unknown how smoking cessation intervention initiated 4 weeks prior to elective surgery affects the probability of permanent cessation. We randomly assigned 117 patients, scheduled to undergo elective...

  3. Impact of smoking on early clinical outcomes in patients undergoing coronary artery bypass grafting surgery

    OpenAIRE

    Ji, Qiang; Zhao, Hang; Mei, YunQing; Shi, YunQing; Ma, RunHua; Ding, WenJun

    2015-01-01

    Background To evaluate the impact of persistent smoking versus smoking cessation over one month prior to surgery on early clinical outcomes in Chinese patients undergoing isolated coronary artery bypass grafting (CABG) surgery in a retrospective study. Methods The peri-operative data of consecutive well-documented patients undergoing isolated CABG surgery from January 2007 to December 2013 were investigated and retrospectively analyzed. All included patients were divided into either a non-smo...

  4. Multidisciplinary perioperative protocol in patients undergoing acute high-risk abdominal surgery

    DEFF Research Database (Denmark)

    Tengberg, L. T.; Bay-Nielsen, M.; Bisgaard, T.

    2017-01-01

    Background: Acute high-risk abdominal (AHA) surgery carries a very high risk of morbidity and mortality and represents a massive healthcare burden. The aim of the present study was to evaluate the effect of a standardized multidisciplinary perioperative protocol in patients undergoing AHA surgery...... = 0·004). Conclusion: The introduction of a multidisciplinary perioperative protocol was associated with a significant reduction in postoperative mortality in patients undergoing AHA surgery. NCT01899885 (http://www.clinicaltrials.gov)....

  5. The prevalence of iron deficiency anaemia in patients undergoing bariatric surgery.

    Science.gov (United States)

    Khanbhai, M; Dubb, S; Patel, K; Ahmed, A; Richards, T

    2015-01-01

    As bariatric surgery rates continue to climb, anaemia will become an increasing concern. We assessed the prevalence of anaemia and length of hospital stay in patients undergoing bariatric surgery. Prospective data (anaemia [haemoglobin bariatric surgery. Results from a prospective database of 1530 patients undergoing elective general surgery were used as a baseline. Fifty-seven patients (14%) were anaemic pre-operatively, of which 98% were females. Median MCV (fL) and overall median ferritin (μg/L) was lower in anaemic patients (83 vs. 86, p=0.001) and (28 vs. 61, psurgery patients, prevalence of anaemia was similar (14% vs. 16%) but absolute iron deficiency was more common in those undergoing bariatric surgery; microcytosis pbariatric surgery. In bariatric patients with anaemia there was an overall increased length of hospital stay. Copyright © 2013 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

  6. Outcome of patients undergoing open heart surgery at the Uganda ...

    African Journals Online (AJOL)

    An approach in which open heart surgeries are conducted locally by visiting teams enabling skills transfer to the local team and helps build to build capacity has been adopted at the Uganda Heart Institute (UHI). Objectives: We reviewed the progress of open heart surgery at the UHI and evaluated the postoperative ...

  7. Perioperative glycemic control in diabetic patients undergoing coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Ehab A. Wahby

    2016-08-01

    Conclusion: Tight glycemic control improved perioperative outcome in diabetic CABG patients. Maintaining perioperative blood glucose level between 110 and 149 mg/dl is safe and should be recommended as a routine practice in diabetic patients undergoing CABG surgery.

  8. Perioperative volume replacement in children undergoing cardiac surgery: albumin versus hydroxyethyl starch 130/0.4

    NARCIS (Netherlands)

    Hanart, Christophe; Khalife, Maher; de Villé, Andrée; Otte, Florence; de Hert, Stefan; van der Linden, Philippe

    2009-01-01

    OBJECTIVE: To compare 4% albumin with 6% hydroxyethyl starch (HES) 130/0.4 in terms of perioperative blood loss and intraoperative fluid requirements in children undergoing cardiac surgery. DESIGN: Prospective randomized study. SETTING: Single University Hospital. PATIENTS: Pediatric patients

  9. Mycoplasma in urine and blood following catheterisation of patients undergoing vascular surgery

    DEFF Research Database (Denmark)

    Levi, N; Eiberg, J; Skov Jensen, J

    1997-01-01

    The purpose of this investigation was to determine if mycoplasmas enter the bloodstream after urinary tract catheterisation in patients undergoing vascular surgery in order to evaluate the efficiency of the routine prophylactic antibiotic treatment.......The purpose of this investigation was to determine if mycoplasmas enter the bloodstream after urinary tract catheterisation in patients undergoing vascular surgery in order to evaluate the efficiency of the routine prophylactic antibiotic treatment....

  10. Influences on decision-making for undergoing plastic surgery: a mental models and quantitative assessment.

    Science.gov (United States)

    Darisi, Tanya; Thorne, Sarah; Iacobelli, Carolyn

    2005-09-01

    Research was conducted to gain insight into potential clients' decisions to undergo plastic surgery, their perception of benefits and risks, their judgment of outcomes, and their selection of a plastic surgeon. Semistructured, open-ended interviews were conducted with 60 people who expressed interest in plastic surgery. Qualitative analysis revealed their "mental models" regarding influences on their decision to undergo plastic surgery and their choice of a surgeon. Interview results were used to design a Web-based survey in which 644 individuals considering plastic surgery responded. The desire for change was the most direct motivator to undergo plastic surgery. Improvements to physical well-being were related to emotional and social benefits. When prompted about risks, participants mentioned physical, emotional, and social risks. Surgeon selection was a critical influence on decisions to undergo plastic surgery. Participants gave considerable weight to personal consultation and believed that finding the "right" plastic surgeon would minimize potential risks. Findings from the Web-based survey were similar to the mental models interviews in terms of benefit ratings but differed in risk ratings and surgeon selection criteria. The mental models interviews revealed that interview participants were thoughtful about their decision to undergo plastic surgery and focused on finding the right plastic surgeon.

  11. More patients should undergo surgery after sigmoid volvulus.

    Science.gov (United States)

    Ifversen, Anne Kathrine Wewer; Kjaer, Daniel Willy

    2014-12-28

    To assess the outcome of patients treated conservatively vs surgically during their first admission for sigmoid volvulus. We conducted a retrospective study of 61 patients admitted to Aarhus University Hospital in Denmark between 1996 and 2011 for their first incidence of sigmoid volvulus. The condition was diagnosed by radiography, sigmoidoscopy or surgery. Patients treated with surgery underwent either a sigmoid resection or a percutaneous endoscopic colostomy (PEC). Conservatively treated patients were managed without surgery. Data was recorded into a Microsoft Access database and calculations were performed with Microsoft Excel. Kaplan-Meier plotting and Mantel-Cox (log-rank) testing were performed using GraphPad Prism software. Mortality was defined as death within 30 d after intervention or surgery. Among the total 61 patients, 4 underwent emergency surgery, 55 underwent endoscopy, 1 experienced resolution of the volvulus after contrast enema, and 1 died without treatment because of large bowel perforation. Following emergency treatment, 28 patients underwent sigmoid resection (semi-elective n = 18; elective n = 10). Two patients who were unfit for surgery underwent PEC and both died, 1 after 36 d and the other after 9 mo, respectively. The remaining 26 patients were managed conservatively without sigmoid resection. Patients treated conservatively on their first admission had a poorer survival rate than patients treated surgically on their first admission (95%CI: 3.67-14.37, P = 0.036). Sixty-three percent of the 26 conservatively treated patients had not experienced a recurrence 3 mo after treatment, but that number dropped to 24% 2 years after treatment. Eight of the 14 patients with recurrence after conservative treatment had surgery with no 30-d mortality. Surgically-treated sigmoid volvulus patients had a higher long-term survival rate than conservatively managed patients, indicating a benefit of surgical resection or PEC insertion if feasible.

  12. Prevention of venous thromboembolism in patients undergoing bariatric surgery

    Science.gov (United States)

    Bartlett, Matthew A; Mauck, Karen F; Daniels, Paul R

    2015-01-01

    Bariatric surgical procedures are now a common method of obesity treatment with established effectiveness. Venous thromboembolism (VTE) events, which include deep vein thrombosis and pulmonary embolism, are an important source of postoperative morbidity and mortality among bariatric surgery patients. Due to an understanding of the frequency and seriousness of these complications, bariatric surgery patients typically receive some method of VTE prophylaxis with lower extremity compression, pharmacologic prophylaxis, or both. However, the optimal approach in these patients is unclear, with multiple open questions. In particular, strategies of adjusted-dose heparins, postdischarge anticoagulant prophylaxis, and the role of vena cava filters have been evaluated, but only to a limited extent. In contrast to other types of operations, the literature regarding VTE prophylaxis in bariatric surgery is notable for a dearth of prospective, randomized clinical trials, and current professional guidelines reflect the uncertainties in this literature. Herein, we summarize the available evidence after systematic review of the literature regarding approaches to VTE prevention in bariatric surgery. Identification of risk factors for VTE in the bariatric surgery population, analysis of the effectiveness of methods used for prophylaxis, and an overview of published guidelines are presented. PMID:26316771

  13. Prior oral conditions in patients undergoing heart valve surgery.

    Science.gov (United States)

    Silvestre, Francisco-Javier; Gil-Raga, Irene; Martinez-Herrera, Mayte; Lauritano, Dorina; Silvestre-Rangil, Javier

    2017-11-01

    Patients scheduled for heart valve surgery should be free of any oral infectious disorders that might pose a risk in the postoperative period. Few studies have been made on the dental conditions of such patients prior to surgery. The present study describes the most frequent prior oral diseases in this population group. A prospective, observational case-control study was designed involving 60 patients (30 with heart valve disease and 30 controls, with a mean age of 71 years in both groups). A dental exploration was carried out, with calculation of the DMFT (decayed, missing and filled teeth) index and recording of the periodontal parameters (plaque index, gingival bleeding index, periodontal pocket depth, and attachment loss). The oral mucosa was also examined, and panoramic X-rays were used to identify possible intrabony lesions. Significant differences in bacterial plaque index were observed between the two groups ( p <0.05), with higher scores in the patients with valve disease. Probing depth and the presence of moderate pockets were also greater in the patients with valve disease than among the controls ( p <0.01). Sixty percent of the patients with valve disease presented periodontitis. Patients scheduled for heart valve surgery should be examined for possible active periodontitis before the operation. Those individuals found to have periodontal disease should receive adequate periodontal treatment before heart surgery. Key words: Valve disease, aortic, mitral, heart surgery, periodontitis.

  14. Predicting who will undergo surgery after physiotherapy for female stress urinary incontinence

    NARCIS (Netherlands)

    Labrie, J.; Lagro-Janssen, A.; Fischer, K.; Berghmans, L.C.; Vaart, C.H. van der

    2015-01-01

    INTRODUCTION AND HYPOTHESIS: To predict who will undergo midurethral sling surgery (surgery) after initial pelvic floor muscle training (physiotherapy) for stress urinary incontinence in women. METHODS: This was a cohort study including women with moderate to severe stress incontinence who were

  15. Predicting who will undergo surgery after physiotherapy for female stress urinary incontinence

    NARCIS (Netherlands)

    Labrie, J.; Lagro-Janssen, A. L. M.; Fischer, K.; Berghmans, L. C. M.; van der Vaart, C. H.

    To predict who will undergo midurethral sling surgery (surgery) after initial pelvic floor muscle training (physiotherapy) for stress urinary incontinence in women. This was a cohort study including women with moderate to severe stress incontinence who were allocated to the physiotherapy arm from a

  16. Comparison of fentanyl, sufentanil, and alfentanil anesthesia in patients undergoing valvular heart surgery

    NARCIS (Netherlands)

    Bovill, J. G.; Warren, P. J.; Schuller, J. L.; van Wezel, H. B.; Hoeneveld, M. H.

    1984-01-01

    The hemodynamic responses to anesthesia and surgery were studied in three groups of 20 patients undergoing valve replacement surgery. Anesthesia was induced with either fentanyl (75 micrograms/kg), sufentanil (15 micrograms/kg), or alfentanil (125 micrograms/kg). Pancuronium (8 mg) was given for

  17. Urinary apolipoprotein M as a biomarker of acute kidney injury in children undergoing heart surgery

    DEFF Research Database (Denmark)

    Svarrer, Eva Martha Madsen; Andersen, Henrik Ørbæk; Helvind, Morten

    2016-01-01

    AIM: To investigate whether apoM is excreted in urine of children undergoing heart surgery and the potential of apoM as early biomarker of acute kidney injury (AKI). MATERIALS & METHODS: Urine was collected in children undergoing heart surgery. ApoM was measured with ELISA. U-apoM was characterized.......018). Sensitivity was 0.71 and specificity was 0.68 at a cutoff level at 1.45 nmol/l. CONCLUSION: ApoM is excreted in the urine of children after cardiac surgery. Its potential as biomarker of AKI deserves exploration....

  18. The Inequity of Bariatric Surgery: Publicly Insured Patients Undergo Lower Rates of Bariatric Surgery with Worse Outcomes.

    Science.gov (United States)

    Hennings, Dietric L; Baimas-George, Maria; Al-Quarayshi, Zaid; Moore, Rachel; Kandil, Emad; DuCoin, Christopher G

    2018-01-01

    Bariatric surgery has been shown to be the most effective method of achieving weight loss and alleviating obesity-related comorbidities. Yet, it is not being used equitably. This study seeks to identify if there is a disparity in payer status of patients undergoing bariatric surgery and what factors are associated with this disparity. We performed a case-control analysis of National Inpatient Sample. We identified adults with body mass index (BMI) greater than or equal to 25 kg/m 2 who underwent bariatric surgery and matched them with overweight inpatient adult controls not undergoing surgery. The sample was analyzed using multivariate logistic regression. We identified 132,342 cases, in which the majority had private insurance (72.8%). Bariatric patients were significantly more likely to be privately insured than any other payer status; Medicare- and Medicaid-covered patients accounted for a low percentage of cases (Medicare 5.1%, OR 0.33, 95% CI 0.29-0.37, p bariatric surgery had an increased risk of complications compared to privately insured patients. Publicly insured patients are significantly less likely to undergo bariatric surgery. As a group, these patients experience higher rates of obesity and related complications and thus are most in need of bariatric surgery.

  19. Fear and anxiety in patients undergoing minor oral surgery | Saheeb ...

    African Journals Online (AJOL)

    Objective: This study was carried out to determine the causes of fear and anxiety in consecutive patients who attended the University of Benin Teaching Hospital for minor oral surgical treatment. Method: All consenting consecutive patients referred for minor oral surgery were studied. Information on all the patients was ...

  20. Study of problems with appendicitis in children undergoing laparoscopic surgery

    International Nuclear Information System (INIS)

    Kosumi, Takuya; Yonekura, Takeo; Yamauchi, Katsuji; Kuroda, Seika; Kimura, Takuya; Ihara, Yoshiyuki

    2011-01-01

    Seventy-one children who underwent laparoscopic appendectomy over the 8 years previous to the study were investigated. The patients were divided into 2 groups: those who had undergome surgery within 24 hours (EA group) and after conservative treatment (IA group). The condition of appendicitis on CT was classified into appendiceal mass (Group A), perforation (Group B), and non-perforation (Group C). Perioperative complications were mainly investigated in these groups. The EA group included 45 patients, and postoperative complications occurred in 2 of 12 patients in Group A (wound infection and intraperitoneal abscess in 1 each) and 2 of 14 patients in Group B (postoperative ileus and intraperitoneal abscess in 1 each). The IA group included 26 patients, and complications occurred only during conservative treatment in 2 of 7 patients in Group A (recurrence of inflammation and ileus in 1 each) and 2 of 2 patients in Group B (recurrence of inflammation and emergency surgery for the aggravation of symptoms in 1 each). No complication occurred in Group C of either the EA or IA group. Treatment was not switched to laparotomy in any patient in the EA or IA group, and no complication occurred during surgery. The total duration of hospitalization was shorter in the EA than in the IA group in all Groups A, B, and C. The risk of postoperative complications was high in the EA group, whereas complications during conservative treatment were problematic in the IA group. (author)

  1. Neurologic Outcomes in Very Preterm Infants Undergoing Surgery.

    LENUS (Irish Health Repository)

    2012-01-31

    OBJECTIVE: To investigate the relationship between surgery in very preterm infants and brain structure at term equivalent and 2-year neurodevelopmental outcome. STUDY DESIGN: A total of 227 infants born at <30 weeks gestation or at a birth weight of <1250 g were prospectively enrolled into a longitudinal observational cohort for magnetic resonance imaging and developmental follow-up. The infants were categorized retrospectively into either a nonsurgical group (n=178) or a surgical group (n=30). Nineteen infants were excluded because of incomplete or unsuitable data. The surgical and nonsurgical groups were compared in terms of clinical demographic data, white matter injury, and brain volume at term. Neurodevelopmental outcome was assessed at age 2 years. RESULTS: Compared with the nonsurgical group, the infants in the surgical group were smaller and more growth-restricted at birth, received more respiratory support and oxygen therapy, and had longer hospital stays. They also had smaller brain volumes, particularly smaller deep nuclear gray matter volumes. Infants who underwent bowel surgery had greater white matter injury. Mental Developmental Index scores were lower in the surgical group, whereas Psychomotor Developmental Index scores did not differ between the groups. The Mental Developmental Index difference became nonsignificant after adjustment for confounding variables. CONCLUSION: Preterm infants exposed to surgery and anesthesia had greater white matter injury and smaller total brain volumes, particularly smaller deep nuclear gray matter volumes. Surgical exposure in the preterm infant should alert the clinician to an increased risk for adverse cognitive outcome.

  2. Managing direct oral anticoagulants in patients undergoing dentoalveolar surgery.

    Science.gov (United States)

    Patel, J P; Woolcombe, S A; Patel, R K; Obisesan, O; Roberts, L N; Bryant, C; Arya, R

    2017-02-24

    Our objective was to describe our experience of managing a cohort of adult patients prescribed direct oral anticoagulants (DOACs) undergoing dentoalveolar procedures between November 2012 and May 2016. Prior to conducting a procedure a formal assessment was made of each patient's anticoagulation treatment. A specific plan was then formulated, balancing the risk of bleeding with the risk of thrombosis. Patients received a telephone consultation one week following treatment to assess any post-operative bleeding. Eighty-two patients underwent 111 oral surgical procedures, the majority of which were dental extractions. In the case of 35 (32%) procedures, advice was given to omit the DOAC, either before or after treatment. There was no bleeding following the majority of procedures. Persistent bleeding followed 15 (13.5%) procedures, of which 7 (6.3%) procedures required specific intervention. The majority of patients prescribed DOACs can undergo dentoalveolar procedures safely. Important considerations when planning treatment are: (i) when the patient usually takes their dose of DOAC, (ii) the time the procedure is performed and, (iii) when the DOAC is taken post-procedure. In our experience, if these factors are considered carefully, omission of DOAC doses is unlikely to be required for most patients.

  3. Cortisol levels and sleep patterns in infants with orofacial clefts undergoing surgery

    Directory of Open Access Journals (Sweden)

    Mueller AA

    2014-10-01

    Full Text Available Andreas A Mueller,1,2 Nadeem Kalak,3 Katja Schwenzer-Zimmerer,1,2 Edith Holsboer-Trachsler,3 Serge Brand3,4 1Craniomaxillofacial Surgery, University of Basel and University Hospital of Basel, Basel, Switzerland; 2Hightech Research Center of Craniomaxillofacial Surgery, University of Basel, Basel, Switzerland; 3Psychiatric Clinics of the University of Basel, Center for Affective, Stress, and Sleep Disorders, Basel, Switzerland; 4Department of Sport and Health Science, Division of Sport Science, University of Basel, Basel, Switzerland Background: Traumatic events during early infancy might damage infants’ psychobiological functioning, such as sleep and cortisol secretion. Infants born with orofacial clefts (OFCs undergo functional, anatomical, and aesthetic surgery. The aim of the present study was to determine whether infants with OFC and undergoing OFC surgery show deteriorated sleep and cortisol secretion compared with healthy controls and with their presurgery status.Methods: A total of 27 infants with OFC (mean age: 22 weeks and 30 healthy controls (mean age: 23 weeks took part in the study. For infants with OFC, sleep actigraphy was performed and saliva cortisol was analyzed 5 days before, during, and 5 days after surgery. For controls, sleep and saliva cortisol were assessed similarly, except for the period taken up with surgery.Results: Compared with healthy controls, infants with OFC undergoing OFC surgery did not differ in sleep and cortisol secretion. Their sleep and cortisol secretion did deteriorate during the perisurgical period but recovered 5 days postsurgery. Conclusion: In infants with OFC undergoing corrective surgery, the pattern of results for sleep and cortisol suggests that OFC surgery does not seem to constitute a traumatic event with long-term consequences. Keywords: cortisol, sleep, orofacial cleft, surgery, infants

  4. Epidemiological evaluation of hepatic trauma victims undergoing surgery.

    Science.gov (United States)

    Kalil, Mitre; Amaral, Isaac Massaud Amim

    2016-02-01

    to evaluate the epidemiological variables and diagnostic and therapeutic modalities related to hepatic trauma patients undergoing laparotomy in a public referral hospital in the metropolitan region of Vitória-ES. we conducted a retrospective study, reviewing charts of trauma patients with liver injuries, whether isolated or in association with other organs, who underwent exploratory laparotomy, from January 2011 to December 2013. We studied 392 patients, 107 of these with liver injury. The male: female ratio was 6.6 : 1 and the mean age was 30.12 years. Penetrating liver trauma occurred in 78.5% of patients, mostly with firearms. Associated injuries occurred in 86% of cases and intra-abdominal injuries were more common in penetrating trauma (p trauma was 60%, and penetrating trauma, 87.5% (p trauma remain high, especially in patients suffering from blunt trauma in relation to penetrating one.

  5. Influence of Music on Preoperative Anxiety and Physiologic Parameters in Women Undergoing Gynecologic Surgery.

    Science.gov (United States)

    Labrague, Leodoro J; McEnroe-Petitte, Denise M

    2016-04-01

    The aim of this study was to determine the influence of music on anxiety levels and physiologic parameters in women undergoing gynecologic surgery. This study employed a pre- and posttest experimental design with nonrandom assignment. Ninety-seven women undergoing gynecologic surgery were included in the study, where 49 were allocated to the control group (nonmusic group) and 48 were assigned to the experimental group (music group). Preoperative anxiety was measured using the State Trait Anxiety Inventory (STAI) while noninvasive instruments were used in measuring the patients' physiologic parameters (blood pressure [BP], pulse [P], and respiration [R]) at two time periods. Women allocated in the experimental group had lower STAI scores (t = 17.41, p music during the preoperative period in reducing anxiety and unpleasant symptoms in women undergoing gynecologic surgery. © The Author(s) 2014.

  6. Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear

    DEFF Research Database (Denmark)

    Pihl, Kenneth; Englund, Martin; Lohmander, L. Stefan

    2017-01-01

    Background and purpose - Recent evidence has questioned the effect of arthroscopic knee surgery for middle-aged and older patients with degenerative meniscal tears with or without concomitant radiographic knee osteoarthritis (OA). We investigated the prevalence of early or more established knee OA...... and patients' characteristics in a cohort of patients undergoing arthroscopic surgery for a meniscal tear. Patients and methods - 641 patients assigned for arthroscopy on suspicion of meniscus tear were consecutively recruited from February 2013 through January 2015. Of these, 620 patients (mean age 49 (18...... established knee OA was present in 43% of patients undergoing knee arthroscopy for meniscal tear....

  7. 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...... 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....

  8. Myenteric plexitis: A frequent feature in patients undergoing surgery for colonic diverticular disease.

    Science.gov (United States)

    Bassotti, Gabrio; Villanacci, Vincenzo; Sidoni, Angelo; Nascimbeni, Riccardo; Dore, Maria P; Binda, Gian A; Bandelloni, Roberto; Salemme, Marianna; Del Sordo, Rachele; Cadei, Moris; Manca, Alessandra; Bernardini, Nunzia; Maurer, Christoph A; Cathomas, Gieri

    2015-12-01

    Diverticular disease of the colon is frequent in clinical practice, and a large number of patients each year undergo surgical procedures worldwide for their symptoms. Thus, there is a need for better knowledge of the basic pathophysiologic mechanisms of this disease entity. Because patients with colonic diverticular disease have been shown to display abnormalities of the enteric nervous system, we assessed the frequency of myenteric plexitis (i.e. the infiltration of myenteric ganglions by inflammatory cells) in patients undergoing surgery for this condition. We analyzed archival resection samples from the proximal resection margins of 165 patients undergoing left hemicolectomy (60 emergency and 105 elective surgeries) for colonic diverticulitis, by histology and immunochemistry. Overall, plexitis was present in almost 40% of patients. It was subdivided into an eosinophilic (48%) and a lymphocytic (52%) subtype. Plexitis was more frequent in younger patients; and it was more frequent in those undergoing emergency surgery (50%), compared to elective (28%) surgery (p = 0.007). All the severe cases of plexitis displayed the lymphocytic subtype. In conclusion, myenteric plexitis is frequent in patients with colonic diverticular disease needing surgery, and it might be implicated in the pathogenesis of the disease.

  9. Impact of the viral respiratory season on postoperative outcomes in children undergoing cardiac surgery.

    Science.gov (United States)

    Spaeder, Michael C; Carson, Kathryn A; Vricella, Luca A; Alejo, Diane E; Holmes, Kathryn W

    2011-08-01

    To compare postoperative outcomes in children undergoing cardiac surgery during the viral respiratory season and nonviral season at our institution. This was a retrospective cohort study and secondary matched case-control analysis. The setting was an urban academic tertiary-care children's hospital. The study was comprised of all patients <18 years of age who underwent cardiac surgery at Johns Hopkins Hospital from October 2002 through September 2007. Patients were stratified by season of surgery, complexity of cardiac disease, and presence or absence of viral respiratory infection. Measurements included patient characteristics and postoperative outcomes. The primary outcome was postoperative length of stay (LOS). A total of 744 patients were included in the analysis. There was no difference in baseline characteristics or outcomes, specifically, no difference in postoperative LOS, intensive care unit (ICU) LOS, and mortality, among patients by seasons of surgery. Patients with viral respiratory illness were more likely to have longer postoperative LOS (p < 0.01) and ICU LOS (p < 0.01) compared with matched controls. We identified no difference in postoperative outcomes based on season in patients undergoing cardiac surgery. Children with viral respiratory infection have significantly worse outcomes than matched controls, strengthening the call for universal administration of influenza vaccination and palivizumab to appropriate groups. Preoperative testing for respiratory viruses should be considered during the winter months for children undergoing elective cardiac surgery.

  10. A Randomized Study Comparing Outcomes of Stapled and Hand-Sutured Anastomoses in Patients Undergoing Open Gastrointestinal Surgery

    OpenAIRE

    Chandramohan, S. M.; Gajbhiye, Raj Narenda; Agwarwal, Anil; Creedon, Erin; Schwiers, Michael L.; Waggoner, Jason R.; Tatla, Daljit

    2012-01-01

    Although stapling is an alternative to hand-suturing in gastrointestinal surgery, recent trials specifically designed to evaluate differences between the two in surgery time, anastomosis time, and return to bowel activity are lacking. This trial compared the outcomes of the two in subjects undergoing open gastrointestinal surgery. Adult subjects undergoing emergency or elective surgery requiring a single gastric, small, or large bowel anastomosis were enrolled into this open-label, prospectiv...

  11. Smoking behaviour and attitudes in patients undergoing cardiac surgery. The Radboud experience.

    NARCIS (Netherlands)

    Saksens, N.T.M.; Noyez, L.

    2010-01-01

    Changes in smoking behaviour and attitudes of 2642 patients, undergoing cardiac surgery, between January 2000 and July 2008 were studied. All patients completed a preoperative questionnaire concerning smoking behaviour and attitude. Study endpoints are behaviour and attitude in relation to tobacco

  12. Postoperative loss of skeletal muscle mass, complications and quality of life in patients undergoing cardiac surgery

    NARCIS (Netherlands)

    van Venrooij, Lenny M. W.; Verberne, Hein J.; de Vos, Rien; Borgmeijer-Hoelen, Mieke M. M. J.; van Leeuwen, Paul A. M.; de Mol, Bas A. J. M.

    2012-01-01

    Objective: The objective of this study was to describe postoperative undernutrition in terms of postoperative losses of appendicular skeletal muscle mass (ASMM) with respect to complications, quality of life, readmission, and 1-y mortality after cardiac surgery. Methods: Patients undergoing cardiac

  13. Sustaining hope and life courage in patients undergoing ovarian cancer surgery - the impact of care

    DEFF Research Database (Denmark)

    Seibaek, L; Delmar, C; Hounsgaard, L

    2018-01-01

    Ovarian cancer is the leading cause of death from a gynaecological malignancy in the Western World. To explore if experiences of physical comfort influenced hope and life courage during final diagnosis and early treatment, qualitative research interviews were performed with women undergoing surgery...

  14. Effects of hand massage on anxiety in patients undergoing ophthalmology surgery using local anesthesia

    Directory of Open Access Journals (Sweden)

    Jafar Rafiei Kiasari

    2012-08-01

    Full Text Available Introduction: Anxiety is a common disorder in patients before surgery. Inappropriately managed anxiety can cause psychological and physiological reactions and will affect the process of surgery and recovery. Therefore, this study examined the effects of hand mas-sage on anxiety in patients undergoing ophthalmology surgery using local anesthesia. Methods: In this interventional study, 52 patients who were supposed to undergo oph-thalmology surgery using local anesthesia were studied. Patients were randomly as-signed to two groups of intervention, who received hand massage before surgery (n = 27 and control (n = 25. Massaging lasted for 5 minutes (2.5 minutes on each hand before surgery. Stroking and scrubbing methods were performed by 2 trained research-ers. Anxiety level, blood pressure, heart rate, and respiratory rate were measured before and after the intervention in both groups. Anxiety was evaluated using Spielberger State-Trait Anxiety Inventory. Data was analyzed by chi-square, independent samples t-test, and paired t-test. Results: There were no significant differences in mean anxiety, systolic blood pressure, diastolic blood pressure, heart rate, and respiratory rate between the two groups before the intervention (p > 0.05. However, there was a significant differenc in the mean stress level between the two groups after the intervention (p 0.05. Conclusion: Our findings suggested that 5 minutes of hand massage before ophthalmology surgery (under local anesthesia could reduce anxiety. Therefore, this method can be used to increase patient comfort and reduce anxiety before surgical interventions.

  15. Pre-operative assessment of patients undergoing endoscopic, transnasal, transsphenoidal pituitary surgery.

    Science.gov (United States)

    Lubbe, D; Semple, P

    2008-06-01

    To demonstrate the importance of pre-operative ear, nose and throat assessment in patients undergoing endoscopic, transsphenoidal surgery for pituitary tumours. Literature pertaining to the pre-operative otorhinolaryngological assessment and management of patients undergoing endoscopic anterior skull base surgery is sparse. We describe two cases from our series of 59 patients undergoing endoscopic pituitary surgery. The first case involved a young male patient with a large pituitary macroadenoma. His main complaint was visual impairment. He had no previous history of sinonasal pathology and did not complain of any nasal symptoms during the pre-operative neurosurgical assessment. At the time of surgery, a purulent nasal discharge was seen emanating from both middle meati. Surgery was abandoned due to the risk of post-operative meningitis, and postponed until the patient's chronic rhinosinusitis was optimally managed. The second patient was a 47-year-old woman with a large pituitary macroadenoma, who presented to the neurosurgical department with a main complaint of diplopia. She too gave no history of previous nasal problems, and she underwent uneventful surgery using the endoscopic, transnasal approach. Two weeks after surgery, she presented to the emergency unit with severe epistaxis. A previous diagnosis of hereditary haemorrhagic telangiectasia was discovered, and further surgical and medical intervention was required before the epistaxis was finally controlled. Pre-operative otorhinolaryngological assessment is essential prior to endoscopic pituitary or anterior skull base surgery. A thorough otorhinolaryngological history will determine whether any co-morbid diseases exist which could affect the surgical field. Nasal anatomy can be assessed via nasal endoscopy and sinusitis excluded. Computed tomography imaging is a valuable aid to decisions regarding additional procedures needed to optimise access to the pituitary fossa.

  16. Perioperative use of tamsulosin significantly decreases rates of urinary retention in men undergoing pelvic surgery.

    Science.gov (United States)

    Poylin, Vitaliy; Curran, Thomas; Cataldo, Thomas; Nagle, Deborah

    2015-09-01

    Urinary retention is a common complication of pelvic surgery, leading to urinary tract infection and prolonged hospital stays. Tamsulosin is an alpha blocker that works by relaxing bladder neck muscles. It is used to treat benign prostatic hypertrophy and retention. We aim to investigate the potential benefits of preemptive tamsulosin use on rates of urinary retention in men undergoing pelvic surgery. This is a retrospective review of an institutional colorectal database. All men undergoing pelvic surgery between 2004 and 2013 were included. Patients given 0.4 mg of tamsulosin 3 days prior and after surgery at discretion of surgeon starting in 2007 were compared with patients receiving expectant postoperative management. One hundred eighty-five patients were included in the study (study group: N = 30; control group: N = 155). Study group patients were older (56.8 vs. 50.1 years). Overall urinary retention rate was 22% with significantly lower rates in the study group compared with control (6.7 vs. 25%; p = 0.029). Study group had higher rates of minimally invasive surgery (61 vs. 29.7%); however, this did not impact urinary retention rate (20.6 vs. 22.7% for minimally invasive surgery vs. open surgery; p = 0.85). Independent predictors of urinary retention included lack of preemptive tamsulosin (odds ratio (OR), 7.67; 95% confidence interval (CI), 1.4-41.7) and cancer location in the distal third of the rectum (OR, 18.8; 95% CI, 2.1-172.8). Preemptive perioperative use of tamsulosin may significantly decrease the incidence of urinary retention in men undergoing pelvic surgery. This may play a role in avoidance of urinary retention, particularly in patients with distal rectal cancer.

  17. Preoperative renin-angiotensin system inhibitors protect renal function in aging patients undergoing cardiac surgery.

    Science.gov (United States)

    Barodka, Viachaslau; Silvestry, Scott; Zhao, Ning; Jiao, Xiangyin; Whellan, David J; Diehl, James; Sun, Jian-Zhong

    2011-05-15

    Renal failure (RF) represents a major postoperative complication for elderly patients undergoing cardiac surgery. This observational cohort study examines effects of preoperative use of renin-angiotensin system (RAS) inhibitors on postoperative renal failure in aging patients undergoing cardiac surgery. We retrospectively analyzed a cohort of 1287 patients who underwent cardiac surgery at this institution (2003-2007). The patients included were ≥65 years old, scheduled for elective cardiac surgery, and without preexisting RF (defined by the criteria of the Society of Thoracic Surgeons as described in Method). Of all patients evaluated, 346 patients met the inclusion criteria and were divided into two groups: using (n = 122) or not using (n = 224) preoperative RAS inhibitors. A comparison of the two groups showed no significant differences in baseline parameters, including creatinine clearance, body mass index, history of diabetes and smoking, preoperative medicines (except that more patients with RAS inhibitors had a history of hypertension or congestive heart failure, fewer RAS inhibitor patients had chronic lung disease), in intraoperative perfusion and aortic cross-clamp time, and in postoperative complications and 30-d mortality. Multivariate logistic regression analysis demonstrated, however, that preoperative RAS inhibitors significantly and independently reduced the incidence of postoperative RF in the patients undergoing cardiac surgery compared with those not taking RAS inhibitors: 1.6% versus 7.6%, yielding an odds ratio of 0.19 (95 % CI 0.04-0.84, P = 0.029). Preoperative RAS inhibitors may have significant renoprotective effects for aging patients undergoing elective cardiac surgery. Copyright © 2011 Elsevier Inc. All rights reserved.

  18. Outcome of patients with reduced ankle brachial index undergoing open heart surgery with cardiopulmonary bypass.

    Science.gov (United States)

    Meyborg, Matthias; Abdi-Tabari, Zila; Hoffmeier, Andreas; Engelbertz, Christiane; Lüders, Florian; Freisinger, Eva; Malyar, Nasser M; Martens, Sven; Reinecke, Holger

    2016-05-01

    In open heart surgery using cardiopulmonary bypass, perfusion of the lower extremities is markedly reduced which may induce critical ischaemia in patients with pre-existing peripheral artery disease. Whether these patients have an increased risk for amputation and should better undergo peripheral revascularization prior to surgery remains unclear. From 1 January 2009 to 31 December 2010, 785 consecutive patients undergoing open heart surgery were retrospectively included. In 443 of these patients, preoperative ankle brachial index (ABI) measurements were available. The cohort was divided into four groups: (i) ABI heart surgery showed more wound-healing disturbances, and higher long-term mortality compared with those with normal ABIs. However, no perioperative ischaemia requiring amputation occurred. Thus, reduced ABIs were not associated with increased peripheral risks in open heart surgery but ABI may be helpful in selecting the site for saphenectomy to potentially avoid delayed healing of related wounds in legs with severely impaired arterial perfusion. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  19. Clinical feasibility of pre-operative neurodevelopmental assessment of infants undergoing open heart surgery.

    Science.gov (United States)

    Campbell, Miranda; Rabbidge, Bridgette; Ziviani, Jenny; Sakzewski, Leanne

    2017-08-01

    Assessing the neurodevelopmental status of infants with congenital heart disease before surgery provides a means of identifying those at heightened risk of developmental delay. This study aimed to investigate factors impacting clinical feasibility of pre-operative neurodevelopmental assessment of infants undergoing early open heart surgery. Infants who underwent open heart surgery prior to 4 months of age participated in this cross-sectional study. The Test of Infant Motor Performance and Prechtl's Assessment of General Movements were undertaken on infants pre-operatively. When assessments could not be undertaken, reasons were ascribed to either infant or environmental circumstances. Demographic data and Aristotle scores were compared between groups of infants who did or did not undergo assessment. Binary logistic regression was used to explore associations. A total of 60 infants participated in the study. Median gestational age was 38.78 weeks (interquartile range: 36.93-39.72). Of these infants, 37 (62%) were unable to undergo pre-operative assessment. Twenty-four (40%) could not complete assessment due to infant-related factors and 13 (22%) due to environmental-related factors. For every point increase in the Aristotle Patient-Adjusted Complexity score, the infants likelihood of being unable to undergo assessment increased by 35% (odds ratio: 0.35; 95% confidence interval: 1.03-1.77, P = 0.03). Over half of the infants undergoing open heart surgery were unable to complete pre-operative neurodevelopmental assessment. The primary reason for this was infant-related medical instability. Findings suggest further research is warranted to investigate whether the Aristotle Patient-Adjusted Complexity score might serve as an indicator to inform developmental surveillance with this medically fragile cohort. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  20. Anesthetic complications in dogs undergoing hepatic surgery: cholecystectomy versus non-cholecystectomy.

    Science.gov (United States)

    Burns, Brigid R; Hofmeister, Erik H; Brainard, Benjamin M

    2014-03-01

    To determine if dogs that undergo laparotomy for cholecystectomy suffer from a greater number or magnitude of perianesthetic complications, including hypotension, hypothermia, longer recovery time, and lower survival rate, than dogs that undergo laparotomy for hepatic surgery without cholecystectomy. Retrospective cohort study. One hundred and three dogs, anesthetised between January 2007 and October 2011. The variables collected from the medical record included age, weight, gender, surgical procedure, pre-operative bloodwork, American Society of Anesthesiologists (ASA) status, emergency status, total bilirubin concentration, anesthetic agents administered, body temperature nadir, final body temperature, hypotension, duration of hypotension, blood pressure nadir, intraoperative drugs, anesthesia duration, surgery duration, time to extubation, final diagnosis, days spent in the intensive care unit (ICU), total bill, survival to discharge, and survival to follow-up. No significant difference in body temperature nadir, final temperature, presence of hypotension, duration of hypotension, blood pressure nadir, the use of inotropes, or final outcome was found between dogs undergoing cholecystectomy and dogs undergoing exploratory laparotomy for other hepatic disease. Dogs that had cholecystectomy had longer anesthesia durations and longer surgery durations than dogs that did not have cholecystectomy. No significant differences existed for temperature nadir (34.8 versus 35.3°C; non-cholecystectomy versus cholecystectomy), final temperature (35.6 versus 35.9°C), time to extubation (30 versus 49 minutes), duration of hypotension (27 versus 21 minutes), or MAP nadir (56 versus 55 mmHg). Hypotension occurred in 66% and 74% and inotropes were used in 64% and 53%, for non-cholecystectomy and cholecystectomy patients, respectively. Dogs that underwent cholecystectomies did not suffer a greater number of anesthesia complications than did dogs undergoing hepatic surgery without

  1. Intravenous clonidine administration and its ability to reduce pulmonary arterial pressure in patients undergoing heart surgery

    Directory of Open Access Journals (Sweden)

    Benedito Barbosa João

    2014-01-01

    Full Text Available Objective: Evaluate the ability of clonidine to reduce pulmonary arterial pressure in patients with pulmonary hypertension undergoing heart surgery, either by reducing the pressure values from the direct measurement of pulmonary arterial pressure or by reducing or eliminating the need for intraoperative dobutamine and nitroprusside. Method: Randomized, double-blind, placebo-controlled, comparative study conducted in 30 patients with pulmonary arterial hypertension type 2 undergoing cardiac surgery. Mean pulmonary arterial pressure and dosage of dobutamine and sodium nitroprusside were assessed four times: before intravenous administration of clonidine (2 μg/kg or placebo (T0, 30 min after tested treatment and before cardiopulmonary bypass (T1, immediately after CPB (T2, 10 min after protamine injection (T3. Results: There were no significant differences regarding mean pulmonary arterial pressure at any time of evaluation. There was no significant difference between groups regarding other variables, such as mean systemic arterial pressure, heart rate, total dose of dobutamine, total dose of sodium nitroprusside, and need for fentanyl. Conclusion: Data analysis from patients included in this study allows us to conclude that intravenous clonidine (2 μg/kg was not able to reduce the mean pulmonary arterial pressure in patients with pulmonary hypertension in group 2 (pulmonary venous hypertension, undergoing heart surgery, or reduce or eliminate the need for intraoperative administration of dobutamine and sodium nitroprusside. Keywords: Clonidine, Pulmonary hypertension, Heart surgery

  2. A novel protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery under cardiopulmonary bypass.

    Science.gov (United States)

    Odaka, Mizuho; Minakata, Kenji; Toyokuni, Hideaki; Yamazaki, Kazuhiro; Yonezawa, Atsushi; Sakata, Ryuzo; Matsubara, Kazuo

    2015-08-01

    This study aimed to develop and assess the effectiveness of a protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery. We established a protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery. This novel protocol was assessed by comparing patients undergoing open heart surgery before (control group; n = 30) and after its implementation (protocol group; n = 31) at Kyoto University Hospital between July 2012 and January 2013. Surgical site infections (SSIs) were observed in 4 control group patients (13.3 %), whereas no SSIs were observed in the protocol group patients (P open heart surgery.

  3. Intraoperative blood loss and blood transfusion requirements in patients undergoing orthognathic surgery.

    Science.gov (United States)

    Faverani, Leonardo Perez; Ramalho-Ferreira, Gabriel; Fabris, André Luis Silva; Polo, Tárik Ocon Braga; Poli, Guilherme Henrique Souza; Pastori, Cláudio Maldonado; Marzola, Clóvis; Assunção, Wirley Gonçalves; Garcia-Júnior, Idelmo Rangel

    2014-09-01

    Procedures for the surgical correction of dentofacial deformities may produce important complications, whether due to the potential for vascular injury or to prolonged surgery, both of which may lead to severe blood loss. Fluid replacement with crystalloid, colloid, or even blood products may be required. The aim of this study was to assess blood loss and transfusion requirements in 45 patients (18 males and 27 females; mean age 29.29 years, range 16-52 years) undergoing orthognathic surgery, assigned to one of two groups according to procedure type-rapid maxillary expansion or double-jaw orthognathic surgery. Preoperative hemoglobin and hematocrit levels and intraoperative blood loss were measured. There was a substantial individual variation in pre- and postoperative hemoglobin values (10.3-17 and 8.8-15.4 g/dL, respectively; p surgery and follow meticulous protocols to minimize the risks.

  4. Effect of melatonin on depressive symptoms and anxiety in patients undergoing breast cancer surgery

    DEFF Research Database (Denmark)

    Hansen, Melissa V; Andersen, Lærke T; Madsen, Michael T

    2014-01-01

    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...

  5. Relationship between cobalamin deficiency and delirium in elderly patients undergoing cardiac surgery

    Directory of Open Access Journals (Sweden)

    Sevuk U

    2015-08-01

    Full Text Available Utkan Sevuk,1 Erkan Baysal,2 Nurettin Ay,3 Yakup Altas,2 Rojhat Altindag,2 Baris Yaylak,2 Vahhac Alp,3 Ertan Demirtas4 1Department of Cardiovascular Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, 2Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, 3Department of General Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, 4Department of Cardiovascular Surgery, Liv Hospital, Ankara, Turkey Background: Delirium is common after cardiac surgery and is independently associated with increased morbidity, mortality, prolonged hospital stays, and higher costs. Cobalamin (vitamin B12 deficiency is a common cause of neuropsychiatric symptoms and affects up to 40% of elderly people. The relationship between cobalamin deficiency and the occurrence of delirium after cardiac surgery has not been examined in previous studies. We examined the relationship between cobalamin deficiency and delirium in elderly patients undergoing coronary artery bypass grafting (CABG surgery.Material and methods: A total of 100 patients with cobalamin deficiency undergoing CABG were enrolled in this retrospective study. Control group comprised 100 patients without cobalamin deficiency undergoing CABG. Patients aged 65 years or over were included. Diagnosis of delirium was made using Intensive Care Delirium Screening Checklist. Delirium severity was measured using the Delirium Rating Scale-revised-98.Results: Patients with cobalamin deficiency had a significantly higher incidence of delirium (42% vs 26%; P=0.017 and higher delirium severity scores (16.5±2.9 vs 15.03±2.48; P=0.034 than patients without cobalamin deficiency. Cobalamin levels were significantly lower in patients with delirium than patients without delirium (P=0.004. Delirium severity score showed a moderate correlation with cobalamin levels (Ρ=-0.27; P=0.024. Logistic regression analysis demonstrated that

  6. Factors Associated With Work Ability in Patients Undergoing Surgery for Cervical Radiculopathy.

    Science.gov (United States)

    Ng, Eunice; Johnston, Venerina; Wibault, Johanna; Löfgren, Håkan; Dedering, Åsa; Öberg, Birgitta; Zsigmond, Peter; Peolsson, Anneli

    2015-08-15

    Cross-sectional study. To investigate the factors associated with work ability in patients undergoing surgery for cervical radiculopathy. Surgery is a common treatment of cervical radiculopathy in people of working age. However, few studies have investigated the impact on the work ability of these patients. Patients undergoing surgery for cervical radiculopathy (n = 201) were recruited from spine centers in Sweden to complete a battery of questionnaires and physical measures the day before surgery. The associations between various individual, psychological, and work-related factors and self-reported work ability were investigated by Spearman rank correlation coefficient, multivariate linear regression, and forward stepwise regression analyses. Factors that were significant (P work ability. Work ability was assessed using the Work Ability Index. The mean Work Ability Index score was 28 (SD, 9.0). The forward stepwise regression analysis revealed 6 factors significantly associated with work ability, which explained 62% of the variance in the Work Ability Index. Factors highly correlated with greater work ability included greater self-efficacy in performing self-cares, lower physical load on the neck at work, greater self-reported chance of being able to work in 6 months' time, greater use of active coping strategies, lower frequency of hand weakness, and higher health-related quality of life. Psychological, work-related and individual factors were significantly associated with work ability in patients undergoing surgery for cervical radiculopathy. High self-efficacy was most associated with greater work ability. Consideration of these factors by surgeons preoperatively may provide optimal return to work outcomes after surgery. 3.

  7. People's experiences of suffering a lower limb fracture and undergoing surgery.

    Science.gov (United States)

    Forsberg, Angelica; Söderberg, Siv; Engström, Åsa

    2014-01-01

    To describe people's experiences of suffering a lower limb fracture and undergoing surgery, from the time of injury through to the care given at the hospital and recovery following discharge. There is a lack of research on people's experiences of suffering a lower limb fracture and undergoing surgery - from injury to recovery. A qualitative approach was used. Interviews with nine participants were subjected to thematic content analysis. One theme was expressed: from realising the seriousness of the injury to regaining autonomy. Participants described feelings of frustration and helplessness when realising the seriousness of their injury. The wait prior to surgery was a strain and painful experience, and participants needed orientation for the future. They expressed feelings of vulnerability about being in the hands of staff during surgery. After surgery, in the postanaesthesia unit, participants expressed a need to have control and to feel safe in their new situation. To mobilise and regain their autonomy was a struggle, and participants stated that their recovery was extended. Participants found themselves in a new and unexpected situation and experienced pain, vulnerability and a striving for control during the process, that is, 'from realising the seriousness of the injury to regaining autonomy'. How this is managed depends on how the patient's needs are met by nurses. The nursing care received while suffering a lower limb fracture and undergoing surgery should be situation specific as well as individual specific. The safe performance of technical interventions and the nurse's comprehensive explanations of medical terms may help the patient to feel secure during the process. © 2013 John Wiley & Sons Ltd.

  8. Effect of clindamycin prophylaxis on the colonic microflora in patients undergoing colorectal surgery.

    OpenAIRE

    Kager, L; Liljeqvist, L; Malmborg, A S; Nord, C E

    1981-01-01

    Clindamycin was given intravenously to 15 patients undergoing colorectal surgery in an initial dose of 600 mg, given at induction of anesthesia followed by 6 doses of 600 mg at 8-h intervals. Series of serum samples and fecal specimens were taken for analysis of clindamycin concentrations. Tissue samples from the gut wall were taken at surgery. The highest serum concentrations observed occurred 30 min after administration of clindamycin and varied between 6.8 and 37.9 microgram/ml (mean, 14.8...

  9. [What preoperative information do the parents of children undergoing surgery want?].

    Science.gov (United States)

    Sartori, Josefina; Espinoza, Pilar; Díaz, María Soledad; Ferdinand, Constanza; Lacassie, Héctor J; González, Alejandro

    2015-01-01

    Parents feel fear and anxiety before surgery is performed on their child, and those feelings could obstruct their preparation for the surgery. Preoperative information could relieve those feelings. To determine the preoperative information needs of parents of children undergoing elective surgery. A study was conducted on the parents of children who underwent elective surgery. Demographic data of parents were recorded. Preoperative information received or would like to have received was assessed in terms of contents, methods, opportunity, place and informant. Descriptive statistics were used. Thirteen hundred parents were surveyed. More than 80% of them want preoperative information about anaesthesia, surgery, preoperative fasting, drugs and anaesthetic complications, monitoring, intravenous line management, pain treatment, postoperative feeding, anxiety control, hospitalisation room, recovery room, and entertainment in recovery room. Most want to be informed verbally, one to two weeks in advance and not on the same day of surgery. The informant should be the surgeon and in his office. In addition, they want information through leaflets, videos and simulation workshops, or guided tours. Parents need complete preoperative information about anesthesia, surgery and postoperative care, received verbally and in advance. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Venous thromboembolism in women undergoing pelvic reconstructive surgery with mechanical prophylaxis alone.

    Science.gov (United States)

    Montoya, T Ignacio; Leclaire, Edgar L; Oakley, Susan H; Crane, Andrea K; Mcpencow, Alexandra; Cichowski, Sara; Rahn, David D

    2014-07-01

    The objective of this study was determine the frequency of symptomatic perioperative venous thromboembolism (VTE) and risk factor(s) associated with VTE occurrence in women undergoing elective pelvic reconstructive surgery using only intermittent pneumatic compression (IPC) for VTE prophylaxis. A multi-center case-cohort retrospective review was conducted at six clinical sites over a 66-month period. All sites utilize IPC as standard VTE prophylaxis for urogynecological surgery. VTE cases occurring during the same hospitalization and up to 6 weeks postoperatively were identified by ICD9 code query. Four controls were temporally matched to each case. Information collected included demographics, medical history, route of surgery, operative time, and intraoperative characteristics. Univariate and multivariate backward stepwise logistic regression analyses were performed to identify potential risk factors for VTE. Symptomatic perioperative VTE was diagnosed in 27 subjects from a cohort of 10,627 women who underwent elective urogynecological surgery (0.25 %). Univariate analysis identified surgical route (laparotomy vs others), type of surgery ("major" vs "minor"), history of gynecological cancer, surgery time, and patient age as risk factors for VTE (P h. In our study cohort, the frequency of symptomatic perioperative VTE was low. Laparotomy, age ≥ 70 years, and surgery duration ≥ 5 h were associated with VTE occurrence.

  11. Proximal mandibular nerve block using electrolocation in 10 dogs undergoing mandibular surgery: a case series report.

    OpenAIRE

    Ravasio, Giuliano; D'Urso, Elisa Silvia; Macchioni, Chiara; Stefanello, Damiano

    2016-01-01

    Peripheral nerve block performed using electrical stimulation (i.e. electrolocation) is widely used for perioperative pain management during several surgical procedures in dogs (Campoy 2008), but few data are reported concerning its application to invasive maxillofacial surgery (Carotenuto et al 2011). The aim of this case series report is to evaluate the efficacy of proximal mandibular nerve block (PMNB) in perioperative pain management in dogs undergoing mandibulectomy. Ten dogs of various ...

  12. Characteristics and clinical aspects of patients with spinal cord injury undergoing surgery

    Directory of Open Access Journals (Sweden)

    João Simão de Melo-Neto

    Full Text Available ABSTRACT OBJECTIVE: To identify the characteristics of patients with spinal cord injury (SCI undergoing surgery. METHODS: Previously, 321 patients with SCI were selected. Clinical and socio-demographic variables were collected. RESULTS: A total of 211 patients were submitted to surgery. Fall and injuries in the upper cervical and lumbosacral regions were associated with conservative treatment. Patients with lesions in the lower cervical spine, worse neurological status, and unstable injuries were associated with surgery. Individuals undergoing surgery were associated with complications after treatment. The authors assessed whether age influenced the characteristics of patients submitted to surgery. Subjects with <60 years of age were associated with motorcycle accidents and the morphologies of injury were fracture-dislocation. Elderly individuals were associated to fall, SCI in the lower cervical spine and the morphology of injury was listhesis. Subsequently, the authors analyzed the gender characteristics in these patients. Women who suffered car accidents were associated to surgery. Women were associated with paraparesis and the morphologic diagnosis was fracture-explosion, especially in the thoracolumbar transition and lumbosacral regions. Men who presented traumatic brain injury and thoracic trauma were related to surgery. These individuals had a worse neurological status and were associated to complications. Men and the cervical region were most affected, thereby, these subjects were analyzed separately (n= 92. The presence of complications increased the length of hospital stay. The simultaneous presence of morphological diagnosis, worst neurological status, tetraplegia, sensory, and motor alterations were associated with complications. Pneumonia and chest trauma were associated with mortality. CONCLUSION: These factors enable investments in prevention, rehabilitation, and treatment.

  13. Comparison of propofol versus sevoflurane on thermoregulation in patients undergoing transsphenoidal pituitary surgery: A preliminary study

    Directory of Open Access Journals (Sweden)

    Tumul Chowdhury

    2012-01-01

    Full Text Available Purpose: General anesthesia causes inhibition of thermoregulatory mechanisms. Propofol has been reported to cause more temperature fall, but in case of deliberate mild hypothermia, both sevoflurane and propofol were comparable. Thermoregulation is found to be disturbed in cases of pituitary tumors. We aimed to investigate which of the two agents, sevoflurane or propofol, results in better preservation of thermoregulation in patients undergoing transsphenoidal excision of pituitary tumors. Methods: Twenty-six patients scheduled to undergo transsphenoidal removal of pituitary adenomas were randomly allocated to receive propofol or sevoflurane anesthesia. Baseline esophageal temperature was noted. Times for temperature to fall by 1°C or 35°C and to return to baseline were also comparable ( P>0.05. After that warmer was started at 43°C and time to rise to baseline was noted. Duration of surgery, total blood loss, and total fluid intake were also noted. If any, side effects such as delayed arousal and recovery from muscle relaxant were noted. Results: The demographics of the patients were comparable. Duration of surgery and total blood loss were comparable in the two groups. The time for temperature to fall by 1°C or 35°C and time to return to baseline was also comparable ( P>0.05. No side effects related to body temperature were noted. Conclusion: Both propofol and sevoflurane show similar effects in maintaining thermal homeostasis in patients undergoing transsphenoidal pituitary surgery.

  14. Incidence of cerebrovascular accidents in patients undergoing minimally invasive valve surgery.

    Science.gov (United States)

    LaPietra, Angelo; Santana, Orlando; Mihos, Christos G; DeBeer, Steven; Rosen, Gerald P; Lamas, Gervasio A; Lamelas, Joseph

    2014-07-01

    Minimally invasive valve surgery has been associated with increased cerebrovascular complications. Our objective was to evaluate the incidence of cerebrovascular accidents in patients undergoing minimally invasive valve surgery. We retrospectively reviewed all the minimally invasive valve surgery performed at our institution from January 2009 to June 2012. The operative times, lengths of stay, postoperative complications, and mortality were analyzed. A total of 1501 consecutive patients were identified. The mean age was 73 ± 13 years, and 808 patients (54%) were male. Of the 1501 patients, 206 (13.7%) had a history of a cerebrovascular accident, and 225 (15%) had undergone previous heart surgery. The procedures performed were 617 isolated aortic valve replacements (41.1%), 658 isolated mitral valve operations (43.8%), 6 tricuspid valve repairs (0.4%), 216 double valve surgery (14.4%), and 4 triple valve surgery (0.3%). Femoral cannulation was used in 1359 patients (90.5%) and central cannulation in 142 (9.5%). In 1392 patients (92.7%), the aorta was clamped, and in 109 (7.3%), the surgery was performed with the heart fibrillating. The median aortic crossclamp and cardiopulmonary bypass times were 86 minutes (interquartile range [IQR], 70-107) minutes and 116 minutes (IQR, 96-143), respectively. The median intensive care unit length of stay was 47 hours (IQR, 29-74), and the median postoperative hospital length of stay was 7 days (IQR, 5-10). A total of 23 cerebrovascular accidents (1.53%) and 38 deaths (2.53%) had occurred at 30 days postoperatively. Minimally invasive valve surgery was associated with an acceptable stroke rate, regardless of the cannulation technique. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  15. Effects of music therapy under general anesthesia in patients undergoing abdominal surgery.

    Science.gov (United States)

    Kahloul, Mohamed; Mhamdi, Salah; Nakhli, Mohamed Said; Sfeyhi, Ahmed Nadhir; Azzaza, Mohamed; Chaouch, Ajmi; Naija, Walid

    2017-12-01

    Music therapy, an innovative approach that has proven effectiveness in many medical conditions, seems beneficial also in managing surgical patients. The aim of this study is to evaluate its effects, under general anesthesia, on perioperative patient satisfaction, stress, pain, and awareness. This is a prospective, randomized, double-blind study conducted in the operating theatre of visceral surgery at Sahloul Teaching Hospital over a period of 4 months. Patients aged more than 18 undergoing a scheduled surgery under general anesthesia were included. Patients undergoing urgent surgery or presenting hearing or cognitive disorders were excluded. Before induction, patients wore headphones linked to an MP3 player. They were randomly allocated into 2 groups: Group M (with music during surgery) and group C (without music). Hemodynamic parameters, quality of arousal, pain experienced, patient's satisfaction, and awareness incidence during anesthesia were recorded. One hundred and forty patients were included and allocated into 2 groups that were comparable in demographic characteristics, surgical intervention type and anesthesia duration. Comparison of these two groups regarding the hemodynamic profile found more stability in group M for systolic arterial blood pressure. A calm recovery was more often noted in group M (77.1% versus 44%, p Music therapy is a non-pharmacological, inexpensive, and non-invasive technique that can significantly enhance patient satisfaction and decrease patients' embarrassing experiences related to perioperative stress, pain, and awareness.

  16. Perioperative management and complications in patients with obstructive sleep apnea undergoing transsphenoidal surgery: Our institutional experience.

    Science.gov (United States)

    Rahimi, Eiman; Mariappan, Ramamani; Tharmaradinam, Suresh; Manninen, Pirjo; Venkatraghavan, Lashmi

    2014-07-01

    Patients with endocrine diseases such as acromegaly and Cushing's disease have a high prevalence of obstructive sleep apnea (OSA). There is controversy regarding the use of continuous positive airway pressure (CPAP) following transsphenoidal surgery. The aim of this study was to compare the perioperative management and complications, in patients with or without OSA undergoing transsphenoidal surgery. After Research Ethics Board approval, we retrospectively reviewed the charts of all patients who underwent transsphenoidal surgery in our institution from 2006 to 2011. Information collected included patients' demographics, pathology of lesion, history of OSA, anesthetic and perioperative management and incidence of perioperative complications. Patients with sleep study proven OSA were compared with a control group, matched for age, sex and pathology of patients without OSA. Statistical analysis was performed using t-test and Chi-square test and the P transsphenoidal surgery, 105 patients were found to be at risk for OSA by a positive STOP-BANG scoring assessment. Preoperative sleep study testing was positive for OSA in 38 patients. Post-operative hypoxemia (SpO2 transsphenoidal surgery can be treated in most but not all patients with high flow oxygen using the face mask. We were able to safely use CPAP in a very small number of patients but caution is needed to prevent complications. Further prospective studies are needed to determine the safe use of CPAP in patients after transsphenoidal surgery.

  17. Trajectory of self-reported pain and function and knee extensor muscle strength in young patients undergoing arthroscopic surgery for meniscal tears

    DEFF Research Database (Denmark)

    Thorlund, Jonas Bloch; Østengaard, Lasse; Cardy, Nathan

    2017-01-01

    . PATIENTS AND INTERVENTION: People aged 30 years or younger undergoing surgery for a meniscal tear. OUTCOMES: and comparator: (1) Self-reported pain and function in patients undergoing meniscal surgery compared to a non-operative control group (2). Knee extensor strength in the leg undergoing surgery...... the trajectory of self-reported pain and function in patients undergoing arthroscopic surgery compared with non-operative treatments for young patients with meniscal tears. Knee extensor strength seemed to be impaired up to 12 months after surgery in young patients undergoing surgery for meniscal tears...

  18. Outcome of patients undergoing open heart surgery at the Uganda heart institute, Mulago hospital complex.

    Science.gov (United States)

    Aliku, Twalib O; Lubega, Sulaiman; Lwabi, Peter; Oketcho, Michael; Omagino, John O; Mwambu, Tom

    2014-12-01

    Heart disease is a disabling condition and necessary surgical intervention is often lacking in many developing countries. Training of the superspecialties abroad is largely limited to observation with little or no opportunity for hands on experience. An approach in which open heart surgeries are conducted locally by visiting teams enabling skills transfer to the local team and helps build to build capacity has been adopted at the Uganda Heart Institute (UHI). We reviewed the progress of open heart surgery at the UHI and evaluated the postoperative outcomes and challenges faced in conducting open heart surgery in a developing country. Medical records of patients undergoing open heart surgery at the UHI from October 2007 to June 2012 were reviewed. A total of 124 patients underwent open heart surgery during the study period. The commonest conditions were: venticular septal defects (VSDs) 34.7% (43/124), Atrial septal defects (ASDs) 34.7% (43/124) and tetralogy of fallot (TOF) in 10.5% (13/124). Non governmental organizations (NGOs) funded 96.8% (120/124) of the operations, and in only 4 patients (3.2%) families paid for the surgeries. There was increasing complexity in cases operated upon from predominantly ASDs and VSDs at the beginning to more complex cases like TOFs and TAPVR. The local team independently operated 19 patients (15.3%). Postoperative morbidity was low with arrhythmias, left ventricular dysfunction and re-operations being the commonest seen. Post operative sepsis occurred in only 2 cases (1.6%). The overall mortality rate was 3.2. Open heart surgery though expensive is feasible in a developing country. With increased direct funding from governments and local charities to support open heart surgeries, more cardiac patients access surgical treatment locally.

  19. Selective Use of Sentinel Lymph Node Surgery in Patients Undergoing Prophylactic Mastectomy Using Intraoperative Pathology.

    Science.gov (United States)

    Murphy, Brittany L; Glasgow, Amy E; Keeney, Gary L; Habermann, Elizabeth B; Boughey, Judy C

    2017-10-01

    Routine sentinel lymph node (SLN) surgery during prophylactic mastectomy (PM) is unnecessary, because most PMs do not contain cancer. Our institution utilizes intraoperative pathology to guide the surgical decision for resection of SLNs in PM. The purpose of this study was to review the effectiveness of this approach. We identified all women aged ≥18 years who underwent bilateral PM (BPM) or contralateral PM (CPM) at our institution from January 2008 to July 2016. We evaluated the frequency of SLN resection and rate of occult breast cancer (DCIS or invasive disease) in the PM. We used the following definitions: over-treatment-SLN surgery in patients without cancer; under-treatment-no SLN surgery in patients with cancer; appropriate treatment-no SLN in patients without cancer or SLN surgery in patients with cancer. PM was performed on 1900 breasts: 1410 (74.2%) CPMs and 490 (25.8%) BPMs. Cancer was identified in 58 (3.0%) cases (32 invasive disease and 26 DCIS) and concurrent SLN surgery was performed in 44 (75.9%) of those cases. Overall, SLN surgery guided by intraoperative pathology resulted in appropriate treatment of 1787 (94.1%) cases: 1319 (93.5%) CPMs and 468 (95.5%) BPMs, by avoiding SLN in 1743/1842 cases without cancer (94.6%), and performing SLN surgery in 44/58 cases with cancer (75.9%). Use of intraoperative pathology to direct SLN surgery in patients undergoing PM minimizes over-treatment from routine SLN in PM and minimizes under-treatment from avoiding SLN in PM, demonstrating the value of intraoperative pathology in this era of focus on appropriateness of care.

  20. Perioperative outcomes of adolescents undergoing bariatric surgery: the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study.

    Science.gov (United States)

    Inge, Thomas H; Zeller, Meg H; Jenkins, Todd M; Helmrath, Michael; Brandt, Mary L; Michalsky, Marc P; Harmon, Carroll M; Courcoulas, Anita; Horlick, Mary; Xanthakos, Stavra A; Dolan, Larry; Mitsnefes, Mark; Barnett, Sean J; Buncher, Ralph

    2014-01-01

    Severe obesity in childhood is a major health problem with few effective treatments. Weight-loss surgery (WLS) is being used to treat severely obese adolescents, although with very limited data regarding surgical safety for currently used, minimally invasive procedures. To assess the preoperative clinical characteristics and perioperative safety outcomes of severely obese adolescents undergoing WLS. This prospective, multisite observational study enrolled patients from February 28, 2007, through December 30, 2011. Consecutive patients aged 19 years or younger who were approved to undergo WLS (n = 277) were offered enrollment into the study at 5 academic referral centers in the United States; 13 declined participation and 22 did not undergo surgery after enrollment, thus the final analysis cohort consisted of 242 individuals. There were no withdrawals. This analysis examined preoperative anthropometrics, comorbid conditions, and major and minor complications occurring within 30 days of operation. All data were collected in a standardized fashion. Reoperations and hospital readmissions were adjudicated by independent reviewers to assess relatedness to the WLS procedure. The mean (SD) age of participants was 17.1 (1.6) years and the median body mass index (calculated as weight in kilograms divided by height in meters squared) was 50.5. Fifty-one percent demonstrated 4 or more major comorbid conditions. Laparoscopic Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and adjustable gastric banding were performed in 66%, 28%, and 6% of patients, respectively. There were no deaths during the initial hospitalization or within 30 days of operation; major complications (eg, reoperation) were seen in 19 patients (8%). Minor complications (eg, readmission for dehydration) were noted in 36 patients (15%). All reoperations and 85% of readmissions were related to WLS. In this series, adolescents with severe obesity presented with abundant comorbid conditions. We observed

  1. The feasibility of sugammadex for general anesthesia and facial nerve monitoring in patients undergoing parotid surgery.

    Science.gov (United States)

    Lu, I-Cheng; Chang, Pi-Ying; Su, Miao-Pei; Chen, Po-Nien; Chen, Hsiu-Ya; Chiang, Feng-Yu; Wu, Che-Wei

    2017-08-01

    The use of neuromuscular blocking agent (NMBA) during anesthesia may interfere with facial nerve monitoring (FNM) during parotid surgery. Sugammadex has been reported to be an effective and safe reversal of rocuronium-induced neuromuscular block (NMB) during surgery. This study investigated the feasibility and clinical effectiveness of sugammadex for NMB reversal during FNM in Parotid surgery. Fifty patients undergoing parotid surgery were randomized allocated into conventional anesthesia group (Group C, n = 25) and sugammadex group (Group S, n = 25). Group C did not receive any NMBA. Group S received rocuronium 0.6 mg/kg at anesthesia induction and sugammadex 2 mg/kg at skin incision. The intubating condition and influence on FNM evoked EMG results were compared between groups. The intubation condition showed significantly better in group S patients than C group patients (excellent in 96% v.s. 24%). In group S, rapid reverse of NMB was found and the twitch (%) recovered from 0 to >90% within 10 min. Positive and high EMG signals were obtained in all patients at the time point of initial facial nerve stimulation in both groups. There was no significant difference as comparing the EMG amplitudes detected at the time point of initial and final facial nerve stimulation in both groups. Implementation of sugammadex in anesthesia protocol is feasible and reliable for successful FNM during parotid surgery. Copyright © 2017. Published by Elsevier Taiwan.

  2. Is low serum albumin associated with postoperative complications in patients undergoing cardiac surgery?

    Science.gov (United States)

    Karas, Pamela L; Goh, Sean L; Dhital, Kumud

    2015-12-01

    A best evidence topic was written according to a structured protocol. The clinical question investigated was: is low serum albumin associated with postoperative complications in patients undergoing cardiac surgery? There were 62 papers retrieved using the reported search strategy. Of these, 12 publications embodied the best evidence to answer this clinical question. The authors, journal, date and country of the publication, patient group investigated, study design, relevant outcomes and results of these papers were tabulated. This paper includes a total of 12 589 patients, and of the papers reviewed, 4 were level 3 and 8 level 4. Each of the publications reviewed and compared either all or some of the following postoperative complications: mortality, postoperative bleeding requiring reoperation, prolonged hospital stay and ventilatory support, infection, liver dysfunction, delirium and acute kidney injury (AKI). Of the studies that examined postoperative mortality, all except for three established a significant multivariate association with low preoperative albumin level. Some scepticism is required in accepting other results that were only present in univariate analysis. While three studies examined multiple levels of serum albumin, most dichotomized the serum albumin levels into normal and abnormal groups. This led to differing classifications of hypoalbuminaemia, ranging from less than 2.5 to 4.0 g/dl. The available evidence, however, suggests that low preoperative serum albumin level in patients undergoing cardiac surgery is associated with the following: (i) increased risk of mortality after surgery and (ii) greater incidence of postoperative morbidity. While the evidence supports the use of preoperative albumin in assessing post-cardiac surgery complications, a specific level of albumin considered to be abnormal cannot be concluded from this review. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio

  3. Granisetron plus dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery: A meta-analysis.

    Science.gov (United States)

    Zhu, Min; Zhou, Chengmao; Huang, Bing; Ruan, Lin; Liang, Rui

    2017-06-01

    Objective This study was designed to compare the effectiveness of granisetron plus dexamethasone for preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic surgery. Methods We searched the literature in the Cochrane Library, PubMed, EMBASE, and CNKI. Results In total, 11 randomized controlled trials were enrolled in this analysis. The meta-analysis showed that granisetron in combination with dexamethasone was significantly more effective than granisetron alone in preventing PONV in patients undergoing laparoscopy surgery. No significant differences in adverse reactions (dizziness and headache) were found in association with dexamethasone. Conclusion Granisetron in combination with dexamethasone was significantly more effective than granisetron alone in preventing PONV in patients undergoing laparoscopic surgery, with no difference in adverse reactions between the two groups. Granisetron alone or granisetron plus dexamethasone can be used to prevent PONV in patients undergoing laparoscopic surgery.

  4. The influence of the premedication consult and preparatory information about anesthesia on anxiety among patients undergoing cardiac surgery

    NARCIS (Netherlands)

    Van der Zee, K.I.; Gallandat Huet, R.CG; Cazemier, C; Evers, K

    The present study examines the impact of patients' subjective evaluation of the premedication consult and of preparatory information about anesthesia on preoperative anxiety among patients undergoing cardiac surgery (N=93). The preparatory information concerned a flyer that contained information

  5. The influence of the premedication consult and preparatory information about anesthesia on anxiety among patients undergoing cardiac surgery

    NARCIS (Netherlands)

    Van der Zee, K. I.; Huet, R. C.Gallandat; Cazemier, C.; Evers, K.

    The present study examines the impact of patients' subjective evaluation of the premedication consult and of preparatory information about anesthesia on preoperative anxiety among patients undergoing cardiac surgery (N = 93). The preparatory information concerned a flyer that contained information

  6. The feasibility of measuring renal blood flow using transesophageal echocardiography in patients undergoing cardiac surgery.

    Science.gov (United States)

    Yang, Ping-Liang; Wong, David T; Dai, Shuang-Bo; Song, Hai-Bo; Ye, Ling; Liu, Jin; Liu, Bin

    2009-05-01

    There is no reliable method to monitor renal blood flow intraoperatively. In this study, we evaluated the feasibility and reproducibility of left renal blood flow measurements using transesophageal echocardiography during cardiac surgery. In this prospective noninterventional study, left renal blood flow was measured with transesophageal echocardiography during three time points (pre-, intra-, and postcardiopulmonary bypass) in 60 patients undergoing cardiac surgery. Sonograms from 6 subjects were interpreted by 2 blinded independent assessors at the time of acquisition and 6 mo later. Interobserver and intraobserver reproducibility were quantified by calculating variability and intraclass correlation coefficients. Patients with Doppler angles of >30 degrees (20 of 60 subjects) were eliminated from renal blood flow measurements. Left renal blood flow was successfully measured and analyzed in 36 of 60 (60%) subjects. Both interobserver and intraobserver variability were renal blood flow measurements were good to excellent (intraclass correlation coefficients 0.604-0.999). Left renal arterial luminal diameter for the pre, intra, and postcardiopulmonary bypass phases, ranged from 3.8 to 4.1 mm, renal arterial velocity from 25 to 35 cm/s, and left renal blood flow from 192 to 299 mL/min. In patients undergoing cardiac surgery, it was feasible in 60% of the subjects to measure left renal blood flow using intraoperative transesophageal echocardiography. The interobserver and intraobserver reproducibility of renal blood flow measurements was good to excellent.

  7. Ventilation and cardiac related impedance changes in children undergoing corrective open heart surgery

    International Nuclear Information System (INIS)

    Schibler, Andreas; Pham, Trang M T; Moray, Amol A; Stocker, Christian

    2013-01-01

    Electrical impedance tomography (EIT) can determine ventilation and perfusion relationship. Most of the data obtained so far originates from experimental settings and in healthy subjects. The aim of this study was to demonstrate that EIT measures the perioperative changes in pulmonary blood flow after repair of a ventricular septum defect in children with haemodynamic relevant septal defects undergoing open heart surgery. In a 19 bed intensive care unit in a tertiary children's hospital ventilation and cardiac related impedance changes were measured using EIT before and after surgery in 18 spontaneously breathing patients. The EIT signals were either filtered for ventilation (ΔZV) or for cardiac (ΔZQ) related impedance changes. Impedance signals were then normalized (normΔZV, normΔZQ) for calculation of the global and regional impedance related ventilation perfusion relationship (normΔZV/normΔZQ). We observed a trend towards increased normΔZV in all lung regions, a significantly decreased normΔZQ in the global and anterior, but not the posterior lung region. The normΔZV/normΔZQ was significantly increased in the global and anterior lung region. Our study qualitatively validates our previously published modified EIT filtration technique in the clinical setting of young children with significant left-to-right shunt undergoing corrective open heart surgery, where perioperative assessment of the ventilation perfusion relation is of high clinical relevance. (paper)

  8. Ventilation and cardiac related impedance changes in children undergoing corrective open heart surgery.

    Science.gov (United States)

    Schibler, Andreas; Pham, Trang M T; Moray, Amol A; Stocker, Christian

    2013-10-01

    Electrical impedance tomography (EIT) can determine ventilation and perfusion relationship. Most of the data obtained so far originates from experimental settings and in healthy subjects. The aim of this study was to demonstrate that EIT measures the perioperative changes in pulmonary blood flow after repair of a ventricular septum defect in children with haemodynamic relevant septal defects undergoing open heart surgery. In a 19 bed intensive care unit in a tertiary children's hospital ventilation and cardiac related impedance changes were measured using EIT before and after surgery in 18 spontaneously breathing patients. The EIT signals were either filtered for ventilation (ΔZV) or for cardiac (ΔZQ) related impedance changes. Impedance signals were then normalized (normΔZV, normΔZQ) for calculation of the global and regional impedance related ventilation perfusion relationship (normΔZV/normΔZQ). We observed a trend towards increased normΔZV in all lung regions, a significantly decreased normΔZQ in the global and anterior, but not the posterior lung region. The normΔZV/normΔZQ was significantly increased in the global and anterior lung region. Our study qualitatively validates our previously published modified EIT filtration technique in the clinical setting of young children with significant left-to-right shunt undergoing corrective open heart surgery, where perioperative assessment of the ventilation perfusion relation is of high clinical relevance.

  9. Predictive factors for red blood cell transfusion in children undergoing noncomplex cardiac surgery.

    Science.gov (United States)

    Mulaj, Muj; Faraoni, David; Willems, Ariane; Sanchez Torres, Cristel; Van der Linden, Philippe

    2014-08-01

    Red blood cell (RBC) transfusion is frequently required in pediatric cardiac surgery and is associated with altered outcome and increased costs. Determining which factors predict transfusion in this context will enable clinicians to adopt strategies that will reduce the risk of RBC transfusion. This study aimed to assess predictive factors associated with RBC transfusion in children undergoing low-risk cardiac surgery with cardiopulmonary bypass (CPB). Children undergoing surgery to repair ventricular septal defect or atrioventricular septal defect from 2006 to 2011 were included in this retrospective study. Demography, preoperative laboratory testing, intraoperative data, and RBC transfusion were reviewed. Univariate and multivariate logistic regression analysis were used to define factors that were able to predict RBC transfusion. Then, we employed receiver operating characteristic analysis to design a predictive score. Among the 334 children included, 261 (78%) were transfused. Age (43 mL/kg), type of oxygenator used, minimal temperature reached during CPB (<32°C), and preoperative hematocrit (<34%) were independently associated with RBC transfusion in the studied population. A predictive score 2 or greater was the best predictor of RBC transfusion. The present study identified several factors that were significantly associated with perioperative RBC transfusion. Based on these factors, we designed a predictive score that can be used to develop a patient-based blood management program with the aim of reducing the incidence of RBC transfusion. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Conjunctival bacterial flora and antibiotic resistance pattern in patients undergoing cataract surgery

    International Nuclear Information System (INIS)

    Ansari, M.R.; Modani, H.

    2008-01-01

    The purpose of this study was to evaluate the conjunctival bacterial flora and its antibiotic susceptibility pattern in eyes of patients undergoing cataract surgery. Conjunctival soap was obtained on the day of surgery before the application of topical anesthetic, antibiotic or povidone-iodine. Culture and antibiotic susceptibility tests were performed. The data was analysed with X/sup 2/ and T tests. Of the 170 patients 89 cases (52.4%) had positive cultures in the eyes. In 79 eyes (88.8%) found coagulase-negative Staphylococcus (CoNS). Eighty two cases (95.3%) of isolated Staphylococcus were susceptible to Amikacin, 86 (100%) sensitive to Ciprofloxacin and 42 (48.8%) sensitive to Ceftazidime. Average susceptibility and resistancy to antibiotics was 2.6 (+-1.8) antibiotics in women and 1.6(+-1.4) in men (P= 0.009). This study showed that the bacterium most frequently found in the conjunctival flora of the patients undergoing cataract surgery was CoNS. Isolates of this bacterium had low CoNS susceptibility rates to Caftazidime and Vancomycin and high susceptibility to Ciprofloxacin and Amikacin. (author)

  11. Conjunctival bacterial flora and antibiotic resistance pattern in patients undergoing cataract surgery

    Directory of Open Access Journals (Sweden)

    Arantes Tiago Eugênio Faria e

    2006-01-01

    Full Text Available PURPOSE: To evaluate the conjunctival bacterial flora and its antibiotic resistance pattern in eyes of patients undergoing cataract surgery. METHODS: From August to October 2004, 50 patients undergoing cataract surgery in the "Fundação Altino Ventura", Recife, Brazil, were prospectively evaluated. Conjunctival material was obtained on the day of surgery, before the application of topical anesthetic, antibiotic or povidone-iodine. The collected material was inoculated and bacterioscopic analysis was carried out. In the cases where there was bacterial growth, antibiotic susceptibility tests and cultures, for isolation and identification of the bacteria, were performed. RESULTS: Of the 50 eyes, 43 (86.0% had positive cultures. The coagulase-negative Staphylococcus (CNS, found in 27 (54.0% eyes, was the most frequent organism. More than 90% of the isolates of this bacterium were susceptible to cephalotin, vancomycin, chloramphenicol, ofloxacin and gatifloxacin; 70 to 90% were susceptible to gentamicin, cefotaxime, oxacillin and ciprofloxacin; and less than 70% were sensible to neomycin. Four (10.5% of the bacterial isolates were resistant to four or more antibiotics, two of them were CNS. CONCLUSION: The most frequent bacterium in the conjunctival flora is the coagulase-negative Staphylococcus. The isolates of this organism showed low susceptibility rate to neomycin, and high susceptibility rates to cephalotin, vancomycin, chloramphenicol, ofloxacin and gatifloxacin.

  12. Factors Associated with Post-Surgical Delirium in Patients Undergoing Open Heart Surgery

    Directory of Open Access Journals (Sweden)

    Yadollah Jannati

    2014-09-01

    Full Text Available Objective: The objective of the present study is to determine the incidence of delirium and the associated factors in patients undergoing open heart surgery. Methods: This is an Analytic-descriptive study conducted on 404 patients undergoing elective open heart surgery in Fatemeh Zahra Heart Center, Sari, over the period of 6 months from July to December 2011. Sampling was achieved in a nonrandomized targeted manner and delirium was assessed using NeeCham questionnaire. A trained nurse evaluated the patients for delirium and completed the risk factor checklist on days 1 to 5 after surgery. Data analyses were accomplished using survival analysis (Kaplan-Meier and Cox regression on SPSS software version 15. Results: We found that variables, including ventilation time, increased drainage during the first 24 hours, the need for re-operation in the first 24 hours, dysrhythmias, use of inotropic agents, increased use of analgesics, increased arterial carbon dioxide, lack of visitors, and use of physical restrainers were associated with the development of delirium. In addition, we found a delirium incidence of 29%. Conclusion: Diagnosis of cognitive disorders is of utmost value; therefore, further studies are required to clarify the risk factors because controlling them will help prevent delirium.

  13. Structural, Nursing, and Physician Characteristics and 30-Day Mortality for Patients Undergoing Cardiac Surgery in Pennsylvania.

    Science.gov (United States)

    Lane-Fall, Meghan B; Ramaswamy, Tara S; Brown, Sydney E S; He, Xu; Gutsche, Jacob T; Fleisher, Lee A; Neuman, Mark D

    2017-09-01

    Cardiac surgery ICU characteristics and clinician staffing patterns have not been well characterized. We sought to describe Pennsylvania cardiac ICUs and to determine whether ICU characteristics are associated with mortality in the 30 days after cardiac surgery. From 2012 to 2013, we conducted a survey of cardiac surgery ICUs in Pennsylvania to assess ICU structure, care practices, and clinician staffing patterns. ICU data were linked to an administrative database of cardiac surgery patient discharges. We used logistic regression to measure the association between ICU variables and death in 30 days. Cardiac surgery ICUs in Pennsylvania. Patients having coronary artery bypass grafting and/or cardiac valve repair or replacement from 2009 to 2011. None. Of the 57 cardiac surgical ICUs in Pennsylvania, 43 (75.4%) responded to the facility survey. Rounds included respiratory therapists in 26 of 43 (60.5%) and pharmacists in 23 of 43 (53.5%). Eleven of 41 (26.8%) reported that at least 2/3 of their nurses had a bachelor's degree in nursing. Advanced practice providers were present in most of the ICUs (37/43; 86.0%) but residents (8/42; 18.6%) and fellows (7/43; 16.3%) were not. Daytime intensivists were present in 21 of 43 (48.8%) responding ICUs; eight of 43 (18.6%) had nighttime intensivists. Among 29,449 patients, there was no relationship between mortality and nurse ICU experience, presence of any intensivist, or absence of residents after risk adjustment. To exclude patients who may have undergone transcatheter aortic valve replacement, we conducted a subgroup analysis of patients undergoing only coronary artery bypass grafting, and results were similar. Pennsylvania cardiac surgery ICUs have variable structures, care practices, and clinician staffing, although none of these are statistically significantly associated with mortality in the 30 days following surgery after adjustment.

  14. Comparing Written and Planned Training On Anxiety among Patients Undergoing Orthopedic Surgery

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    maryam tolyat

    2017-03-01

    Full Text Available Introduction and objectives: The prevalence of preoperative state anxiety is an unavoidable complication. Aside from its type and scope, the surgical operation is considered as a severe stressful situation for patients. Considering the importance of reducing the state anxiety in patients undergoing surgery, there are different methods, one of which is patient education; therefore the aim of the current study was compare the effect of written and planned training on the state anxiety among patients undergoing orthopedic surgery. Method: In this study, 81 patients candidate for orthopedic surgery were selected using convenience sampling and were randomly divided into 3 groups, including planned training, pamphlet and control groups. All patients answered 20 questions-State-Traits Anxiety Inventory (STAI Questionnaire the day before surgery and the intervention was later carried out in the planned training and pamphlet groups. Then the effect of preoperative state anxiety was re-evaluated about half an hour after training in three groups. For data analysis, in addition to mean and standard deviation, independent t-test and ANOVA were used in Spss16. Results: The results of comparing pre- and post-training mean score of the state anxiety in three groups showed that the mean score of state anxiety reached from 50.41 to 41.03, 52.41 to 44.37 and 45.04 to 50.56 in planned, pamphlet and control groups, respectively. ANOVA test showed that there is a significant difference in this comparison. The results of Tukey's test also revealed that the mean score of state anxiety in the planned and pamphlet groups was lower significantly than the control group (p<0.05. Conclusion: Based on research findings, the planned training method was more effective in decreasing state anxiety among patients compared to the pamphlet group before orthopedic surgery. Therefore, considering the fact that nurses play an important role in examining and relieving the state anxiety

  15. Depression as an independent predictor of postoperative delirium in spine deformity patients undergoing elective spine surgery.

    Science.gov (United States)

    Elsamadicy, Aladine A; Adogwa, Owoicho; Lydon, Emily; Sergesketter, Amanda; Kaakati, Rayan; Mehta, Ankit I; Vasquez, Raul A; Cheng, Joseph; Bagley, Carlos A; Karikari, Isaac O

    2017-08-01

    OBJECTIVE Depression is the most prevalent affective disorder in the US, and patients with spinal deformity are at increased risk. Postoperative delirium has been associated with inferior surgical outcomes, including morbidity and mortality. The relationship between depression and postoperative delirium in patients undergoing spine surgery is relatively unknown. The aim of this study was to determine if depression is an independent risk factor for the development of postoperative delirium in patients undergoing decompression and fusion for deformity. METHODS The medical records of 923 adult patients (age ≥ 18 years) undergoing elective spine surgery at a single major academic institution from 2005 through 2015 were reviewed. Of these patients, 255 (27.6%) patients had been diagnosed with depression by a board-certified psychiatrist and constituted the Depression group; the remaining 668 patients constituted the No-Depression group. Patient demographics, comorbidities, and intra- and postoperative complication rates were collected for each patient and compared between groups. The primary outcome investigated in this study was rate of postoperative delirium, according to DSM-V criteria, during initial hospital stay after surgery. The association between depression and postoperative delirium rate was assessed via multivariate logistic regression analysis. RESULTS Patient demographics and comorbidities other than depression were similar in the 2 groups. In the Depression group, 85.1% of the patients were taking an antidepressant prior to surgery. There were no significant between-group differences in intraoperative variables and rates of complications other than delirium. Postoperative complication rates were also similar between the cohorts, including rates of urinary tract infection, fever, deep and superficial surgical site infection, pulmonary embolism, deep vein thrombosis, urinary retention, and proportion of patients transferred to the intensive care unit. In

  16. High Prevalence of Nonalcoholic Fatty Liver Disease in Adolescents Undergoing Bariatric Surgery.

    Science.gov (United States)

    Xanthakos, Stavra A; Jenkins, Todd M; Kleiner, David E; Boyce, Tawny W; Mourya, Reena; Karns, Rebekah; Brandt, Mary L; Harmon, Carroll M; Helmrath, Michael A; Michalsky, Marc P; Courcoulas, Anita P; Zeller, Meg H; Inge, Thomas H

    2015-09-01

    Little is known about the prevalence of nonalcoholic fatty liver disease (NAFLD) among severely obese adolescents or factors that determine its development. We investigated the prevalence of NAFLD in a multicenter cohort of adolescents undergoing bariatric surgery and the factors associated with it. We enrolled 242 adolescents undergoing bariatric surgery between March 2007 and February 2012 at 5 tertiary care centers into a multicenter, prospective observational cohort study. Intraoperative core liver biopsies were collected from 165 subjects; 17 were excluded because of insufficient liver tissue or use of hepatotoxic medications, so 148 remained in the study (mean age, 16.8 ± 1.6 years; median body mass index = 52 kg/m(2)). Liver tissues were analyzed by histology using validated criteria. Hepatic gene expression was analyzed in 67 samples. NAFLD was present in 59% of this predominantly female (72%), white (68%), non-Hispanic (91%) cohort. Of subjects with NAFLD, 24% had borderline and 10% had definite nonalcoholic steatohepatitis (NASH). Mild fibrosis (stage 2 or lower) was observed in 18% of liver biopsies and stage 3 was observed in 0.7%, but cirrhosis was not detected. Dyslipidemia was present in 78% of subjects, hypertension in 44%, and diabetes in 14%. More severe NAFLD was associated with increasing levels of alanine aminotransferase, fasting glucose level, hypertension (each P adolescents undergoing bariatric surgery in this cohort had NAFLD, yet the prevalence of severe or fibrotic NASH was low. Increasing severity of NAFLD was associated with level of alanine aminotransferase and cardiometabolic risk factors, but not body mass index. Based on gene expression analysis, borderline and definite NASH were associated with abnormal immune function, intestinal cholesterol absorption, and lipid metabolism. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

  17. Early symptoms in the prodromal phase of delirium: a prospective cohort study in elderly patients undergoing hip surgery

    NARCIS (Netherlands)

    de Jonghe, Jos F. M.; Kalisvaart, Kees J.; Dijkstra, Marty; van Dis, Huib; Vreeswijk, Ralph; Kat, Martin G.; Eikelenboom, Piet; van der Ploeg, Tjeerd; van Goo, Willem A.

    2007-01-01

    OBJECTIVES: The authors investigated prodromal delirium symptoms in elderly patients undergoing hip surgery. METHODS: This was a prospective cohort study in the setting of a large medical school-affiliated general hospital in Alkmaar, The Netherlands. Participants were patients undergoing hip

  18. Rhabdomyolysis and compartment syndrome in a bodybuilder undergoing minimally invasive cardiac surgery

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    Sebastian John Baxter

    2017-01-01

    Full Text Available Rhabdomyolysis is the result of skeletal muscle tissue injury and is characterized by elevated creatine kinase levels, muscle pain, and myoglobinuria. It is caused by crush injuries, hyperthermia, drugs, toxins, and abnormal metabolic states. This is often difficult to diagnose perioperatively and can result in renal failure and compartment syndrome if not promptly treated. We report a rare case of inadvertent rhabdomyolysis and compartment syndrome in a bodybuilder undergoing minimally invasive cardiac surgery. The presentation, differential diagnoses, and management are discussed. Hyperkalemia may be the first presenting sign. Early recognition and management are essential to prevent life-threatening complications.

  19. A study of dysphagia symptoms and esophageal body function in children undergoing anti-reflux surgery

    OpenAIRE

    Omari, T.; Connor, F.; McCall, L.; Ferris, L.; Ellison, S.; Hanson, B.; Abu-Assi, R.; Khurana, S.; Moore, D.

    2018-01-01

    Background: The role of high-resolution esophageal impedance manometry (HRIM) for establishing risk for dysphagia after anti-reflux surgery is unclear. We conducted a prospective study of children with primary gastroesophageal reflux (GER) disease, for whom symptoms of dysphagia were determined pre-operatively and then post-operatively and we examined for features that may predict post-operative dysphagia. Methods: Thirteen children (aged 6.8–15.5 years) undergoing work-up prior to 360 o Niss...

  20. Incidence and Prognosis of Psoriasis and Psoriatic Arthritis in Patients Undergoing Bariatric Surgery

    DEFF Research Database (Denmark)

    Egeberg, Alexander; Sørensen, Jens Ahm; Gislason, Gunnar Hilmar

    2017-01-01

    and psoriatic arthritis in patients undergoing bariatric surgery (gastric bypass and gastric banding). Design, Setting, and Participants: This population-based cohort study used individual-level linkage of administrative and public health registers in Denmark. All Danish citizens who received gastric bypass.......29 (95% CI, 0.12-0.71) and 0.53 (95% CI, 0.08-3.56) for gastric bypass and gastric banding, respectively. Conclusions and Relevance: Gastric bypass was associated with a significantly reduced risk and improved prognosis of psoriasis and psoriatic arthritis, whereas gastric banding was not. This finding...

  1. Glucose and protein kinetics in patients undergoing colorectal surgery: perioperative amino acid versus hypocaloric dextrose infusion.

    Science.gov (United States)

    Lugli, Andrea Kopp; Schricker, Thomas; Wykes, Linda; Lattermann, Ralph; Carli, Franco

    2010-11-01

    Surgical injury provokes a stress response that leads to a catabolic state and, when prolonged, interferes with the postoperative recovery process. This study tests the impact of 2 nutrition support regimens on protein and glucose metabolism as part of an integrated approach in the perioperative period incorporating epidural analgesia in 18 nondiabetic patients undergoing colorectal surgery. To test the hypothesis that parenteral amino acid infusion (amino acid group, n = 9) maintains glucose homeostasis while maintaining normoglycemia and reduces proteolysis compared with infusion of dextrose alone (DEX group, n = 9), glucose and protein kinetics were measured before and on the second day after surgery using a stable isotope tracer technique. Postoperatively, the rate of appearance of glucose was higher (P dextrose alone. Copyright © 2010 Elsevier Inc. All rights reserved.

  2. Postoperative infection and natural killer cell function following blood transfusion in patients undergoing elective colorectal surgery

    DEFF Research Database (Denmark)

    Jensen, L S; Andersen, A J; Christiansen, P M

    1992-01-01

    The frequency of infection in 197 patients undergoing elective colorectal surgery and having either no blood transfusion, transfusion with whole blood, or filtered blood free from leucocytes and platelets was investigated in a prospective randomized trial. Natural killer cell function was measured...... before operation and 3, 7 and 30 days after surgery in 60 consecutive patients. Of the patients 104 required blood transfusion; 48 received filtered blood and 56 underwent whole blood transfusion. Postoperative infections developed in 13 patients transfused with whole blood (23 per cent, 95 per cent...... confidence interval 13-32 per cent), in one patient transfused with blood free from leucocytes and platelets (2 per cent, 95 per cent confidence interval 0.05-11 per cent) and in two non-transfused patients (2 per cent, 95 per cent confidence interval 0.3-8 per cent) (P less than 0.01). Natural killer cell...

  3. Quality of life of patients undergoing surgery by videolaparoscopy for GERD treatment.

    Science.gov (United States)

    Andrade, Francisco José Cavalcante; de Almeida, Eliete Rodrigues; dos Santos, Maria Teresa Botti Rodrigues; Soares-Filho, Eurípedes; Lopes, João Batista; Veras e Silva, Roberto Cavalcante

    2012-01-01

    Gastroesophageal reflux disease is a chronic disease of high prevalence in Western countries, with negative effects on quality of life. Surgery is indicated for patients with intolerance to continuous medication, prolonged treatment or control, or in complicated forms of the disease. To evaluate the quality of life of patients undergoing surgery by videolaparoscopy for gastroesophageal reflux disease treatment. Sample comprised 43 patients of both genders (mean age = 51.4 years). For quality of life evaluation was made using the questionnaire Gastroesophageal Reflux Disease Health Related Quality of Life, translated and validated into Portuguese. Data were analyzed by Epi Info version 3.5.1, using Duncan test and Pearson's correlation coefficient, with 5% for null hypothesis (p ≤ 0.05). Over 50% of participants showed good quality of life (scores quality of life and high level of satisfaction with their postoperative condition.

  4. Blood utilization in neonates and infants undergoing cardiac surgery requiring cardiopulmonary bypass.

    Science.gov (United States)

    Wesley, Mark C; Yuki, Koichi; Daaboul, Dima G; Dinardo, James A

    2011-07-01

    Neonates and infants undergoing cardiac surgery with cardiopulmonary bypass are exposed to multiple blood products from different donors. The volume of the bypass circuit is often as large as the patient's total blood volume and asanguineous bypass primes are unusual. As a result, blood products are required for the cardiopulmonary bypass prime and are often used to treat the postbypass dilutional coagulopathy. We review clot formation and strength, cardiopulmonary bypass prime considerations, assessment of postbypass coagulopathy, component therapy use, ultrafiltration techniques, and use of antifibrinolytic medications. A combined approach including techniques to minimize the prime volume, utilization of ultrafiltration, administration of antifibrinolytics during surgery, and the proper treatment of the dilutional coagulopathy can limit the transfusion requirements.

  5. Sarcopenia is a predictor of outcomes in very elderly patients undergoing emergency surgery.

    Science.gov (United States)

    Du, Yang; Karvellas, Constantine J; Baracos, Vickie; Williams, David C; Khadaroo, Rachel G

    2014-09-01

    With the increasing aging population, the number of very elderly patients (age ≥80 years) undergoing emergency operations is increasing. Evaluating patient-specific risk factors for postoperative morbidity and mortality in the acute care surgery setting is crucial to improving outcomes. We hypothesize that sarcopenia, a severe depletion of skeletal muscles, is a predictor of morbidity and mortality in very elderly patients undergoing emergency surgery. A total of 170 patients older than the age of 80 underwent emergency surgery between 2008 and 2010 at a tertiary care facility; 100 of these patients had abdominal computed tomography images within 30 days of the operation that were adequate for the assessment of sarcopenia. The impact of sarcopenia on the operative outcomes was evaluated using both univariate and multivariate analysis. The mean patient age was 84 years, with an in-hospital mortality of 18%. Sarcopenia was present in 73% of patients. More sarcopenic patients had postoperative complications (45% sarcopenic versus 15% nonsarcopenic, P = .005) and more died in hospital (23 vs 4%, P = .037). There were no differences in duration of stay or requirement for intensive care unit postoperatively. After we controlled for confounding factors, increasing skeletal muscle index (per incremental cm(2)/m(2)) was associated with decreased in-hospital mortality (odds ratio ∼0.834, 95% confidence interval 0.731-0.952, P = .007) in multivariate analysis. Sarcopenia was independently predictive of greater complication rates, discharge disposition, and in-hospital mortality in the very elderly emergency surgery population. Using sarcopenia as an objective tool to identify high-risk patients would be beneficial in developing tailored preventative strategies and potentially resource allocation in the future. Copyright © 2014 Mosby, Inc. All rights reserved.

  6. Intraoperative Ultrasound in Patients Undergoing Transsphenoidal Surgery for Pituitary Adenoma: Systematic Review [corrected].

    Science.gov (United States)

    Marcus, Hani J; Vercauteren, Tom; Ourselin, Sebastien; Dorward, Neil L

    2017-10-01

    Transsphenoidal surgery is the gold standard for pituitary adenoma resection. However, despite advances in microsurgical and endoscopic techniques, some pituitary adenomas can be challenging to cure. We sought to determine whether, in patients undergoing transsphenoidal surgery for pituitary adenoma, intraoperative ultrasound is a safe and effective technologic adjunct. The PubMed database was searched between January 1996 and January 2016 to identify relevant publications that 1) featured patients undergoing transsphenoidal surgery for pituitary adenoma, 2) used intraoperative ultrasound, and 3) reported on safety or effectiveness. Reference lists were also checked, and expert opinions were sought to identify further publications. Ultimately, 10 studies were included, comprising 1 cohort study, 7 case series, and 2 case reports. One study reported their prototype probe malfunctioned, leading to false-positive results in 2 cases, and another study' prototype probe was too large to safely enter the sphenoid sinus in 2 cases. Otherwise, no safety issues directly related to use of intraoperative ultrasound were reported. In the only comparative study, remission occurred in 89.7% (61/68) of patients with Cushing disease in whom intraoperative ultrasound was used, compared with 83.8% (57/68) in whom it was not. All studies reported that surgeons anecdotally found intraoperative ultrasound helpful. Although there is limited and low-quality evidence available, the use of intraoperative ultrasound appears to be a safe and effective technologic adjunct to transsphenoidal surgery for pituitary adenoma. Advances in ultrasound technology may allow for more widespread use of such devices. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. The prevalence of glaucoma in patients undergoing surgery for eyelid entropion or ectropion

    Directory of Open Access Journals (Sweden)

    Golan S

    2016-10-01

    Full Text Available Shani Golan, Gilad Rabina, Shimon Kurtz, Igal Leibovitch Division of Orbital and Ophthalmic Plastic Surgery, Department of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Purpose and design: The aim of this study was to establish the prevalence of known glaucoma in patients undergoing ectropion or entropion surgical repair. In this study, retrospective review of case series was performed.Participants: All patients who underwent ectropion or entropion surgery in a tertiary medical center between 2007 and 2014 were included. The etiology of eyelid malpositioning was involutional or cicatricial.Methods: The medical files of the study participants were reviewed for the presence and type of glaucoma, medical treatment, duration of treatment, and the amount of drops per day. These data were compared to a matched control group of 101 patients who underwent blepharoplasty for dermatochalasis in the same department during the same period.Main outcome measure: In this study, the prevalence of glaucoma in individuals with ectropion or entropion was the main outcome measure.Results: A total of 227 patients (57% men, mean age: 79.2 years who underwent ectropion or entropion surgery comprised the study group and 101 patients who underwent upper blepharoplasty for dermatochalasis comprised the control group. Compared to four patients in the control group (4%, P=0.01, 30 of the study patients (13.2% had coexisting glaucoma. Of 30 glaucomatous patients, 25 had primary open-angle glaucoma for a mean duration of 10.3 years. The glaucomatous patients were treated with an average of 2.7 antiglaucoma medications.Conclusion: An increased prevalence of known glaucoma in patients undergoing ectropion or entropion repair surgery was found. This observation may indicate that the chronic usage of topical anti-glaucoma eyedrops may lead to an increased risk of developing eyelid malpositions, especially in

  8. 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.

  9. Obesity is associated with increased health care charges in patients undergoing outpatient plastic surgery.

    Science.gov (United States)

    Sieffert, Michelle R; Fox, Justin P; Abbott, Lindsay E; Johnson, R Michael

    2015-05-01

    Obesity is associated with greater rates of surgical complications. To address these complications after outpatient plastic surgery, obese patients may seek care in the emergency department and potentially require admission to the hospital, which could result in greater health care charges. The purpose of this study was to determine the relationship of obesity, postdischarge hospital-based acute care, and hospital charges within 30 days of outpatient plastic surgery. From state ambulatory surgery center databases in four states, all discharges for adult patients who underwent liposuction, abdominoplasty, breast reduction, and blepharoplasty were identified. Patients were grouped by the presence or absence of obesity. Multivariable regression models were used to compare the frequency of hospital-based acute care, serious adverse events, and hospital charges within 30 days between groups while controlling for confounding variables. The final sample included 47,741 discharges, with 2052 of these discharges (4.3 percent) being obese. Obese patients more frequently had a hospital-based acute care encounter [7.3 percent versus 3.9 percent; adjusted OR, 1.35 (95% CI,1.13 to 1.61)] or serious adverse event [3.2 percent versus 0.9 percent; adjusted OR, 1.73 (95% CI, 1.30 to 2.29)] within 30 days of surgery. Obese patients had adjusted hospital charges that were, on average, $3917, $7412, and $7059 greater (p Obese patients who undergo common outpatient plastic surgery procedures incur substantially greater health care charges, in part attributable to more frequent adverse events and hospital-based health care within 30 days of surgery. Risk, II.

  10. Analysis of the prevalence of atelectasis in patients undergoing bariatric surgery

    Directory of Open Access Journals (Sweden)

    Letícia Baltieri

    Full Text Available Abstract Background and objective: To observe the prevalence of atelectasis in patients undergoing bariatric surgery and the influence of the body mass index (BMI, gender and age on the prevalence of atelectasis. Method: Retrospective study of 407 patients and reports on chest X-rays carried out before and after bariatric surgery over a period of 14 months. Only patients who underwent bariatric surgery by laparotomy were included. Results: There was an overall prevalence of 37.84% of atelectasis, with the highest prevalence in the lung bases and with greater prevalence in women (RR = 1.48. There was a ratio of 30% for the influence of age for individuals under the age of 36, and of 45% for those older than 36 (RR = 0.68. There was no significant influence of BMI on the prevalence of atelectasis. Conclusion: The prevalence of atelectasis in bariatric surgery is 37% and the main risk factors are being female and aged over 36 years.

  11. Cerebral oxygenation monitoring in patients with bilateral carotid stenosis undergoing urgent cardiac surgery: Observational case series

    Directory of Open Access Journals (Sweden)

    Dincer Aktuerk

    2016-01-01

    Full Text Available Background: Patients with significant bilateral carotid artery stenosis requiring urgent cardiac surgery have an increased risk of stroke and death. The optimal management strategy remains inconclusive, and the available evidence does not support the superiority of one strategy over another. Materials and Methods: A number of noninvasive strategies have been developed for minimizing perioperative stroke including continuous real-time monitoring of cerebral oxygenation with near-infrared spectroscopy (NIRS. The number of patients presenting with this combination (bilateral significant carotid stenosis requiring urgent cardiac surgery in any single institution will be small and hence there is a lack of large randomized studies. Results: This case series describes our early experience with NIRS in a select group of patients with significant bilateral carotid stenosis undergoing urgent cardiac surgery (n = 8. In contrast to other studies, this series is a single surgeon, single center study, where the entire surgery (both distal ends and proximal ends was performed during single aortic clamp technique, which effectively removes several confounding variables. NIRS monitoring led to the early recognition of decreased cerebral oxygenation, and corrective steps (increased cardiopulmonary bypass flow, increased pCO 2 , etc., were taken. Conclusion: The study shows good clinical outcome with the use of NIRS. This is our "work in progress," and we aim to conduct a larger study.

  12. Preoperative Electrocardiogram Score for Predicting New-Onset Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery.

    Science.gov (United States)

    Gu, Jiwei; Andreasen, Jan J; Melgaard, Jacob; Lundbye-Christensen, Søren; Hansen, John; Schmidt, Erik B; Thorsteinsson, Kristinn; Graff, Claus

    2017-02-01

    To investigate if electrocardiogram (ECG) markers from routine preoperative ECGs can be used in combination with clinical data to predict new-onset postoperative atrial fibrillation (POAF) following cardiac surgery. Retrospective observational case-control study. Single-center university hospital. One hundred consecutive adult patients (50 POAF, 50 without POAF) who underwent coronary artery bypass grafting, valve surgery, or combinations. Retrospective review of medical records and registration of POAF. Clinical data and demographics were retrieved from the Western Denmark Heart Registry and patient records. Paper tracings of preoperative ECGs were collected from patient records, and ECG measurements were read by two independent readers blinded to outcome. A subset of four clinical variables (age, gender, body mass index, and type of surgery) were selected to form a multivariate clinical prediction model for POAF and five ECG variables (QRS duration, PR interval, P-wave duration, left atrial enlargement, and left ventricular hypertrophy) were used in a multivariate ECG model. Adding ECG variables to the clinical prediction model significantly improved the area under the receiver operating characteristic curve from 0.54 to 0.67 (with cross-validation). The best predictive model for POAF was a combined clinical and ECG model with the following four variables: age, PR-interval, QRS duration, and left atrial enlargement. ECG markers obtained from a routine preoperative ECG may be helpful in predicting new-onset POAF in patients undergoing cardiac surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Hemostatic function to regulate perioperative bleeding in patients undergoing spinal surgery: A prospective observational study.

    Directory of Open Access Journals (Sweden)

    Atsushi Kimura

    Full Text Available Although bleeding is a common complication of surgery, routine laboratory tests have been demonstrated to have a low ability to predict perioperative bleeding. Better understanding of hemostatic function during surgery would lead to identification of high-risk patients for bleeding. Here, we aimed to elucidate hemostatic mechanisms to determine perioperative bleeding. We prospectively enrolled 104 patients undergoing cervical spinal surgery without bleeding diathesis. Blood sampling was performed just before the operation. Volumes of perioperative blood loss were compared with the results of detailed laboratory tests assessing primary hemostasis, secondary hemostasis, and fibrinolysis. Platelet aggregations induced by several agonists correlated with each other, and only two latent factors determined inter-individual difference. Platelet aggregability independently determined perioperative bleeding. We also identified low levels of plasminogen-activator inhibitor-1 (PAI-1 and α2-plasmin inhibitor to be independent risk factors for intraoperative and postoperative bleeding, respectively. Most important independent factor to determine postoperative bleeding was body weight. Of note, obese patients with low levels of PAI-1 became high-risk patients for bleeding during surgery. Our data suggest that bleeding after surgical procedure may be influenced by inter-individual differences of hemostatic function including platelet function and fibrinolysis, even in the patients without bleeding diathesis.

  14. The evaluation of preoperative nutritional status in patients undergoing thoracic surgery.

    Science.gov (United States)

    Trufă, D I; Arhire, Lidia Iuliana; Niţă, Otilia; Gherasim, Andreea; Niţă, G; Graur, Mariana

    2014-01-01

    The aim of this study was to assess the preoperative nutritional status of patients undergoing thoracic surgery using different nutritional tools. . We conducted a prospective study on a sample of 43 thoracic patients, including 23 with neoplasms and 20 with non-neoplastic pathology who underwent thoracic surgery procedures between July-September 2011, in the Thoracic Surgery Clinic in Iaşi. Weight and height were measured and body mass index (BMI) was calculated. WHO classification for BMI categories was used. Preoperative serum level of transthyretin (TTR) and demographic data (gender, age) were also assessed. All patients were examined by the Subjective Global Assessment (SGA) and the Nutritional Risk Screening 2002 (NRS 2002). After performing SGA, 67.9% of the patients were well-nourished, 21.4% were moderately or suspected of being malnourished and 10.7% were severely malnourished. The level of TTR was significantly lower in the moderately or severely malnourished group, compared to those considered well-nourished. According to NRS-2002, 42.9% of the patients were considered at nutritional risk. The level of TTR of these patients was lower than the level of TTR of the patients without nutritional risk, but without statistical significance. Subjective Global Assessment (SGA) and the Nutritional Risk Screening 2002 (NRS 2002) are useful in identifying patients with nutritional risk, so that appropriate nutritional management could be initialised even before surgery.

  15. Analysis of the prevalence of atelectasis in patients undergoing bariatric surgery.

    Science.gov (United States)

    Baltieri, Letícia; Peixoto-Souza, Fabiana Sobral; Rasera-Junior, Irineu; Montebelo, Maria Imaculada de Lima; Costa, Dirceu; Pazzianotto-Forti, Eli Maria

    To observe the prevalence of atelectasis in patients undergoing bariatric surgery and the influence of the body mass index (BMI), gender and age on the prevalence of atelectasis. Retrospective study of 407 patients and reports on chest X-rays carried out before and after bariatric surgery over a period of 14 months. Only patients who underwent bariatric surgery by laparotomy were included. There was an overall prevalence of 37.84% of atelectasis, with the highest prevalence in the lung bases and with greater prevalence in women (RR=1.48). There was a ratio of 30% for the influence of age for individuals under the age of 36, and of 45% for those older than 36 (RR=0.68). There was no significant influence of BMI on the prevalence of atelectasis. The prevalence of atelectasis in bariatric surgery is 37% and the main risk factors are being female and aged over 36 years. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  16. Cosmetic Surgery Makeover Programs and Intentions to Undergo Cosmetic Enhancements: A Consideration of Three Models of Media Effects

    Science.gov (United States)

    Nabi, Robin L.

    2009-01-01

    The recent proliferation of reality-based television programs highlighting cosmetic surgery has raised concerns that such programming promotes unrealistic expectations of plastic surgery and increases the desire of viewers to undergo such procedures. In Study 1, a survey of 170 young adults indicated little relationship between cosmetic surgery…

  17. Oral Nutrition as a Form of Pre-Operative Enhancement in Patients Undergoing Surgery for Colorectal Cancer

    NARCIS (Netherlands)

    Bruns, Emma R.J.; Argillander, Tanja E.; Heuvel, Van Den Baukje; Buskens, Christianne J.; Duijvendijk, Van Peter; Winkels, Renate M.; Kalf, Annette; Zaag, Van Der Edwin S.; Wassenaar, Eelco B.; Bemelman, Willem A.; Munster, Van Barbara C.

    2018-01-01

    Background: Nutritional status has major impacts on the outcome of surgery, in particular in patients with cancer. The aim of this review was to assess the merit of oral pre-operative nutritional support as a part of prehabilitation in patients undergoing surgery for colorectal cancer. Methods: A

  18. Oral Nutrition as a Form of Pre-Operative Enhancement in Patients Undergoing Surgery for Colorectal Cancer: A Systematic Review

    NARCIS (Netherlands)

    Bruns, Emma R. J.; Argillander, Tanja E.; van den Heuvel, Baukje; Buskens, Christianne J.; van Duijvendijk, Peter; Winkels, Renate M.; Kalf, Annette; van der Zaag, Edwin S.; Wassenaar, Eelco B.; Bemelman, Willem A.; van Munster, Barbara C.

    2018-01-01

    Background: Nutritional status has major impacts on the outcome of surgery, in particular in patients with cancer. The aim of this review was to assess the merit of oral pre-operative nutritional support as a part of prehabilitation in patients undergoing surgery for colorectal cancer. Methods: A

  19. Urinary protein profiles in ketorolac-associated acute kidney injury in patients undergoing orthopedic day surgery

    Directory of Open Access Journals (Sweden)

    Mariano F

    2017-09-01

    Full Text Available Filippo Mariano,1 Chiara Cogno,1 Fulvia Giaretta,2,3 Ilaria Deambrosis,2,3 Simona Pozza,4 Maurizio Berardino,5 Giuseppe Massazza,6 Luigi Biancone1,3 1Department of General and Specialist Medicine, Nephrology, Dialysis and Transplantation Unit, City of Health and Science, CTO Hospital, Turin, 2Department of General and Specialist Medicine, Laboratory of Nephrology and Immunopathology, City of Health and Science, Molinette Hospital, Turin, 3Department of Medical Sciences, University of Turin, Turin, 4Department of Radiology and Radiotherapy, CTO Radiology, City of Health and Science, CTO Hospital, Turin, 5Department of Anesthesiology and Intensive Care, Anesthesiology and Intensive Care 5, City of Health and Science, CTO Hospital, Turin, 6Department of Orthopedics and Traumatology, Week Hospital Unit, City of Health and Science, CTO Hospital, and University of Turin, Turin, Italy Background: Parenteral administration of ketorolac is very effective in controlling postoperative pain for orthopedic surgery. Ketorolac can induce clinically relevant renal alterations in elderly patients, whereas its short course is considered safe for young adults with normal preoperative renal function. In this study, of a cohort of young adults undergoing elective orthopedic day surgery, we sought cases complicated by readmission due to acute kidney injury (AKI.Patients and methods: Among 1397 young adults, aged 18–32 years who were admitted to undergo orthopedic day surgery from 2013 to 2015, four patients (0.29%, three males/one female treated in postprocedure with ketorolac (from 60 to 90 mg/day for 1–2 days were readmitted for suspected severe AKI. We evaluated functional outcome, urinary protein profiles and kidney biopsy (1 patient.Results: After day surgery discharge, they experienced gastrointestinal disturbances, flank pain and fever. Readmitted on post-surgery days 3–4, they presented with oliguric AKI (creatinine range 158.4–466.4 µmol/L and

  20. Dipyridamole-thallium scanning in patients undergoing vascular surgery. Optimizing preoperative evaluation of cardiac risk

    International Nuclear Information System (INIS)

    Eagle, K.A.; Singer, D.E.; Brewster, D.C.; Darling, R.C.; Mulley, A.G.; Boucher, C.A.

    1987-01-01

    Dipyridamole-thallium imaging has been suggested as a method of preoperatively assessing cardiac risk in patients undergoing major surgery. To define more clearly its proper role in preoperative assessment, we prospectively evaluated 111 patients undergoing vascular surgery. In the first set of 61 patients, our data confirmed the value of preoperative dipyridamole-thallium scanning in identifying the patients who suffered postoperative ischemic events. Events occurred in eight of 18 patients with reversible defects on preoperative imaging, compared with no events in 43 patients with no thallium redistribution (confidence interval for the risk difference: 0.624, 0.256). The results also suggested that clinical factors might allow identification of a low-risk subset of patients. To test the hypothesis that patients with no evidence of congestive heart failure, angina, prior myocardial infarction, or diabetes do not require further preoperative testing, we evaluated an additional 50 patients having vascular procedures. None of the 23 without the clinical markers had untoward outcomes, while ten of 27 patients with one or more of these clinical markers suffered postoperative ischemic events (confidence interval for the risk difference: 0.592, 0.148). In the clinical high-risk subset, further risk stratification is achieved with dipyridamole-thallium scanning

  1. A novel risk classification system for 30-day mortality in children undergoing surgery

    Science.gov (United States)

    Walter, Arianne I.; Jones, Tamekia L.; Huang, Eunice Y.; Davis, Robert L.

    2018-01-01

    A simple, objective and accurate way of grouping children undergoing surgery into clinically relevant risk groups is needed. The purpose of this study, is to develop and validate a preoperative risk classification system for postsurgical 30-day mortality for children undergoing a wide variety of operations. The National Surgical Quality Improvement Project-Pediatric participant use file data for calendar years 2012–2014 was analyzed to determine preoperative variables most associated with death within 30 days of operation (D30). Risk groups were created using classification tree analysis based on these preoperative variables. The resulting risk groups were validated using 2015 data, and applied to neonates and higher risk CPT codes to determine validity in high-risk subpopulations. A five-level risk classification was found to be most accurate. The preoperative need for ventilation, oxygen support, inotropic support, sepsis, the need for emergent surgery and a do not resuscitate order defined non-overlapping groups with observed rates of D30 that vary from 0.075% (Very Low Risk) to 38.6% (Very High Risk). When CPT codes where death was never observed are eliminated or when the system is applied to neonates, the groupings remained predictive of death in an ordinal manner. PMID:29351327

  2. The effect of natural sounds on the anxiety of patients undergoing coronary artery bypass graft surgery

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    Mohammad Javad Amiri

    2017-11-01

    Full Text Available Abstract Background This study aims to investigate the effect of natural sounds on the anxiety of patients undergoing coronary artery bypass graft surgery (CABG. Methods In this clinical trial, 90 patients, who were candidates for CABG in an urban area of Iran, were selected and randomly assigned to intervention and control groups by the minimization method. In the intervention group, natural sounds were broadcast through headphones for 30 min. In the control group, headphones connected to a silent device were used. The research instruments were a demographic questionnaire and the Spielberger State-Trait Anxiety Inventory (STAI. These were used before the intervention, 30 min after the music, and before the surgery in the waiting room for both groups. Data was analyzed using SPSS software. Results The mean anxiety level of the intervention group has been found to be significantly lower than that of the control group half an hour after the intervention as well as in the waiting room in the preoperative period (p = 0.001. Moreover, the mean anxiety of the intervention group decreases, while it increases for the control group over time (p < 0.001. Conclusion Natural sounds can be used as a non-pharmacological way to reduce the anxiety of patients undergoing CABG. Trial registration I RCT2017011723190N3 , Registered 1 March 2017.

  3. The safety of dipyridamole in patients undergoing myocardial perfusion scintigraphy prior to lung volume reduction surgery

    International Nuclear Information System (INIS)

    Roman, M.R.; Angelides, S.; Parker, M.K.; Silva, I. da; Freeman, A.P.

    2001-01-01

    Patients with end-stage chronic obstructive pulmonary disease (COPD) undergoing lung volume reduction surgery (LVRS) are at high risk of peri-operative cardiac complications, and myocardial perfusion scintigraphy (MPS) is commonly used for risk stratification. This study prospectively assessed the safety of dipyridamole in these patients and compared the incidence of side-effects (particularly dyspnoea) with that in patients undergoing dipyridamole MPS prior to elective non-cardiothoracic surgery. Fifty patients were enrolled: 25 in the LVRS cohort (13 males, 12 females), with a mean age of 65 years and a mean FEV 1 of 0.79 l, and 25 (with no history of asthma or COPD) in the control cohort (14 males, 11 females), with a mean age of 66 years. Fourteen patients (56%) in each group developed side-effects. Dyspnoea was reported by five patients (20%) in the LVRS and two patients (8%) in the control cohort (P=NS). One patient in each cohort developed severe hypotension and bradycardia. Eight (32%) other patients developed minor side-effects in the LVRS cohort compared with 11 (44%) in the control group. All side-effects responded promptly to intravenous aminophylline. In summary, there was a statistically non-significant increase in the incidence of dyspnoea in patients with end-stage COPD and all side-effects responded to aminophylline. Thus, dipyridamole can be used safely in these patients. (orig.)

  4. Effects of auditory and audiovisual presentations on anxiety and behavioral changes in children undergoing elective surgery.

    Science.gov (United States)

    Hatipoglu, Z; Gulec, E; Lafli, D; Ozcengiz, D

    2018-06-01

    : Preoperative anxiety is a critical issue in children, and associated with postoperative behavioral changes. : The purpose of the current study is to evaluate how audiovisual and auditory presentations about the perioperative period impact preoperative anxiety and postoperative behavioral disturbances of children undergoing elective ambulatory surgery. : A total of 99 patients between the ages of 5-12, scheduled to undergo outpatient surgery, participated in this study. Participants were randomly assigned to one of three groups; audiovisual group (Group V, n = 33), auditory group (Group A, n = 33), and control group (Group C, n = 33). During the evaluation, the Modified Yale Preoperative Anxiety Scale (M-YPAS) and the posthospitalization behavioral questionnaire (PHBQ) were used. : There were no significant differences in demographic characteristics between the groups. M-YPAS scores were significantly lower in Group V than in Groups C and A (P audiovisual presentations, in terms of being memorable and interesting, may be more effective in reducing children's anxiety. In addition, we can suggest that both methods can be equally effective for postoperative behavioral changes.

  5. Decreased circulating T regulatory lymphocytes in obese patients undergoing bariatric surgery.

    Science.gov (United States)

    Agabiti-Rosei, Claudia; Trapletti, Valentina; Piantoni, Silvia; Airò, Paolo; Tincani, Angela; De Ciuceis, Carolina; Rossini, Claudia; Mittempergher, Francesco; Titi, Amin; Portolani, Nazario; Caletti, Stefano; Coschignano, Maria Antonietta; Porteri, Enzo; Tiberio, Guido A M; Pileri, Paola; Solaini, Leonardo; Kumar, Rajesh; Ministrini, Silvia; Agabiti Rosei, Enrico; Rizzoni, Damiano

    2018-01-01

    It has been previously demonstrated that T lymphocytes may be involved in the development of hypertension and microvascular remodeling, and that circulating T effector lymphocytes may be increased in hypertension. In particular, Th1 and Th 17 lymphocytes may contribute to the progression of hypertension and microvascular damage while T-regulatory (Treg) lymphocytes seem to be protective in this regard. However, no data is available about patients with severe obesity, in which pronounced microvascular alterations were observed. We have investigated 32 severely obese patients undergoing bariatric surgery, as well as 24 normotensive lean subjects and 12 hypertensive lean subjects undergoing an elective surgical intervention. A peripheral blood sample was obtained before surgery for assessment of CD4+ T lymphocyte subpopulations. Lymphocyte phenotype was evaluated by flow cytometry in order to assess T-effector and Treg lymphocytes. A marked reduction of several Treg subpopulations was observed in obese patients compared with controls, together with an increased in CD4+ effector memory T-effector cells. In severely obese patients, Treg lymphocytes are clearly reduced and CD4+ effector memory cells are increased. It may be hypothesized that they might contribute to the development of marked microvascular alterations previously observed in these patients.

  6. Demographics and ocular biometric characteristics of patients undergoing cataract surgery in Auckland, New Zealand.

    Science.gov (United States)

    Yoon, Jinny J; Misra, Stuti L; McGhee, Charles Nj; Patel, Dipika V

    2016-03-01

    The aim is to investigate ethnic variation, in presentation and biometric parameters, within the population undergoing cataract surgery in Auckland. The design is a retrospective study. Four thousand nine hundred thirty-one eyes of 3524 consecutive patients undergoing cataract surgery in Auckland Public Hospital over 18 months were included in the study. Analysis of preoperative medical records was performed. Age, gender, self-reported ethnicity, keratometry, anterior chamber depth, axial length and intraocular lens (IOL) power data were collected. Māori (4.7%) were under-represented compared with the proportion of Māori attending the eye clinic (5.5%) and in the major patient catchment area (8.2%). People of Māori, Pacific and Indian ethnicities presented at a significantly younger age (66.4, 65.9 and 67.9 years, respectively) than those of Caucasian and Asian ethnicities (76.4 and 71.3 years, respectively, P biometric parameters. These data may help identify potential biometric refinements and those at risk of developing ocular morbidities known to be associated with these parameters. © 2015 Royal Australian and New Zealand College of Ophthalmologists.

  7. The role of physiotherapy in patients undergoing pulmonary surgery for lung cancer. A literature review.

    Science.gov (United States)

    Kendall, F; Abreu, P; Pinho, P; Oliveira, J; Bastos, P

    This review aims to appraise the role of physiotherapy care in patients submitted to pulmonary surgery, in preoperative, perioperative, and postoperative phases. Pulmonary surgery is the gold standard treatment for patients with lung cancer if it is completely resectable. However, the major impairments and complications induced by surgery are well known. Physiotherapy has been regularly used both in the preparation of the surgical candidates; in their functional recovery in the immediate postoperative period, and in the medium/long term but there is a lack of concise evidence-based recommendations. Therefore, the aim of this review is to appraise the literature about the role of physiotherapy interventions in patients undergoing lung surgery for lung cancer, in preoperative, perioperative, postoperative and maintenance stages, to the recovery and well-being, regardless of the extent of surgical approach. In conclusion, physiotherapy programs should be individually designed, and the goals established according to surgery timings, and according to each subject's needs. It can also be concluded that in the preoperative phase, the main goals are to avoid postoperative pulmonary complications and reduce the length of hospital stay, and the therapeutic targets are respiratory muscle training, bronchial hygiene and exercise training. For the perioperative period, breathing exercises for pulmonary expansion and bronchial hygiene, as well as early mobilization and deambulation, postural correction and shoulder range of motion activities, should be added. Finally, it can be concluded that in the postoperative phase exercise training should be maintained, and adoption of healthy life-style behaviours must be encouraged. Copyright © 2017 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  8. CORRELATION BETWEEN NUTRITIONAL STATUS AND CLINICAL RESULTS IN PATIENTS UNDERGOING SPINAL SURGERY

    Directory of Open Access Journals (Sweden)

    SAMUEL MACHADO MARTINS

    Full Text Available ABSTRACT Objective: To investigate the relationship between preoperative vitamin D and albumin levels and postoperative quality of life in patients undergoing spinal surgery. Methods: Patients undergoing thoracic and lumbar spine surgery were evaluated in this prospective study. Their vitamin D and albumin levels were assessed before surgery and quality of life was measured by two questionnaires, Oswestry Disability Index (ODI and Scoliosis Research Society - 22 (SRS-22, one year after the procedure. Data on infection occurrence and healing time were collected. Preoperative nutritional values and patients’ quality of life were analyzed using the chi-square test and ANOVA for albumin and vitamin D, respectively. The relationship among nutritional status, healing time, and the occurrence of infection was evaluated by the Pearson correlation coefficient. Results: Forty-six patients were included and their mean nutritional values were 19.1 (6.6 ng/mL for vitamin D and 3.9 (0.6 g/dL for albumin [mean (standard deviation]. No association was found between vitamin D and quality of life of patients measured by ODI (p=0.534 and SRS-22 (p=0.739 questionnaires. There was also no association between albumin levels and quality of life measured by ODI (p=0.259 and SRS-22 (p=0.076 questionnaires. No correlation was found between the healing time or occurrence of infection and nutritional values. Conclusions: There was no association between vitamin D and albumin levels and the surgical result, according to the patient’s perception, besides the occurrence of complications with the surgical wound.

  9. Multifilament Cable Wire versus Conventional Wire for Sternal Closure in Patients Undergoing Major Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    You Na Oh

    2015-08-01

    Full Text Available Background: Stainless steel wiring remains the most popular technique for primary sternal closure. Recently, a multifilament cable wiring system (Pioneer Surgical Technology Inc., Marquette, MI, USA was introduced for sternal closure and has gained wide acceptance due to its superior resistance to tension. We aimed to compare conventional steel wiring to multifilament cable fixation for sternal closure in patients undergoing major cardiac surgery. Methods: Data were collected retrospectively on 1,354 patients who underwent sternal closure after major cardiac surgery, using either the multifilament cable wiring system or conventional steel wires between January 2009 and October 2010. The surgical outcomes of these two groups of patients were compared using propensity score matching based on 18 baseline patient characteristics. Results: Propensity score matching yielded 392 pairs of patients in the two groups whose baseline profiles showed no significant differences. No significant differences between the two groups were observed in the rates of early mortality (2.0% vs. 1.3%, p=0.578, major wound complications requiring reconstruction (1.3% vs. 1.3%, p>0.99, minor wound complications (3.6% vs. 2.0%, p=0.279, or mediastinitis (0.8% vs. 1.0%, p=1.00. Patients in the multifilament cable group had fewer sternal bleeding events than those in the conventional wire group, but this tendency was not statistically significant (4.3% vs. 7.4%, p=0.068. Conclusion: The surgical outcomes of sternal closure using multifilament cable wires were comparable to those observed when conventional steel wires were used. Therefore, the multifilament cable wiring system may be considered a viable option for sternal closure in patients undergoing major cardiac surgery.

  10. Multifilament Cable Wire versus Conventional Wire for Sternal Closure in Patients Undergoing Major Cardiac Surgery.

    Science.gov (United States)

    Oh, You Na; Ha, Keong Jun; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won

    2015-08-01

    Stainless steel wiring remains the most popular technique for primary sternal closure. Recently, a multifilament cable wiring system (Pioneer Surgical Technology Inc., Marquette, MI, USA) was introduced for sternal closure and has gained wide acceptance due to its superior resistance to tension. We aimed to compare conventional steel wiring to multifilament cable fixation for sternal closure in patients undergoing major cardiac surgery. Data were collected retrospectively on 1,354 patients who underwent sternal closure after major cardiac surgery, using either the multifilament cable wiring system or conventional steel wires between January 2009 and October 2010. The surgical outcomes of these two groups of patients were compared using propensity score matching based on 18 baseline patient characteristics. Propensity score matching yielded 392 pairs of patients in the two groups whose baseline profiles showed no significant differences. No significant differences between the two groups were observed in the rates of early mortality (2.0% vs. 1.3%, p=0.578), major wound complications requiring reconstruction (1.3% vs. 1.3%, p>0.99), minor wound complications (3.6% vs. 2.0%, p=0.279), or mediastinitis (0.8% vs. 1.0%, p=1.00). Patients in the multifilament cable group had fewer sternal bleeding events than those in the conventional wire group, but this tendency was not statistically significant (4.3% vs. 7.4%, p=0.068). The surgical outcomes of sternal closure using multifilament cable wires were comparable to those observed when conventional steel wires were used. Therefore, the multifilament cable wiring system may be considered a viable option for sternal closure in patients undergoing major cardiac surgery.

  11. Evaluation of perioperative nutritional status with subjective global assessment method in patients undergoing gastrointestinal cancer surgery.

    Science.gov (United States)

    Erdim, Aylin; Aktan, Ahmet Özdemir

    2017-01-01

    This study was designed to evaluate the perioperative nutritional status of patients undergoing surgery for gastrointestinal cancer using Subjective Global Assessment and surgeon behavior on nutritional support. We recruited 100 patients undergoing surgery for gastrointestinal cancer in one university and two state teaching hospitals. Subjective Global Assessment was administered to evaluate preoperative and postoperative nutritional status. Fifty-two patients in the state hospitals (Group 1) and 48 in the university hospital were assessed. Anthropometric and biochemical measurements were performed. Changes in preoperative Subjective Global Assessment scores and scores at the time of discharge and types of nutritional support were compared. Subjective Global Assessment-B was regarded as moderate and Subjective Global Assessment-C as heavy malnutrition. Ten patients had Subjective Global Assessment-B and 29 had Subjective Global Assessment-C malnutrition in Group 1 and nine had Subjective Global Assessment-B and 31 had Subjective Global Assessment-C malnutrition in Group 2 during preoperative assessment. Respective numbers in postoperative assessment were 12 for Subjective Global Assessment-B and 30 for Subjective Global Assessment-C in Group 1 and 14 for Subjective Global Assessment-B and 26 for Subjective Global Assessment-C in Group 2. There was no difference between two groups. Nutritional methods according to Subjective Global Assessment evaluation in pre- and postoperative periods were not different between the groups. This study demonstrated that the malnutrition rate is high among patients scheduled for gastrointestinal cancer surgery and the number of surgeons were inadequate to provide perioperative nutritional support. Both university and state hospitals had similar shortcomings. Subjective Global Assessment is an easy and reliable test and if utilized will be helpful to detect patients requiring nutritional support.

  12. Burden of Geriatric Events Among Older Adults Undergoing Major Cancer Surgery.

    Science.gov (United States)

    Tan, Hung-Jui; Saliba, Debra; Kwan, Lorna; Moore, Alison A; Litwin, Mark S

    2016-04-10

    Most malignancies are diagnosed in older adults who are potentially susceptible to aging-related health conditions; however, the manifestation of geriatric syndromes during surgical cancer treatment is not well quantified. Accordingly, we sought to assess the prevalence and ramifications of geriatric events during major surgery for cancer. Using Nationwide Inpatient Sample data from 2009 to 2011, we examined hospital admissions for major cancer surgery among elderly patients (ie, age ≥ 65 years) and a referent group age 55 to 64 years. From these observations, we identified geriatric events that included delirium, dehydration, falls and fractures, failure to thrive, and pressure ulcers. We then estimated the collective prevalence of these events according to age, comorbidity, and cancer site and further explored their relationship with other hospital-based outcomes. Within a weighted sample of 939,150 patients, we identified at least one event in 9.2% of patients. Geriatric events were most common among patients age ≥ 75 years, with a Charlson comorbidity score ≥ 2, and who were undergoing surgery for cancer of the bladder, ovary, colon and/or rectum, pancreas, or stomach (P geriatric event had a greater likelihood of concurrent complications (odds ratio [OR], 3.73; 95% CI, 3.55 to 3.92), prolonged hospitalization (OR, 5.47; 95% CI, 5.16 to 5.80), incurring high cost (OR, 4.97; 95% CI, 4.58 to 5.39), inpatient mortality (OR, 3.22; 95% CI, 2.94 to 3.53), and a discharge disposition other than home (OR, 3.64; 95% CI, 3.46 to 3.84). Many older patients who receive cancer-directed surgery experience a geriatric event, particularly those who undergo major abdominal surgery. These events are linked to operative morbidity, prolonged hospitalization, and more expensive health care. As our population ages, efforts focused on addressing conditions and complications that are more common in older adults will be essential to delivering high-quality cancer care. © 2016 by

  13. Repair of the threatened feminine identity: experience of women with cervical cancer undergoing fertility preservation surgery.

    Science.gov (United States)

    Komatsu, Hiroko; Yagasaki, Kaori; Shoda, Rie; Chung, Younghui; Iwata, Takashi; Sugiyama, Juri; Fujii, Takuma

    2014-01-01

    Fertility preservation is important for women of reproductive age with cervical cancer. The underlying reasons behind suboptimal reproductive results after successful fertility-preserving surgery have not yet been fully revealed. The objective of this study was to explore the experience of fertility preservation with radical trachelectomy from the perspective of women with cervical cancer. We conducted interviews with women with cervical cancer who underwent radical trachelectomy using a Grounded Theory methodology with a theoretical framework of symbolic interactionism. Our findings articulate a process in which feminine identity is first threatened by a diagnosis of cancer, then repaired by fertility preservation with radical trachelectomy, and finally reconstructed after the surgery, through interactions with self, others, and external events in women with cervical cancer. Feeling incomplete as a woman because of the loss of the uterus was a critical factor in the women's feeling that their feminine identity was threatened. Thus, fertility preservation was significant for these women. The meaning of fertility preservation varied among the women, and their life perspectives were therefore distinct after the surgery. Women with cervical cancer who undergo radical trachelectomy experience an identity transformation process, and child bearing is not the only expected outcome of fertility preservation. Nurses should coordinate care through the cancer trajectory. Understanding the identity transformation process helps nurses to assess patients' needs and provide appropriate individual care.

  14. Effect of fast track surgery on anxiety index and stress indices in patients undergoing laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    LU Xia

    2017-02-01

    Full Text Available ObjectiveTo investigate the effect of fast track surgery (FTS on anxiety index and stress indices in patients undergoing laparoscopic cholecystectomy. MethodsThe patients who were hospitalized in Department of General Surgery, The Second People′s Hospital of Lanzhou, from March 2015 to July 2016 and underwent laparoscopic cholecystectomy were enrolled and randomly divided into FTS group and conventional treatment group, with 200 patients in each group. The patients in the FTS group were given FTS in the perioperative period, and those in the conventional treatment group were given conventional treatment. The C-reactive protein (CRP level, white blood cell count (WBC, and interleukin-6 (IL-6 level were measured on admission, at 1 hour before surgery, and at 24 and 48 hours after surgery, as well as the anxiety index in Hamilton anxiety scale (HAMA. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsThere was no significant difference in anxiety index between the FTS group and the conventional treatment group on admission (P>0.05; at 1 hour before surgery and at 24 and 48 hours after surgery, there were significant differences in anxiety index between the two groups (χ2=12.73, 13.17, and 14.12, all P<0.05. On admission and at 1 hour before surgery, there were no significant differences in the CRP level, WBC, and IL-6 level between the FTS group and the conventional treatment group (all P>0.05; at 24 and 48 hours after surgery, there were significant differences in the CRP level, WBC, and IL-6 level between the two groups [CRP24h: 8.47±0.78 mg/L vs 17.56±1.31 mg/L, t=17.63, P<0.05; WBC24h: (8.3±3.4×109/L vs (10.2±3.8×109/L, t=21.62, P<0.05; IL-624h: 127.43±37.46 ng/L vs 146.25±42.56 ng/L, t=2632, P<0.05; CRP48h:(6.57±1.27 mg/L vs (10.76±1.25 mg/L,t=19.25,P<0.05;WBC48h:(7.1±2.3×109/L vs (9.3±2.4×109/L

  15. A COMPARISON OF TWO DIFFERENT DOSES OF DEXMEDETOMIDINE INFUSION DURING MAINTENANCE OF GENERAL ANAESTHESIA IN PATIENTS UNDERGOING SPINE SURGERIES, FUNCTIONAL ENDOSCOPIC SINUS SURGERY AND MIDDLE EAR SURGERIES

    Directory of Open Access Journals (Sweden)

    Bijay

    2016-03-01

    Full Text Available BACKGROUND This study is undertaken to compare the hemodynamic effects and reduction in the doses of volatile anaesthetics and muscle relaxants using two different doses of dexmedetomidine infusion during maintenance of anaesthesia in spine, functional endoscopic sinus surgery and middle ear surgeries. METHODS Sixty patients are randomly divided into 2 groups of 30 each. After shifting to the operation theatre baseline vitals were recorded. Anesthesia induced with thiopentone sodium and intubation done with the help of succinylcholine and maintained with oxygen, nitrous oxide and isoflurane. After 1 min of intubation, maintenance infusion of dexmedetomidine (0.4 mcg/kg/hr and 0.7 mcg/kg/hr for patients allotted in 2 separate groups was started and stopped 15 min before end of surgery. Hemodynamic parameters and any reduction in the doses of volatile anaesthetics and muscle relaxants was noted. RESULTS Dexmedetomidine infusion (0.4 mcg/kg/hr and 0.7 mcg/kg/hr in both groups reduced the requirements of muscle relaxants and volatile anaesthetics. Hemodynamic stability was better in the group receiving 0.4 mcg/kg/hr. Patients receiving 0.7 mcg/kg/hr had higher incidence of hypotension, bradycardia and delayed emergence from anaesthesia. CONCLUSION Dexmedetomidine infusion at 0.4 mcg/kg/hr during maintenance of anaesthesia in spine surgery, FESS and middle ear surgery would be good option to reduce the requirements of volatile anaesthetics, muscle relaxants and for better hemodynamic stability. OBJECTIVE OF STUDY: Primary Objective To compare and evaluate the hemodynamic effects and reduction in requirements of volatile anaesthetics and muscle relaxants with two different doses of dexmedetomidine infusion during maintenance of general anaesthesia in patients undergoing spine, FESS and middle ear surgeries.

  16. Thoracic spinal anesthesia is safe for patients undergoing abdominal cancer surgery.

    Science.gov (United States)

    Ellakany, Mohamed Hamdy

    2014-01-01

    A double-blinded randomized controlled study to compare discharge time and patient satisfaction between two groups of patients submitted to open surgeries for abdominal malignancies using segmental thoracic spinal or general anesthesia. Open surgeries for abdominal malignancy are usually done under general anesthesia, but many patients with major medical problems sometimes can't tolerate such anesthesia. Regional anesthesia namely segmental thoracic spinal anesthesia may be beneficial in such patients. A total of 60 patients classified according to American Society of Anesthesiology (ASA) as class II or III undergoing surgeries for abdominal malignancy, like colonic or gastric carcinoma, divided into two groups, 30 patients each. Group G, received general anesthesia, Group S received a segmental (T9-T10 injection) thoracic spinal anesthesia with intrathecal injection of 2 ml of hyperbaric bupivacaine 0.5% (10 mg) and 20 ug fentanyl citrate. Intraoperative monitoring, postoperative pain, complications, recovery time, and patient satisfaction at follow-up were compared between the two groups. Spinal anesthesia was performed easily in all 30 patients, although two patients complained of paraesthesiae, which responded to slight needle withdrawal. No patient required conversion to general anesthesia, six patients required midazolam for anxiety and six patients required phenylephrine and atropine for hypotension and bradycardia, recovery was uneventful and without sequelae. The two groups were comparable with respect to gender, age, weight, height, body mass index, ASA classification, preoperative oxygen saturation and preoperative respiratory rate and operative time. This preliminary study has shown that segmental thoracic spinal anesthesia can be used successfully and effectively for open surgeries for abdominal malignancies by experienced anesthetists. It showed shorter postanesthesia care unit stay, better postoperative pain relief and patient satisfaction than

  17. What dose of tranexamic acid is most effective and safe for adult patients undergoing cardiac surgery?

    Science.gov (United States)

    Hodgson, Sam; Larvin, Joseph T; Dearman, Charles

    2015-09-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: what dose of tranexamic acid is most effective and safe for adult patients undergoing cardiac surgery? Altogether 586 papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Current evidence shows clinical benefit of using high-dose tranexamic acid (>80 mg/kg total dose) as opposed to low-dose tranexamic acid (tranexamic acid lose less blood postoperatively than patients receiving low-dose tranexamic acid (590 vs 820 ml, P = 0.01). Patients receiving high-dose tranexamic acid also require fewer units of blood product transfusion (2.5 units vs 4.1 units; P = 0.02) and are less likely to undergo repeat surgery to achieve haemostasis. This effect is larger in those who are at high risk of bleeding. Several prospective studies comparing doses found no difference in clinical outcomes between high- and low-dose regimens, but excluded patients at high risk of bleeding. However, data from numerous observational studies demonstrate that tranexamic acid use is associated with an increased risk of postoperative seizure; one analysis showed tranexamic acid use to be a very strong independent predictor (odds ratio = 14.3, P tranexamic acid. We conclude that, in general, patients with a high risk of bleeding should receive high-dose tranexamic acid, while those at low risk of bleeding should receive low-dose tranexamic acid with consideration given to potential dose-related seizure risk. We recommend the regimens of high-dose (30 mg kg(-1) bolus + 16 mg kg(-1) h(-1) + 2 mg kg(-1) priming) and low-dose (10 mg kg(-1) bolus + 1 mg kg(-1) h(-1) + 1 mg kg(-1) priming) tranexamic acid, as these are well established in terms of safety profile and have the

  18. STUDY OF METABOLIC ACIDOSIS IN PATIENTS UNDERGOING SURGERIES OF OPERATIVE TIME GREATER THAN 2 HOURS DURATION

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    Sathu T. S

    2018-02-01

    Full Text Available BACKGROUND Metabolic acidosis is proven complication of major surgery, but very less significance is given to it. Metabolic acidosis has a significant effect in postoperative recovery and morbidity of patients undergoing major surgery. Metabolic acidosis has a say in proper functioning of cardiovascular, renal and pulmonary system, added to severe stress full condition related to postoperative period, it bring about major shift in the speedy recovery of patient. It becomes significantly important that metabolic acidosis in diagnosed as early as possible and corrective measures are taken immediately. MATERIALS AND METHODS Study design is a prospective observational study. 109 patients who underwent elective and emergency surgeries in the department of General Surgery, Govt. Medical College Kottayam was studied for a period of 3 months (2016. On arrival of the patient, a detailed history of the patient was taken, along with emphasis to the multiple factors in the history which could be contributory to postoperative metabolic acidosis such as diabetic status, drug history, history of respiratory, cardiac and renal status. Basic preoperative laboratory investigation was carried out and its values were recorded. A preoperative arterial blood gas analysis (ABG of the patient was done before patient was taken for surgery, values of which were recorded and analysed to rule out existing acidotic status of patient, if the patient is already having metabolic acidosis he was excluded from the study. A second ABG was sent at 2 hours after induction of anaesthesia, values of which was recorded, along with the values of intraoperative fluids, preoperative Hb, duration of surgery, type of surgery, blood transfusion and colloid administration given during the time of anaesthesia. A third ABG was sent within six hours of completion of surgery and the values analysed, with due notes on postoperative care done and the days of ICU stay, for analysis and comparison

  19. The Role of Ethnicity and Acculturation in Preoperative Distress in Parents of Children Undergoing Surgery.

    Science.gov (United States)

    Stevenson, Robert S; Rosales, Alvina; Fortier, Michelle A; Campos, Belinda; Golianu, Brenda; Zuk, Jeannie; Gold, Jeffrey; Kain, Zeev N

    2017-06-01

    This study examined the effects of acculturation on anxiety and stress in Latino and non-Latino white parents of children undergoing outpatient surgery. Participants included 686 parent-child dyads from four major children's hospitals in the United States. Latino parents who grew up in the U.S. reported higher levels of anxiety (p = 0.009) and stress (p stress compared to both Spanish-speaking Latino and non-Latino white parents (p's stress and anxiety. Results of the current study were consistent with the immigrant health paradox in that more acculturated Latino parents reported higher levels of anxiety and stress than less acculturated Latino and non-Latino white parents, supporting the need for culturally tailored interventions in the perioperative environment.

  20. Effects of growth hormone (GH) treatment on body fluid distribution in patients undergoing elective abdominal surgery

    DEFF Research Database (Denmark)

    Møller, Jacob; Jensen, Martin Bach; Frandsen, E.

    1998-01-01

    OBJECTIVE: To investigate the possible beneficial effects of growth hormone (GH) in catabolic patients we examined the impact of GH on body fluid distribution in patients with ulcerative colitis undergoing elective abdominal surgery. DESIGN AND MEASUREMENTS: Twenty-four patients (14 female, 10 male...... at day -2 and at day 7, and body composition was estimated by dual X-ray absorptiometry and bioimpedance. Changes in body weight and fluid balance were recorded and hence intracellular volume was assessed. RESULTS: During placebo treatment body weight decreased 4.3 +/- 0.6 kg; during GH treatment body.......05). Plasma renin and aldosterone remained unchanged in both study groups. CONCLUSION: Body weight, plasma volume and intracellular volume is preserved during GH treatment in catabolic patients and ECV is increased. From a therapeutic point of view these effects may be desirable under conditions of surgical...

  1. Growth hormone treatment improves body fluid distribution in patients undergoing elective abdominal surgery

    DEFF Research Database (Denmark)

    Møller, J; Jensen, M B; Frandsen, E

    1998-01-01

    OBJECTIVE: To investigate the possible beneficial effects of growth hormone (GH) in catabolic patients we examined the impact of GH on body fluid distribution in patients with ulcerative colitis undergoing elective abdominal surgery. DESIGN AND MEASUREMENTS: Twenty-four patients (14 female, 10 male...... at day -2 and at day 7, and body composition was estimated by dual X-ray absorptiometry and bioimpedance. Changes in body weight and fluid balance were recorded and hence intracellular volume was assessed. RESULTS: During placebo treatment body weight decreased 4.3 +/- 0.6 kg; during GH treatment body.......05). Plasma renin and aldosterone remained unchanged in both study groups. CONCLUSION: Body weight, plasma volume and intracellular volume is preserved during GH treatment in catabolic patients and ECV is increased. From a therapeutic point of view these effects may be desirable under conditions of surgical...

  2. TCF7L2 expression in diabetic patients undergoing bariatric surgery.

    Science.gov (United States)

    Hindle, A Katharine; Brody, Fred; Tevar, Rahul; Kluk, Brian; Hill, Sarah; McCaffrey, Timothy; Fu, Sidney

    2009-04-01

    The cause of diabetes in morbidly obese patients is multifactorial, including genetic, social, and dietary components. Transcription factor 7-like 2 (TCF7L2) is a gene that is related to the development of diabetes. This pilot study examines TCF7L2 expression in liver samples obtained from morbidly obese patients undergoing bariatric surgery. TCF7L2 expression is compared between diabetic and nondiabetic patients. Liver samples were obtained from 20 morbidly obese patients undergoing bariatric surgery. Samples were flash frozen in liquid nitrogen. Total RNA was extracted from tissue samples using the TRIzol reagent (Invitrogen Inc, Carlsbad, CA). Using the iScript cDNA synthesis kit (Bio-Rad Laboratories, Hercules,CA), cDNA was synthesized. Quantitative polymerase chain reaction (qPCR) was done using SYBR Green qPCR Reagents (Stratagene, Cedar Creek TX) and the 7300 Real-Time PCR system (Applied Biosystems, Foster City CA). Preoperative demographic and gene expression data were correlated using univariate analysis and logistic regression models. Only associations with a p-value less than 0.05 were considered significant. For the entire group, there was no correlation between body mass index (BMI) and TCF7L2 expression. In morbidly obese nondiabetic patients, there was a positive correlation between TCF7L2 expression and BMI (R(2)=0.21). In morbidly obese diabetic patients, there was an inverse correlation between TCF7L2 expression and BMI (R(2)=0.58). There was no significant relationship between TCF7L2 expression and age or glycosylated hemoglobin (HbA1c). The cause of diabetes is multifactorial but the data from our pilot study documents the relationship of TCF7L2 with type 2 diabetes in morbidly obese patients.

  3. Antiemetic effects of granisetron versus dexamethasone in clonidine premedicated children undergoing strabismus surgery

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    Indu Sen

    2007-01-01

    Full Text Available In a prospective, double blind, randomized trial, 120 children, aged 3-8 years,ASAI-II, undergoing strabismus repair were randomly divided into three groups (n = 40 each. Oral clonidine premedication (4gg.kg-1 was administered to all the patients two hours prior to surgery. Soon after induction of anaesthesia, Group G patients were administered intravenous granisetron (40gg.kg-1 , Group D intravenous dexamethasone (150gg.kg-1 and group S received 4ml normal saline. Postoperatively, children were continuously monitored and assessed half-hourly till discharge and then after 24 hours for vomiting and pain. The overall incidence of postoperative emesis was lower (15.4% in the Group G compared with the Group D (21.6% in the first 24 hours (P>0.05. The Group S had a highest incidence of postoperative vomiting ((37% P value < 0.0324 compared to group G. The frequency of early vomiting was highest in the S group. Both G and D groups showed better control of delayed emetic episodes. We observed that in children who were premedicated with clonidine, both IV granisetron or dexamethasone were efficacious in reducing the incidence and severity of POV in day-care strabismus surgery.

  4. The feasibility of sugammadex for general anesthesia and facial nerve monitoring in patients undergoing parotid surgery

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    I-Cheng Lu

    2017-08-01

    Fifty patients undergoing parotid surgery were randomized allocated into conventional anesthesia group (Group C, n = 25 and sugammadex group (Group S, n = 25. Group C did not receive any NMBA. Group S received rocuronium 0.6 mg/kg at anesthesia induction and sugammadex 2 mg/kg at skin incision. The intubating condition and influence on FNM evoked EMG results were compared between groups. The intubation condition showed significantly better in group S patients than C group patients (excellent in 96% v.s. 24%. In group S, rapid reverse of NMB was found and the twitch (% recovered from 0 to >90% within 10 min. Positive and high EMG signals were obtained in all patients at the time point of initial facial nerve stimulation in both groups. There was no significant difference as comparing the EMG amplitudes detected at the time point of initial and final facial nerve stimulation in both groups. Implementation of sugammadex in anesthesia protocol is feasible and reliable for successful FNM during parotid surgery.

  5. One lung ventilation strategies for infants and children undergoing video assisted thoracoscopic surgery

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    Teddy Suratos Fabila

    2013-01-01

    Full Text Available The advantages of video assisted thoracoscopic surgery (VATS in children have led to its increased usage over the years. VATS, however, requires an efficient technique for one lung ventilation. Today, there is an increasing interest in developing the technique for lung isolation to meet the anatomic and physiologic variations in infants and children. This article aims to provide an updated and comprehensive review on one-lung ventilation strategies for infants and children undergoing VATS. Search of terms such as ′One lung ventilation for infants and children′, ′Video assisted thoracoscopic surgery for infants and children′, and ′Physiologic changes during one lung ventilation for infants and children′ were used. The search mechanics and engines for this review included the following: Kandang Kerbau Hospital (KKH eLibrary, PubMed, Ovid Medline, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. During the search the author focused on significant current and pilot randomized control trials, case reports, review articles, and editorials. Critical decision making on what device to use based on the age, weight, and pathology of the patient; and how to use it for lung isolation are discussed in this article. Furthermore, additional information regarding the advantages, limitations, techniques of insertion and maintenance of each device for one lung ventilation in infants and children were the highlights in this article.

  6. Surgery-Independent Language Function Decline in Patients Undergoing Awake Craniotomy.

    Science.gov (United States)

    Gonen, Tal; Sela, Gal; Yanakee, Ranin; Ram, Zvi; Grossman, Rachel

    2017-03-01

    Despite selection process before awake-craniotomy, some patients experience an unexpected decline in language functions in the operating room (OR), compared with their baseline evaluation, which may impair their functional monitoring. To investigate this phenomenon we prospectively compared language function the day before surgery and on entrance to the OR. Data were collected prospectively from consecutive patients undergoing awake-craniotomy with intraoperative cortical mapping for resection of gliomas affecting language areas. Language functions of 79 patients were evaluated and compared 1-2 days before surgery and after entering the OR. Changes in functional linguistic performance were analyzed with respect to demographic, clinical, and pathologic characteristics. There was a significant decline in language function, beyond sedation effect, after entering the OR, (from median/interquartile range: 0.94/0.72-0.98 to median/interquartile range: 0.86/0.51-0.94; Z = -7.19, P awake-craniotomy may experience a substantial decline in language functioning after entering the OR. Tumor grade and the presence of preoperative language deficits were significant risk factors for this phenomenon, suggesting a possible relation between cognitive reserve, psychobehavioral coping abilities and histologic features of a tumor involving language areas. Capturing and identifying this unique population of patients who are prone to experience such language decline may improve our ability in the future to select patients eligible for awake-craniotomy. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Effect of clindamycin prophylaxis on the colonic microflora in patients undergoing colorectal surgery.

    Science.gov (United States)

    Kager, L; Liljeqvist, L; Malmborg, A S; Nord, C E

    1981-12-01

    Clindamycin was given intravenously to 15 patients undergoing colorectal surgery in an initial dose of 600 mg, given at induction of anesthesia followed by 6 doses of 600 mg at 8-h intervals. Series of serum samples and fecal specimens were taken for analysis of clindamycin concentrations. Tissue samples from the gut wall were taken at surgery. The highest serum concentrations observed occurred 30 min after administration of clindamycin and varied between 6.8 and 37.9 microgram/ml (mean, 14.8 +/- 2.0 [standard error] microgram/ml). The clindamycin concentrations in the tissue samples were between 1.8 and 13.0 microgram/g. Clindamycin concentration in the fecal samples varied between 2.1 and 460 microgram/g. Fecal samples were also collected during the investigation period for cultivation of aerobic and anaerobic bacteria. Among the aerobic bacteria, enterococci and streptococci decreased during the prophylaxis period. Anaerobic bacteria also decreased significantly during the same period. After the clindamycin administration period, enterococci, streptococci and anaerobic bacteria proliferated. No anaerobic strains resistant to clindamycin were isolated. Postoperative infections due to Streptococcus faecalis and different enterobacteria such as Escherichia coli, Enterobacter cloacae, Citrobacter freundii, and Klebsiella occurred in five patients.

  8. Evaluating Compliance with Institutional Preoperative Testing Guidelines for Minimal-Risk Patients Undergoing Elective Surgery

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    Arunotai Siriussawakul

    2013-01-01

    Full Text Available Background. Few investigations preoperatively are important for low-risk patients. This study was designed to determine the level of compliance with preoperative investigation guidelines for ASA I patients undergoing elective surgery. Secondary objectives included the following: to identify common inappropriate investigations, to evaluate the impact of abnormal testing on patient management, to determine factors affecting noncompliant tests, and to estimate unnecessary expenditure. Methods. This retrospective study was conducted on adult patients over a one-year period. The institute’s guidelines recommend tests according to the patients’ age groups: a complete blood count (CBC for those patients aged 18–45; CBC, chest radiograph (CXR and electrocardiography (ECG for those aged 46–60; and CBC, CXR, ECG, electrolytes, blood glucose, blood urea nitrogen (BUN, and creatinine (Cr for patients aged 61–65. Results. The medical records of 1,496 patients were reviewed. Compliant testing was found in only 12.1% (95% CI, 10.5–13.9. BUN and Cr testings were the most frequently overprescribed tests. Overinvestigations tended to be performed on major surgery and younger patients. Overall, overinvestigation incurred an estimated cost of US 200,000 dollars during the study period. Conclusions. The need to utilize the institution’s preoperative guidelines should be emphasized in order to decrease unnecessary testing and the consequential financial burden.

  9. Evaluating compliance with institutional preoperative testing guidelines for minimal-risk patients undergoing elective surgery.

    Science.gov (United States)

    Siriussawakul, Arunotai; Nimmannit, Akarin; Rattana-arpa, Sirirat; Chatrattanakulchai, Siritda; Saengtawan, Puttachard; Wangdee, Aungsumat

    2013-01-01

    Few investigations preoperatively are important for low-risk patients. This study was designed to determine the level of compliance with preoperative investigation guidelines for ASA I patients undergoing elective surgery. Secondary objectives included the following: to identify common inappropriate investigations, to evaluate the impact of abnormal testing on patient management, to determine factors affecting noncompliant tests, and to estimate unnecessary expenditure. This retrospective study was conducted on adult patients over a one-year period. The institute's guidelines recommend tests according to the patients' age groups: a complete blood count (CBC) for those patients aged 18-45; CBC, chest radiograph (CXR) and electrocardiography (ECG) for those aged 46-60; and CBC, CXR, ECG, electrolytes, blood glucose, blood urea nitrogen (BUN), and creatinine (Cr) for patients aged 61-65. The medical records of 1,496 patients were reviewed. Compliant testing was found in only 12.1% (95% CI, 10.5-13.9). BUN and Cr testings were the most frequently overprescribed tests. Overinvestigations tended to be performed on major surgery and younger patients. Overall, overinvestigation incurred an estimated cost of US 200,000 dollars during the study period. The need to utilize the institution's preoperative guidelines should be emphasized in order to decrease unnecessary testing and the consequential financial burden.

  10. Effect of opium use on short-term outcome in patients undergoing coronary artery bypass surgery.

    Science.gov (United States)

    Safaii, Nasser; Kazemi, Babak

    2010-02-01

    Data regarding the effect of opium use on short-term outcome in patients undergoing coronary artery bypass surgery are limited. We sought to assess the morbidity and in-hospital mortality of current and past users compared the data with those from nonusers of opium after coronary artery bypass grafting (CABG). This is a descriptive analytical review of prospectively collected data on 782 consecutive male patients who underwent isolated CABG between January 2005 and December 2007. Of these, 708 (90.5%) were nonusers, 56 (7.1%) were current users, and 18 (2.3%) were former opium users of more than 4 weeks. The effect of opium usage on clinical, admission, and outcome variables were analyzed. Current opium users were younger (P = 0.004) and more likely to be cigarette smokers (P = 0.0004). Other demographic characteristics, major coronary risk factors, rates of postoperative complications, intensive care unit readmission, postoperative length of stay, and in-hospital mortality did not differ among the three groups. Current opium users needed less analgesic postoperatively (P = 0.0001), were significantly less compliant with medical and dietary recommendations after discharge (P opium (P opium is a significant predictor of rehospitalization with a cardiac cause within 6 months of CABG surgery. This may be partly due to the low compliance of these patients with treatment recommendations.

  11. Pulmonary oedema in a patient undergoing vitreo-retinal surgery under peribulbar block

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    Anjolie Chhabra

    2012-01-01

    Full Text Available A 42 - year-old diabetic and hypertensive male with good effort tolerance was administered peribulbar block for vitreo-retinal surgery. Ten millilitres of an equal mixture of 2% lignocaine and 0.5% bupivacaine was administered for the block after ascertaining negative aspiration for blood. Inadequate akinesia of the eye necessitated further supplementation with 4 mL of local anaesthetic (LA mixture. Thirty minutes later, the patient complained of uneasiness, respiratory distress and desaturated despite oxygen supplementation. He was found to be in pulmonary oedema. He subsequently developed a weak thready pulse, became unresponsive, apnoeic and had generalized tonic clonic convulsions. Immediately, atropine 0.6 mg, followed by midazolam, intubation, mechanical ventilation, morphine and furosemide, were administered intravenously. Spontaneous respiration returned in 20 minutes and he started responding to verbal commands 90 minutes later. He was weaned off the ventilator the next morning. There was no evidence of an ischemic myocardial event and non-contrast computerized tomography scan of the head was normal. The reversible cardiorespiratory arrest, associated convulsions and loss of consciousness were suggestive of LA toxicity. Pulmonary oedema manifesting as respiratory distress and desaturation can be the initial manifestation of LA toxicity in patients with pre-existing cardiovascular disease undergoing eye surgery under peribulbar block.

  12. Outcome in 55 dogs with pulmonic stenosis that did not undergo balloon valvuloplasty or surgery.

    Science.gov (United States)

    Francis, A J; Johnson, M J S; Culshaw, G C; Corcoran, B M; Martin, M W S; French, A T

    2011-06-01

    To determine the outcome, independent predictors of cardiac death, and the Doppler-derived pressure gradient cut-off for predicting cardiac death in dogs with pulmonic stenosis, with or without tricuspid regurgitation, that do not undergo balloon valvuloplasty or valve surgery. Review of medical records of two UK referral centres between July 1997 and October 2008 for all cases of pulmonic stenosis that had no balloon valvuloplasty or valve surgery. Inclusion criteria included a diagnosis of pulmonic stenosis; spectral Doppler pulmonic velocity greater than 1·6 m/s; characteristic valve leaflet morphological abnormalities. Exclusion criteria included concurrent significant cardiac defects, including tricuspid dysplasia. Dogs with tricuspid regurgitation were included. Dogs were classified according to Doppler-derived pressure gradients into mild, moderate or severe pulmonic stenosis categories. Presence of tricuspid regurgitation and severe stenosis were independent predictors of cardiac death. A pulmonic pressure gradient of more than 60 mmHg was associated with 86% sensitivity, and 71% specificity of predicting cardiac death. There is an increased probability of cardiac death in those cases which have a pulmonary pressure gradient greater than 60 mmHg and tricuspid regurgitation, though the effect of severity of tricuspid regurgitation on outcome was not measurable because of small sample sizes. These animals might benefit from intervention. © 2011 British Small Animal Veterinary Association.

  13. A standardized multidisciplinary approach reduces the use of allogeneic blood products in patients undergoing cardiac surgery.

    Science.gov (United States)

    Van der Linden, P; De Hert, S; Daper, A; Trenchant, A; Jacobs, D; De Boelpaepe, C; Kimbimbi, P; Defrance, P; Simoens, G

    2001-10-01

    Individual and institutional practices remain an independent predictor factor for allogeneic blood transfusion. Application of a standardized multidisciplinary transfusion strategy should reduce the use of allogeneic blood transfusion in major surgical patients. This prospective non randomized observational study evaluated the effects of a standardized multidisciplinary transfusion strategy on allogeneic blood products exposure in patients undergoing non-emergent cardiac surgery. The developed strategy involved a standardized blood conservation program and a multidisciplinary allogeneic blood transfusion policy based mainly on clinical judgement, not only on a specific hemoglobin concentration. Data obtained in a first group including patients operated from September 1997 to August 1998 (Group pre: n=321), when the transfusion strategy was progressively developed, were compared to those obtained in a second group, including patients operated from September 1998 to August 1999 (Group post: n=315) when the transfusion strategy was applied uniformly. Patient populations and surgical procedures were similar. Patients in Group post underwent acute normovolemic hemodilution more frequently, had a higher core temperature at arrival in the intensive care unit and presented lower postoperative blood losses at day one. Three hundred forty units of packed red blood cells were transfused in 33% of the patients in Group pre whereas 161 units were transfused in 18% of the patients in Group post (P <0.001). Pre- and postoperative hemoglobin concentrations, mortality and morbidity were not different among groups. Development of a standardized multidisciplinary transfusion strategy markedly reduced the exposure of cardiac surgery patients to allogeneic blood.

  14. Analysis of the prevalence of atelectasis in patients undergoing bariatric surgery

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    Letícia Baltieri

    2016-11-01

    Full Text Available Background and objective: To observe the prevalence of atelectasis in patients undergoing bariatric surgery and the influence of the body mass index (BMI, gender and age on the prevalence of atelectasis. Method: Retrospective study of 407 patients and reports on chest X-rays carried out before and after bariatric surgery over a period of 14 months. Only patients who underwent bariatric surgery by laparotomy were included. Results: There was an overall prevalence of 37.84% of atelectasis, with the highest prevalence in the lung bases and with greater prevalence in women (RR = 1.48. There was a ratio of 30% for the influence of age for individuals under the age of 36, and of 45% for those older than 36 (RR = 0.68. There was no significant influence of BMI on the prevalence of atelectasis. Conclusion: The prevalence of atelectasis in bariatric surgery is 37% and the main risk factors are being female and aged over 36 years. Resumo: Justificativa e objectivo: Observar a prevalência de atelectasia em pacientes submetidos à cirurgia bariátrica e a influência do índice de massa corporal (IMC, sexo e idade sobre a prevalência de atelectasia. Método: Estudo retrospectivo de 407 pacientes e laudos de radiografias de tórax realizadas antes e após a cirurgia bariátrica durante um período de 14 meses. Apenas os pacientes submetidos à cirurgia bariátrica por laparotomia foram incluídos. Resultados: Houve uma prevalência geral de atelectasia de 37,84%, com maior prevalência nas bases pulmonares e em mulheres (RR = 1,48. Houve uma proporção de 30% para a influência da idade nos indivíduos com idade inferior a 36 anos e de 45% naqueles com idade superior a 36 anos (RR = 0,68. Não houve influência significativa do IMC sobre a prevalência de atelectasia. Conclusão: A prevalência de atelectasia em cirurgia bariátrica é de 37%, e os principais fatores de risco são sexo feminino e idade superior a 36 anos. Keywords: Morbid obesity

  15. Structural pathology is not related to patient-reported pain and function in patients undergoing meniscal surgery

    DEFF Research Database (Denmark)

    Christensen, Simon Tornbjerg; Nissen, Nis; Englund, Martin

    2017-01-01

    BACKGROUND: The relationship between meniscal tears and other joint pathologies with patient-reported symptoms is not clear. We investigated associations between structural knee pathologies identified at surgery with preoperative knee pain and function in patients undergoing arthroscopic meniscal...... of meniscal tears questionnaire, supplemented with information extracted from surgery reports. Following hypothesis-driven preselection of candidate variables, backward elimination regressions were performed to investigate associations between patient-reported outcomes and structural knee pathologies. RESULTS...... surgery. METHODS: This study included 443 patients from the Knee Arthroscopy Cohort Southern Denmark (KACS), a prospective cohort following patients 18 years or older undergoing arthroscopic meniscal surgery at 4 hospitals between 1 February 2013 and 31 January 2014. Patient-reported outcomes, including...

  16. Psychiatric comorbidity as predictor of costs in back pain patients undergoing disc surgery: a longitudinal observational study

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    Konnopka Alexander

    2012-09-01

    Full Text Available Abstract Background Psychiatric comorbidity is common in back pain patients undergoing disc surgery and increases economic costs in many areas of health. The objective of this study was to analyse psychiatric comorbidity as predictor of direct and indirect costs in back pain patients undergoing disc surgery in a longitudinal study design. Methods A sample of 531 back pain patients was interviewed after an initial disc surgery (T0, 3 months (T1 and 15 months (T2 using the Composite International Diagnostic Interview to assess psychiatric comorbidity and a modified version of the Client Sociodemographic and Service Receipt Inventory to assess resource utilization and lost productivity for a 3-month period prior interview. Health care utilization was monetarily valued by unit costs and productivity by labour costs. Costs were analysed using random coefficient models and bootstrap techniques. Results Psychiatric comorbidity was associated with significantly (p  Conclusion Psychiatric comorbidity presents an important predictor of direct and indirect costs in back pain patients undergoing disc surgery, even if patients do not utilize mental health care. This effect seems to be stable over time. More attention should be given to psychiatric comorbidity and cost-effective treatments should be applied to treat psychiatric comorbidity in back pain patients undergoing disc surgery to reduce health care utilization and costs associated with psychiatric comorbidity.

  17. Effectiveness of massage therapy on post-operative outcomes among patients undergoing cardiac surgery: A systematic review

    Directory of Open Access Journals (Sweden)

    C. Ramesh

    2015-09-01

    Full Text Available The incidence and prevalence of cardiovascular disease (CVD are increasing rapidly in developing countries. Most patients with CVD do not respond to medical treatment and have to undergo cardiac surgery. This highly stressful experience results in increased levels of anxiety for patients. The objective of this review was to evaluate the efficacy of massage therapy on postoperative outcomes among patients undergoing cardiac surgery. A comprehensive literature search was made on PubMed-Medline, CINAHL, Science Direct, Scopus, Web of Science and the Cochrane library databases for original research articles published between 2000 and 2015. Original articles that reported the efficacy of massage therapy in patients undergoing cardiac surgery were included. The Cochrane data extraction form was used to extract data. A total of 297 studies were identified in the literature search. However, only seven studies were eligible for analysis. Of the seven studies, six studies demonstrated the effects of massage therapy on improving post-operative outcomes of patients, while one study found no evidence of improvement. Although the methods varied considerably, most of the studies included in this review reported positive results. Therefore, there is some evidence that massage therapy can lead to positive postoperative outcomes. Evidence of the effectiveness of massage therapy in patients undergoing cardiac surgery remains inconclusive. Additional research is needed to provide a strong evidence base for the use of massage therapy to improve post-operative outcomes and recovery among cardiac surgery patients

  18. Influence of psychological variables in morbidly obese patients undergoing bariatric surgery after 24 months of evolution.

    Science.gov (United States)

    Rodríguez-Hurtado, José; Ferrer-Márquez, Manuel; Fontalba-Navas, Andrés; García-Torrecillas, Juan Manuel; Olvera-Porcel, M Carmen

    Bariatric surgery is considered a more effective means of achieving weight loss than non-surgical options in morbid obesity. Rates of failure or relapse range from 20 to 30%. The study aims to analyse the influence of psychological variables (self-esteem, social support, coping strategies and personality) in the maintenance of weight loss after bariatric surgery. A cohort study was conducted involving 64 patients undergoing bariatric surgery for 24 months. At the end of the follow-up period, patients were divided into 2sub-cohorts classified as successes or failures. Success or favorable development was considered when the value of percent excess weight loss was 50 or higher. No statistically significant differences were observed between the 2groups in any variable studied. All patients had high self-esteem (87,3 those who failed and 88,1 those who are successful) and social support (90,2 and 90,9). Patients who succeed presented higher scores for cognitive restructuring (57,1) and were more introverted (47,1), while those who failed scored more highly in desiderative thinking (65,7) and were more prone to aggression (50,7) and neuroticism (51,7). High self-esteem and social support does not guarantee successful treatment. The groups differed in how they coped with obesity but the data obtained do not justify the weight evolution. In the absence of psychopathology, personality trait variability between patients is insufficient to predict the results. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Coronary risk stratification of patients undergoing surgery for valvular heart disease.

    Science.gov (United States)

    Hasselbalch, Rasmus Bo; Engstrøm, Thomas; Pries-Heje, Mia; Heitmann, Merete; Pedersen, Frants; Schou, Morten; Mickley, Hans; Elming, Hanne; Steffensen, Rolf; Køber, Lars; Iversen, Kasper

    2017-01-15

    Multislice computed tomography (MSCT) is a non-invasive, less expensive, low-radiation alternative to coronary angiography (CAG) prior to valvular heart surgery. MSCT has a high negative predictive value for coronary artery disease (CAD) but previous studies of patients with valvular disease have shown that MSCT, as the primary evaluation technique, lead to re-evaluation with CAG in about a third of cases and it is therefore not recommended. If a subgroup of patients with low- to intermediate risk of CAD could be identified and examined with MSCT, it could be cost-effective, reduce radiation and the risk of complications associated with CAG. The study cohort was derived from a national registry of patients undergoing CAG prior to valvular heart surgery. Using logistic regression, we identified significant risk factors for CAD and developed a risk score (CT-valve score). The score was validated on a similar cohort of patients from another registry. The study cohort consisted of 2221 patients, 521 (23.5%) had CAD. The validation cohort consisted of 2575 patients, 771 (29.9%) had CAD. The identified risk factors were male sex, age, smoking, hyperlipidemia, hypertension, aortic valve disease, extracardiac arteriopathy, ejection fraction <30% and diabetes mellitus. CT-valve score could identify a third of the population with a risk about 10%. A score based on risk factors of CAD can identify patients that might benefit from using MSCT as a gatekeeper to CAG prior to heart valve surgery. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. Prognostic factors for perioperative pulmonary events among patients undergoing upper abdominal surgery

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    Rafael Luis Sakai

    Full Text Available CONTEXT AND OBJECTIVE: The significant relationship between upper abdominal surgery and early (perioperative pulmonary events was investigated among patients with preoperative pulmonary conditions undergoing general anesthesia. DESIGN AND SETTING: Retrospective study for which data were obtained prospectively from 1999 to 2004, at a tertiary university hospital. METHODS: We retrospectively studied 3107 patients over 11 years old presenting American Society of Anesthesiologists (ASA status I, II or III who underwent upper abdominal surgery under general anesthesia and were discharged to the recovery room. The preoperative conditions analyzed using logistic regression were: age, sex, ASA physical status, congestive heart failure, asthma, chronic obstructive pulmonary disease (COPD, respiratory failure and smoking. The outcomes or dependent variables included intraoperative and postoperative events: bronchospasm, hypoxemia, hypercapnia, prolonged intubation and airway secretion. RESULTS: Among these patients (1500 males, 1607 females, mean age 48 years, 1088 ASA I, 1402 ASA II and 617 ASA III, there were 80 congestive heart failures, 82 asthmatics, 122 with COPD, 21 respiratory failures and 428 smokers. Logistic regression analysis showed that female sex (p < 0.001, age over 70 years (p < 0.01, smoking (p < 0.001 and COPD (p < 0.02 significantly influenced pulmonary event development, particularly hypoxemia and bronchospasm, at both times but not in the same patients. Asthma and congestive heart failure cases did not present pulmonary events in the recovery room. CONCLUSION: In upper abdominal surgery under general anesthesia, female sex, age over 70, smoking and COPD were independent risk factors for intra and postoperative pulmonary events.

  1. TLR4 Expression Is Associated with Left Ventricular Dysfunction in Patients Undergoing Coronary Artery Bypass Surgery.

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    Orna Avlas

    Full Text Available Toll-like receptor 4 (TLR4 is an innate immune receptor expressed in immune cells and the heart. Activation of the immune system following myocardial ischemia causes the release of proinflammatory mediators that may negatively influence heart function.The aim of this study is to determine whether TLR4 is activated in peripheral monocytes and heart tissue taken from patients with varying degrees of myocardial dysfunction caused by coronary artery diseases and scheduled for coronary artery bypass graft (CABG surgery before 12 months following operation.Patients (n = 44 undergoing CABG surgery having left ventricular ejection fraction ≤ 45% ('reduced EF', n = 20 were compared to patients with preserved EF >45% ('preserved EF' group, n = 24. 'Reduced EF' patients exhibited increased TLR4 expression in monocytes (2.78±0.49 vs. 1.76±0.07 rMFI, p = 0.03. Plasma levels of C-reactive protein, microRNA miR-320a, brain natriuretic peptide (pro BNP and NADPH oxidase (NOX4 were also significantly different between the 'preserved EF' and 'reduced EF'groups. Elevated TLR4 gene expression levels in the right auricle correlated with those of EF (p<0.008, NOX4 (p<0.008 and miR320, (p<0.04. In contrast, no differences were observed in peripheral monocyte TLR2 expression. After CABG surgery, monocyte TLR4 expression decreased in all patients, reaching statistical significance in the 'reduced EF' group.TLR4 is activated in peripheral monocytes and heart tissue obtained from patients with ischemic heart disease and reduced left ventricular function. Coronary revascularization decreases TLR4 expression. We therefore propose that TLR4 plays a pathogenic role and may serve as an additional marker of ischemic myocardial dysfunction.

  2. Patient characteristics of smokers undergoing lumbar spine surgery: an analysis from the Quality Outcomes Database.

    Science.gov (United States)

    Asher, Anthony L; Devin, Clinton J; McCutcheon, Brandon; Chotai, Silky; Archer, Kristin R; Nian, Hui; Harrell, Frank E; McGirt, Matthew; Mummaneni, Praveen V; Shaffrey, Christopher I; Foley, Kevin; Glassman, Steven D; Bydon, Mohamad

    2017-12-01

    OBJECTIVE In this analysis the authors compare the characteristics of smokers to nonsmokers using demographic, socioeconomic, and comorbidity variables. They also investigate which of these characteristics are most strongly associated with smoking status. Finally, the authors investigate whether the association between known patient risk factors and disability outcome is differentially modified by patient smoking status for those who have undergone surgery for lumbar degeneration. METHODS A total of 7547 patients undergoing degenerative lumbar surgery were entered into a prospective multicenter registry (Quality Outcomes Database [QOD]). A retrospective analysis of the prospectively collected data was conducted. Patients were dichotomized as smokers (current smokers) and nonsmokers. Multivariable logistic regression analysis fitted for patient smoking status and subsequent measurement of variable importance was performed to identify the strongest patient characteristics associated with smoking status. Multivariable linear regression models fitted for 12-month Oswestry Disability Index (ODI) scores in subsets of smokers and nonsmokers was performed to investigate whether differential effects of risk factors by smoking status might be present. RESULTS In total, 18% (n = 1365) of patients were smokers and 82% (n = 6182) were nonsmokers. In a multivariable logistic regression analysis, the factors significantly associated with patients' smoking status were sex (p smoker (p = 0.0008), while patients with coronary artery disease had greater odds of being a smoker (p = 0.044). Patients' propensity for smoking was also significantly associated with higher American Society of Anesthesiologists (ASA) class (p smokers and nonsmokers. CONCLUSIONS Using a large, national, multiinstitutional registry, the authors described the profile of patients who undergo lumbar spine surgery and its association with their smoking status. Compared with nonsmokers, smokers were younger, male

  3. Treatment for preventing bleeding in people with haemophilia or other congenital bleeding disorders undergoing surgery.

    Science.gov (United States)

    Coppola, Antonio; Windyga, Jerzy; Tufano, Antonella; Yeung, Cindy; Di Minno, Matteo Nicola Dario

    2015-02-09

    of safety assessments, no fatal adverse events were reported. The second primary outcome of blood loss was assessed after surgery and these trials showed the reduction of blood loss and requirement of post-operative replacement treatment in people receiving antifibrinolytic agents compared with placebo. The remaining primary outcome of need for re-intervention was not reported by either trial.Two trials reported on 53 people with haemophilia A and B with inhibitors treated with different regimens of recombinant activated factor VII (rFVIIa) for haemostatic coverage of 33 major and 20 minor surgical interventions. Neither of the included trials specifically addressed any of the review's primary outcomes (mortality, blood loss and need for re-intervention). In one trial a high-dose rFVIIa regimen (90 μg/kg) was compared with a low-dose regimen (35 μg/kg); the higher dose showed increased haemostatic efficacy, in particular in major surgery, with shorter duration of treatment, similar total dose of rFVIIa administered and similar safety levels. In the second trial, bolus infusion and continuous infusion of rFVIIa were compared, showing similar haemostatic efficacy, duration of treatment and safety. There is insufficient evidence from randomised controlled trials to assess the most effective and safe haemostatic treatment to prevent bleeding in people with haemophilia or other congenital bleeding disorders undergoing surgical procedures. Ideally large, adequately powered, and well-designed randomised controlled trials would be needed, in particular to address the cost-effectiveness of such demanding treatments in the light of the increasing present economic constraints, and to explore the new challenge of ageing patients with haemophilia or other congenital bleeding disorders. However, performing such trials is always a complex task in this setting and presently does not appear to be a clinical and research priority. Indeed, major and minor surgeries are effectively

  4. Back school or brain school for patients undergoing surgery for lumbar radiculopathy? Protocol for a randomised, controlled trial

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    Kelly Ickmans

    2016-07-01

    Discussion: This study will determine whether pain neuroscience education is worthwhile for patients undergoing surgery for lumbar radiculopathy. It is expected that participants who receive perioperative pain neuroscience education will report less pain and have improved endogenous pain modulation, lower postoperative healthcare costs and improved surgical experience. Lower pain and improved endogenous pain modulation after surgery may reduce the risk of developing postoperative chronic pain.

  5. Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study)

    NARCIS (Netherlands)

    Vlug, Malaika S.; Wind, Jan; Hollmann, Markus W.; Ubbink, Dirk T.; Cense, Huib A.; Engel, Alexander F.; Gerhards, Michael F.; van Wagensveld, Bart A.; van der Zaag, Edwin S.; van Geloven, Anna A. W.; Sprangers, Mirjam A. G.; Cuesta, Miguel A.; Bemelman, Willem A.; Preckel, Benedikt; Bossuyt, Patrick; Gouma, Dirk; van Berge Henegouwen, Mark; Fuhring, Jan; van Lenthe, Ineke Picard; Bakker, Chris; King-Kalimanis, Bellinda; Hofland, Jan; Dejong, Cornelis; van Dam, Ronald; van der Peet, Donald; van Zalingen, Edith; Noordhuis, Astrid; de Jong, Dick; Goei, T. Hauwy; de Stoppelaar, Erica; van den Dongen, Marjon; van Tets, Willem; van den Elsen, Maarten; Swart, Annemiek; deWit, Laurens; Siepel, Muriel; Molly, Glaresa; Juttmann, Jan; Clevers, Wilfred; Bieleman, Andrea; Coenen, Ludo; Bonekamp, Elly; van Abeelen, Jacobus; van Iterson-de Jong, Diana; Krombeen, Margriet

    2011-01-01

    To investigate which perioperative treatment, ie, laparoscopic or open surgery combined with fast track (FT) or standard care, is the optimal approach for patients undergoing segmental resection for colon cancer. Important developments in elective colorectal surgery are the introduction of

  6. Sarcopenia increases risk of long-term mortality in elderly patients undergoing emergency abdominal surgery.

    Science.gov (United States)

    Rangel, Erika L; Rios-Diaz, Arturo J; Uyeda, Jennifer W; Castillo-Angeles, Manuel; Cooper, Zara; Olufajo, Olubode A; Salim, Ali; Sodickson, Aaron D

    2017-12-01

    Frailty is associated with poor surgical outcomes in elderly patients but is difficult to measure in the emergency setting. Sarcopenia, or the loss of lean muscle mass, is a surrogate for frailty and can be measured using cross-sectional imaging. We sought to determine the impact of sarcopenia on 1-year mortality after emergency abdominal surgery in elderly patients. Sarcopenia was assessed in patients 70 years or older who underwent emergency abdominal surgery at a single hospital from 2006 to 2011. Average bilateral psoas muscle cross-sectional area at L3, normalized for height (Total Psoas Index [TPI]), was calculated using computed tomography. Sarcopenia was defined as TPI in the lowest sex-specific quartile. Primary outcome was mortality at 1 year. Secondary outcomes were in-hospital mortality and mortality at 30, 90, and 180 days. The association of sarcopenia with mortality was assessed using Cox proportional hazards regression and model performance judged using Harrell's C-statistic. Two hundred ninety-seven of 390 emergency abdominal surgery patients had preoperative imaging and height. The median age was 79 years, and 1-year mortality was 32%. Sarcopenic and nonsarcopenic patients were comparable in age, sex, race, comorbidities, American Society of Anesthesiologists classification, procedure urgency and type, operative severity, and need for discharge to a nursing facility. Sarcopenic patients had lower body mass index, greater need for intensive care, and longer hospital length of stay (p Sarcopenia was independently associated with increased in-hospital mortality (risk ratio, 2.6; 95% confidence interval [CI], 1.6-3.7) and mortality at 30 days (hazard ratio [HR], 3.7; 95% CI, 1.9-7.4), 90 days (HR, 3.3; 95% CI, 1.8-6.0), 180 days (HR, 2.5; 95% CI, 1.4-4.4), and 1 year (HR, 2.4; 95% CI, 1.4-3.9). Sarcopenia is associated with increased risk of mortality over 1 year in elderly patients undergoing emergency abdominal surgery. Sarcopenia defined by TPI is

  7. Impact of Right Ventricular Performance in Patients Undergoing Extracorporeal Membrane Oxygenation Following Cardiac Surgery.

    Science.gov (United States)

    Bartko, Philipp E; Wiedemann, Dominik; Schrutka, Lore; Binder, Christina; Santos-Gallego, Carlos G; Zuckermann, Andreas; Steinlechner, Barbara; Koinig, Herbert; Heinz, Gottfried; Niessner, Alexander; Zimpfer, Daniel; Laufer, Günther; Lang, Irene M; Distelmaier, Klaus; Goliasch, Georg

    2017-07-28

    Extracorporeal membrane oxygenation following cardiac surgery safeguards end-organ oxygenation but unfavorably alters cardiac hemodynamics. Along with the detrimental effects of cardiac surgery to the right heart, this might impact outcome, particularly in patients with preexisting right ventricular (RV) dysfunction. We sought to determine the prognostic impact of RV function and to improve established risk-prediction models in this vulnerable patient cohort. Of 240 patients undergoing extracorporeal membrane oxygenation support following cardiac surgery, 111 had echocardiographic examinations at our institution before implantation of extracorporeal membrane oxygenation and were thus included. Median age was 67 years (interquartile range 60-74), and 74 patients were male. During a median follow-up of 27 months (interquartile range 16-63), 75 patients died. Fifty-one patients died within 30 days, 75 during long-term follow-up (median follow-up 27 months, minimum 5 months, maximum 125 months). Metrics of RV function were the strongest predictors of outcome, even stronger than left ventricular function ( P <0.001 for receiver operating characteristics comparisons). Specifically, RV free-wall strain was a powerful predictor univariately and after adjustment for clinical variables, Simplified Acute Physiology Score-3, tricuspid regurgitation, surgery type and duration with adjusted hazard ratios of 0.41 (95%CI 0.24-0.68; P =0.001) for 30-day mortality and 0.48 (95%CI 0.33-0.71; P <0.001) for long-term mortality for a 1-SD (SD=-6%) change in RV free-wall strain. Combined assessment of the additive EuroSCORE and RV free-wall strain improved risk classification by a net reclassification improvement of 57% for 30-day mortality ( P =0.01) and 56% for long-term mortality ( P =0.02) compared with the additive EuroSCORE alone. RV function is strongly linked to mortality, even after adjustment for baseline variables and clinical risk scores. RV performance improves

  8. Kinetics of circulating endothelial progenitor cells in patients undergoing carotid artery surgery

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    Kalender G

    2016-12-01

    Full Text Available G Kalender,1 A Kornberger,2 M Lisy,1 Andres Beiras-Fernandez,2 UA Stock2 1Deparment of General, Thoracic and Vascular Surgery, Hoechst Hospital, 2Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany Aim: Endothelial progenitor cells (EPCs are primitive cells found in the bone marrow and peripheral blood (PB. In particular, the potential of EPCs to differentiate into mature endothelial cells remains of high interest for clinical applications such as bio-functionalized patches for autologous seeding after implantation. The objective of this study was to determine EPCs’ kinetics in patients undergoing carotid artery thromboendarterectomy (CTEA and patch angioplasty. Methods: Twenty CTEA patients were included (15 male, mean age 76 years. PB samples were taken at 1 day preoperatively, and at 1, 3, and 5 days postoperatively. Flow cytometric analysis was performed for CD34, CD133, KDR, and CD45. Expression of KDR, SDF-1α, and G-CSF was analyzed by means of enzyme-linked immunosorbent assay. Results: Fluorescence-activated cell sorting analysis revealed 0.031%±0.016% (% of PB mononuclear cells KDR+ cells and 0.052%±0.022% CD45-/CD34+/CD133+ cells, preoperatively. A 33% decrease of CD45–/CD34+/CD133+ cells was observed at day 1 after surgery. However, a relative number (compared to initial preoperative values of CD45-/CD34+/CD133+ cells was found on day 3 (82% and on day 5 (94% postoperatively. More profound upregulated levels of CD45–CD34+/CD133+ cells were observed for diabetic (+47% compared to nondiabetic and male (+38% compared to female patients. No significant postoperative time-dependent differences were found in numbers of KDR+ cells and the concentrations of the cytokines KDR and G-CSF. However, the SDF-1α levels decreased significantly on day 1 postoperatively but returned to preoperative levels by day 3. Conclusion: CTEA results in short-term downregulation of circulating

  9. The Efficacy of Aromatherapy in the Treatment of Postdischarge Nausea in Patients Undergoing Outpatient Abdominal Surgery.

    Science.gov (United States)

    Mcilvoy, Laura; Richmer, Linda; Kramer, Deborah; Jackson, Rita; Shaffer, Leslee; Lawrence, Jeffrey; Inman, Kevin

    2015-10-01

    The purpose of this study was to explore the effectiveness of the aromatherapy product QueaseEASE (QE) for decreasing postdischarge nausea (PDN) in patients undergoing outpatient abdominal surgery. Prospective exploratory study. Informed Consent was obtained preoperatively from a convenience sample of adult patients scheduled for outpatient abdominal surgery procedures. Prior to discharge, subjects were instructed in the use of QE and given instructions on how to rate their nausea on a 0-10 scale. They recorded nausea scales > 0 any time they occurred for the next 24 hours, used the QE, and recorded their nausea scales 3 minutes later. A study nurse called subjects the next day to collect the information. The sample included 70 outpatients who underwent abdominal surgery. Twenty-five participants (36%) reported experiencing PDN and their concomitant use of QE. There was a significant difference in mean age of those reporting PDN (37 years) versus those without nausea (48 years, P = .004) as well as a significant difference in mean intravenous fluid intake during hospitalization of those reporting PDN (1,310 mL) versus those without nausea (1,511 mL, P = .04). The PDN group had more female participants (72% vs 42%, P = .02), more participants that were less than 50 years of age (84% vs 53%, P = .02), and received more opioids (100% vs 76%, P = .006) than the no nausea group. The 25 PDN participants reported 47 episodes of PDN in which they used QE. For all of the 47 PDN episodes experienced, participants reported a decrease in nausea scale (0 to 10) after the use of QE; for 22 (47%) of the PDN episodes experienced, a nausea scale of 0 after using QE was reported. The mean decrease in nausea scale for all 25 participants was 4.78 (±2.12) after using QE. This study found that the aromatherapy QE was an effective treatment of PDN in select same-day abdominal surgery patients. Copyright © 2015 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc

  10. Thoracic epidural analgesia reduces myocardial injury in ischemic patients undergoing major abdominal cancer surgery

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    Mohamad MF

    2017-04-01

    Full Text Available Mohamad Farouk Mohamad,1 Montaser A Mohammad,1 Diab F Hetta,1 Eman Hasan Ahmed,2 Ahmed A Obiedallah,3 Alaa Ali M Elzohry1 1Department of Anesthesia, ICU and Pain Relief, 2Department of Clinical Pathology, South Egypt Cancer Institute, 3Department of Internal Medicine, Faculty of Medicine, Assiut University, Arab Republic of Egypt Background and objectives: Major abdominal cancer surgeries are associated with significant perioperative mortality and morbidity due to myocardial ischemia and infarction. This study examined the effect of perioperative patient controlled epidural analgesia (PCEA on occurrence of ischemic cardiac injury in ischemic patients undergoing major abdominal cancer surgery.Patients and methods: One hundred and twenty patients (American Society of Anesthesiologists grade II and III of either sex were scheduled for elective upper gastrointestinal cancer surgeries. Patients were allocated randomly into two groups (60 patients each to receive, besides general anesthesia: continuous intra and postoperative intravenous (IV infusion with fentanyl for 72 h postoperatively (patient controlled intravenous analgesia [PCIA] group or continuous intra and postoperative epidural infusion with bupivacaine 0.125% and fentanyl (PCEA group for 72 h postoperatively. Perioperative hemodynamics were recorded. Postoperative pain was assessed over 72 h using visual analog scale (VAS. All patients were screened for occurrence of myocardial injury (MI by electrocardiography, echocardiography, and cardiac troponin I serum level. Other postoperative complications as arrhythmia, deep venous thrombosis (DVT, pulmonary embolism, pneumonia, and death were recorded.Results: There was a significant reduction in overall adverse cardiac events (myocardial injury, arrhythmias, angina, heart failure and nonfatal cardiac arrest in PCEA group in comparison to PCIA group. Also, there was a significant reduction in dynamic VAS pain score in group PCEA in comparison

  11. Risk model of prolonged intensive care unit stay in Chinese patients undergoing heart valve surgery.

    Science.gov (United States)

    Wang, Chong; Zhang, Guan-xin; Zhang, Hao; Lu, Fang-lin; Li, Bai-ling; Xu, Ji-bin; Han, Lin; Xu, Zhi-yun

    2012-11-01

    The aim of this study was to develop a preoperative risk prediction model and an scorecard for prolonged intensive care unit length of stay (PrlICULOS) in adult patients undergoing heart valve surgery. This is a retrospective observational study of collected data on 3925 consecutive patients older than 18 years, who had undergone heart valve surgery between January 2000 and December 2010. Data were randomly split into a development dataset (n=2401) and a validation dataset (n=1524). A multivariate logistic regression analysis was undertaken using the development dataset to identify independent risk factors for PrlICULOS. Performance of the model was then assessed by observed and expected rates of PrlICULOS on the development and validation dataset. Model calibration and discriminatory ability were analysed by the Hosmer-Lemeshow goodness-of-fit statistic and the area under the receiver operating characteristic (ROC) curve, respectively. There were 491 patients that required PrlICULOS (12.5%). Preoperative independent predictors of PrlICULOS are shown with odds ratio as follows: (1) age, 1.4; (2) chronic obstructive pulmonary disease (COPD), 1.8; (3) atrial fibrillation, 1.4; (4) left bundle branch block, 2.7; (5) ejection fraction, 1.4; (6) left ventricle weight, 1.5; (7) New York Heart Association class III-IV, 1.8; (8) critical preoperative state, 2.0; (9) perivalvular leakage, 6.4; (10) tricuspid valve replacement, 3.8; (11) concurrent CABG, 2.8; and (12) concurrent other cardiac surgery, 1.8. The Hosmer-Lemeshow goodness-of-fit statistic was not statistically significant in both development and validation dataset (P=0.365 vs P=0.310). The ROC curve for the prediction of PrlICULOS in development and validation dataset was 0.717 and 0.700, respectively. We developed and validated a local risk prediction model for PrlICULOS after adult heart valve surgery. This model can be used to calculate patient-specific risk with an equivalent predicted risk at our centre in

  12. Enhancing tumor apparent diffusion coefficient histogram skewness stratifies the postoperative survival in recurrent glioblastoma multiforme patients undergoing salvage surgery.

    Science.gov (United States)

    Zolal, Amir; Juratli, Tareq A; Linn, Jennifer; Podlesek, Dino; Sitoci Ficici, Kerim Hakan; Kitzler, Hagen H; Schackert, Gabriele; Sobottka, Stephan B; Rieger, Bernhard; Krex, Dietmar

    2016-05-01

    Objective To determine the value of apparent diffusion coefficient (ADC) histogram parameters for the prediction of individual survival in patients undergoing surgery for recurrent glioblastoma (GBM) in a retrospective cohort study. Methods Thirty-one patients who underwent surgery for first recurrence of a known GBM between 2008 and 2012 were included. The following parameters were collected: age, sex, enhancing tumor size, mean ADC, median ADC, ADC skewness, ADC kurtosis and fifth percentile of the ADC histogram, initial progression free survival (PFS), extent of second resection and further adjuvant treatment. The association of these parameters with survival and PFS after second surgery was analyzed using log-rank test and Cox regression. Results Using log-rank test, ADC histogram skewness of the enhancing tumor was significantly associated with both survival (p = 0.001) and PFS after second surgery (p = 0.005). Further parameters associated with prolonged survival after second surgery were: gross total resection at second surgery (p = 0.026), tumor size (0.040) and third surgery (p = 0.003). In the multivariate Cox analysis, ADC histogram skewness was shown to be an independent prognostic factor for survival after second surgery. Conclusion ADC histogram skewness of the enhancing lesion, enhancing lesion size, third surgery, as well as gross total resection have been shown to be associated with survival following the second surgery. ADC histogram skewness was an independent prognostic factor for survival in the multivariate analysis.

  13. Use of antibiotics for urinary tract infection in women undergoing surgery for urinary incontinence: a cohort study.

    Science.gov (United States)

    Guldberg, Rikke; Kesmodel, Ulrik Schiøler; Brostrøm, Søren; Kærlev, Linda; Hansen, Jesper Kjær; Hallas, Jesper; Nørgård, Bente Mertz

    2014-02-04

    To describe the use of antibiotics for urinary tract infection (UTI) before and after surgery for urinary incontinence (UI); and for those with use of antibiotics before surgery, to estimate the risk of treatment for a postoperative UTI, relative to those without use of antibiotics before surgery. A historical population-based cohort study. Denmark. Women (age ≥18 years) with a primary surgical procedure for UI from the county of Funen and the Region of Southern Denmark from 1996 throughout 2010. Data on redeemed prescriptions of antibiotics ±365 days from the date of surgery were extracted from a prescription database. Use of antibiotics for UTI in relation to UI surgery, and the risk of being a postoperative user of antibiotics for UTI among preoperative users. A total of 2151 women had a primary surgical procedure for UI; of these 496 (23.1%) were preoperative users of antibiotics for UTI. Among preoperative users, 129 (26%) and 215 (43.3%) also redeemed prescriptions of antibiotics for UTI within 0-60 and 61-365 days after surgery, respectively. Among preoperative non-users, 182 (11.0%) and 235 (14.2%) redeemed prescriptions within 0-60 and 61-365 days after surgery, respectively. Presurgery exposure to antibiotics for UTI was a strong risk factor for postoperative treatment for UTI, both within 0-60 days (adjusted OR, aOR=2.6 (95% CI 2.0 to 3.5)) and within 61-365 days (aOR=4.5 (95% CI 3.5 to 5.7)). 1 in 4 women undergoing surgery for UI was treated for UTI before surgery, and half of them had a continuing tendency to UTIs after surgery. Use of antibiotics for UTI before surgery was a strong risk factor for antibiotic use after surgery. In women not using antibiotics for UTI before surgery only a minor proportion initiated use after surgery.

  14. A Meta-Analysis Detailing Overall Sexual Function and Orgasmic Function in Women Undergoing Midurethral Sling Surgery for Stress Incontinence

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    Nicole Szell, DO

    2017-06-01

    Szell N, Komisaruk B, Goldstein SW, et al. A Meta-Analysis Detailing Overall Sexual Function and Orgasmic Function in Women Undergoing Midurethral Sling Surgery for Stress Incontinence. Sex Med 2017;5:e84–e93.

  15. Ultra Low-Dose Naloxone and Tramadol/Acetaminophen in Elderly Patients Undergoing Joint Replacement Surgery: A Pilot Study

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    Ngozi N Imasogie

    2009-01-01

    Full Text Available OBJECTIVE: A pilot study was conducted to assess whether both the rationale and feasibility exist for future randomized clinical trials to evaluate the combined use of naloxone infusion and tramadol/acetaminophen as opioid-sparing drugs in elderly patients undergoing lower extremity joint replacement surgery.

  16. Hepatic Steatosis in Morbidly Obese Patients Undergoing Gastric Bypass Surgery: Assessment With Open-System 1H-MR Spectroscopy

    NARCIS (Netherlands)

    van Werven, Jochem R.; Schreuder, Tim C. M. A.; Aarts, Edo O.; Nederveen, Aart J.; Meijer, Jos W. R.; Berends, Frits J.; Janssen, Ignace M. C.; Mulder, Chris J.; Jansen, Peter L. M.; Stoker, Jaap

    2011-01-01

    The purpose of this study was to assess, with histopathologic control, the use of open-system 1-T (1)H MR spectroscopy for the evaluation of hepatic steatosis in morbidly obese patients undergoing gastric bypass surgery. Patients underwent (1)H MR spectroscopy (MRS) for the assessment of steatosis

  17. Obstructive Sleep Apnea and Postoperative Complications in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Need for Preventive Strategies

    Directory of Open Access Journals (Sweden)

    Babak Amra

    2014-01-01

    Conclusions: Obstructive sleep apnea is frequent, but unrecognized among patients undergoing CABG. In these patients, OSA is associated with prolonged intubation duration. Preventing these problems may be possible by early diagnosis and management of OSA in cardiac surgery patients. Further studies with larger sample of patients and longer follow-ups are required in this regard.

  18. Coronary artery disease in patients undergoing cardiac surgery for non-coronary lesions in a tertiary care centre

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    Cholenahally Nanjappa Manjunath

    2014-01-01

    Conclusion: The overall prevalence of CAD among patients undergoing non-coronary cardiac surgery is 8.7%. Coronary artery disease is relatively uncommon in patients with rheumatic VHD (4.9%, while its prevalence is highest in DAVD (23.4%.

  19. S100B increases in cyanotic versus noncyanotic infants undergoing heart surgery and cardiopulmonary bypass (CPB).

    Science.gov (United States)

    Varrica, Alessandro; Satriano, Angela; Gavilanes, Antonio D W; Zimmermann, Luc J; Vles, Hans J S; Pluchinotta, Francesca; Anastasia, Luigi; Giamberti, Alessandro; Baryshnikova, Ekaterina; Gazzolo, Diego

    2017-11-28

    S100B has been proposed as a consolidated marker of brain damage in infants with congenital heart disease (CHD) undergoing cardiac surgery and cardiopulmonary bypass (CPB). The present study aimed to investigate whether S100B blood levels in the perioperative period differed in infants complicated or not by cyanotic CHD (CHDc) and correlated with oxygenation status (PaO 2 ). We conducted a case-control study of 48 CHD infants without pre-existing neurological disorders undergoing surgical repair and CPB. 24 infants were CHDc and 24 were CHD controls. Blood samples for S100B assessment were collected at six monitoring time-points: before the surgical procedure (T0), after sternotomy but before CPB (T1), at the end of the cross-clamp CPB phase (T2), at the end of CPB (T3), at the end of the surgical procedure (T4), at 24 h postsurgery (T5). In the CHDc group, S100B multiples of median (MoM) were significantly higher (p  .05, for all) were found at T2, T3, T5. Linear regression analysis showed a positive correlation between S100B MoM at T3 and PaO 2 (R = 0.84; p < .001). The present data showing higher hypoxia/hyperoxia-mediated S100B concentrations in CHDc infants suggest that CHDc are more prone to perioperative brain stress/damage and suggest the usefulness of further investigations to detect the "optimal" PaO 2 target in order to avoid the side effects associated with reoxygenation during CPB.

  20. Cardiac dual-source CT for the preoperative assessment of patients undergoing bariatric surgery

    International Nuclear Information System (INIS)

    Tognolini, A.; Arellano, C.S.; Marfori, W.; Sayre, J.W.; Hollada, J.L.; Goldin, J.G.; Dutson, E.P.; Ruehm, S.G.

    2013-01-01

    Aim: To assess the diagnostic value of coronary dual-source computed tomography (DSCT) as a comprehensive, non-invasive tool in the preoperative cardiac evaluation of patients undergoing bariatric surgery. Materials and methods: Thirty consecutive obese [average body mass index (BMI): 45 ± 7.6, range: 35–59] patients (24 women; six men; median age: 52 ± 15 years) were enrolled in this institutional review board (IRB)-approved, Health Insurance Portability and Accountability Act of 1996 (HIPAA)-compliant prospective study. Calcium scoring (CaS) and electrocardiography (ECG)-gated images of the coronary arteries were obtained with a large body habitus protocol (120 kV; 430 mAs; 100 ml iodinated contrast medium at 7 ml/s injection rate) on a DSCT machine. Qualitative (four-point: 1 = excellent to 4 = not delineable) coronary segmental analysis, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) measurements were performed. The presence and degree of vascular disease (four-grade scale: mild to severe) was correlated with CaS and cardiovascular (CV) risk stratification blood tests. In patients with severe stenosis (>70%), findings were compared with cardiac nuclear medicine imaging (single photon-emission computed tomography; SPECT) imaging. Results: The average HR, enhancement, and quality score were 64 ± 7 beats/min, 288 ± 66 HU and 1.8 ± .5, respectively. Ninety-three percent (417/450) of the coronary segments were rated diagnostic. The SNRs and CNRs were 17 ± 9 and 12 ± 7 for the right coronary artery; 17 ± 8 and 12 ± 7 for the left main coronary artery; 16 ± 9 and 11 ± 7 for the left anterior descending coronary artery; and 15 ± 7 and 10 ± 6 for the left circumflex coronary artery. Ten of the 30 patients (33%) demonstrated coronary artery disease (CAD) of which two (6%) showed three-vessel disease. Four (13%) patients showed severe disease: in three of which the presence of significant stenosis was confirmed by SPECT and by catheter

  1. A Multimodal Approach to Post-Operative Pain Relief in Children Undergoing Ambulatory Eye Surgery

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    V V Jaichandran

    2008-01-01

    Full Text Available This study was carried to assess the efficacy of multimodal analgesia using ketorolac and fentanyl, for post-operative pain relief in children undergoing ambulatory eye surgery. Total of 161 children, aged 1 to 5 years, were randomly stratified to three different analgesic regimens: Group A Ketorolac 0.75 mg.kg -1 I.M. , Group B Fentanyl 0.75 µg.kg -1 I.V. and Group C Ketorolac 0.50mg.kg -1 I.M. and Fentanyl 0.50µg.kg -1 I.V. Ketorolac I.M. was given 45 minutes before extubation and fentanyl I.V. was given soon after extubation in the respective groups. Post-operative pain was assessed in a double blinded manner using Children′s Hospital of Eastern Onatario Pain Scale (CHEOPS scoring system and by recording the heart rate at 10, 30 and 60 minutes. If the score was above 8, the child was left with the parents. In case the score did not improve and persisted to be greater than 8, fentanyl 0.50µg.kg -1 I.V. was given as the rescue analgesia. The incidence of nausea, vomiting, sleep disturbances or any other complaints were recorded by a staff nurse 24 hours post operatively. Mean CHEOPS score at 10, 30 and 60 minutes and mean heart rate at 10 and 30 minutes were significantly higher for Group A compared with Group C. Mean pain score emerged significantly higher for Group B compared with Group C at 30 and 60 minutes, (P< 0.01. Rescue analgesia required was significantly higher in Group A compared to Groups B and C, (P< 0.0001. Post-operatively, significant incidence of drowsiness was reported in children in Group B compared to Groups A and C, (P< 0.01. A multimodal approach using both ketorolac and fentanyl at low doses produce effective and safe analgesia in children undergoing ambula-tory eye surgery.

  2. Audit of preoperative localisation of tumor with tattoo for patients undergoing laparoscopic colorectal surgery.

    Science.gov (United States)

    Saleh, A; Ihedioha, U; Babu, B; Evans, J; Kang, P

    2016-08-01

    Preoperative localisation of tumour is an essential requirement in laparoscopic colorectal surgery. Since the introduction of laparoscopic colorectal resections in NGH in February 2010, the difficulties of tumour localisation at the time of surgery without tattoo have been highlighted. Furthermore, endoscopic documentation of site of tattoo with respect to the tumour can be inconsistent and at times misleading or difficult to interpret. Tattooing guidelines should be simple to follow and consistent for all lesions irrespective of the location of the tumour. The recommendations were to place at least three spots of tattoo one mucosal fold distal to the lesion and clearly document site of tattoo with respect to tumour in the endoscopy report. We identified 100 patients undergoing elective laparoscopic colorectal cancer resections over a two-year period. Data were collected regarding presence of tattoo preoperatively as documented in the colonoscopy report and subsequently the visibility of the tattoo at time of laparoscopy and its accuracy in relation to the tumour. Abdominoperineal resections and emergency colorectal operations were excluded. Only 59% of the patients had a visible and accurate tattoo. In 17% of the patients, the tattoo was not visible at all, although it was documented in the endoscopy report that it had been administered. In 4% of patients, it was visible but inaccurately placed. In 20% of the patients, there were no tattoos at all, necessitating on table endoscopy and intraoperative specimen analysis to confirm that the tumour/lesion was within the resection specimen. Preoperative tumour localisation is extremely important to correctly identify the site of tumour or lesion at laparoscopy. A standardised departmental protocol should be implemented by all endoscopists to place three spots of tattoo one mucosal fold distal to any significant lesions found. Failure to tattoo lesions/cancers preoperatively can lead to intraoperative delays and

  3. Anesthetic management of patients undergoing extra-anatomic renal bypass surgery for renovascular hypertension.

    Science.gov (United States)

    Kumar, Bhupesh; Sinha, Prabhat Kumar; Unnikrishnan, M

    2011-01-01

    Renal artery disease is the most common cause for surgically curable form of hypertension. In a small subset of patients with severe aortic disease where the aorta is not suitable for endovascular technique and to provide an arterial inflow, an extra-anatomic renal bypass surgery (EARBS) is an option. Anesthetic management of such procedures has not been described so far in the literature. We retrospectively analyzed the anesthetic techniques used in all patients who underwent EARBS between February 1998 and June 2008 at this institute. We also further analyzed data concerning blood pressure (BP) control and renal function response following surgery as outcome variable measures. A total of 11 patients underwent EARBS during this period. Five received oral clonidine with premedication. During laryngoscopy, esmolol was used in 4 patients, while lignocaine was used in remaining 7 patients. Of 11 patients, 7 showed significant hemodynamic response to laryngoscopy and intubation; among these, one had oral clonidine with premedicant, and 6 received lignocaine just before laryngoscopy. Intravenous vasodilators were used to maintain target BP within 20% of baseline during perioperative period. All patients received renal protective measures. During follow-up, 10% were considered cured, 70% had improved BP response, while 20% failed to show improvement in BP response. Renal functions improved in 54.5%, remain unchanged in 36.5%, and worsened in 9% of patients. Use of clonidine during premedication and esmolol before laryngoscopy were beneficial in attenuating hemodynamic response to laryngoscopy, while use of vasodilators to maintain target BP within 20% of baseline, and routine use of renal protective measures appear to be promising in patients undergoing EARBS.

  4. Anesthetic management of patients undergoing extra-anatomic renal bypass surgery for renovascular hypertension

    Directory of Open Access Journals (Sweden)

    Kumar Bhupesh

    2011-01-01

    Full Text Available Renal artery disease is the most common cause for surgically curable form of hypertension. In a small subset of patients with severe aortic disease where the aorta is not suitable for endovascular technique and to provide an arterial inflow, an extra-anatomic renal bypass surgery (EARBS is an option. Anesthetic management of such procedures has not been described so far in the literature. We retrospectively analyzed the anesthetic techniques used in all patients who underwent EARBS between February 1998 and June 2008 at this institute. We also further analyzed data concerning blood pressure (BP control and renal function response following surgery as outcome variable measures. A total of 11 patients underwent EARBS during this period. Five received oral clonidine with premedication. During laryngoscopy, esmolol was used in 4 patients, while lignocaine was used in remaining 7 patients. Of 11 patients, 7 showed significant hemodynamic response to laryngoscopy and intubation; among these, one had oral clonidine with premedicant, and 6 received lignocaine just before laryngoscopy. Intravenous vasodilators were used to maintain target BP within 20% of baseline during perioperative period. All patients received renal protective measures. During follow-up, 10% were considered cured, 70% had improved BP response, while 20% failed to show improvement in BP response. Renal functions improved in 54.5%, remain unchanged in 36.5%, and worsened in 9% of patients. Use of clonidine during premedication and esmolol before laryngoscopy were beneficial in attenuating hemodynamic response to laryngoscopy, while use of vasodilators to maintain target BP within 20% of baseline, and routine use of renal protective measures appear to be promising in patients undergoing EARBS.

  5. Clonidine or remifentanil for adequate surgical conditions in patients undergoing endoscopic sinus surgery: a randomized study

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    Laurent Bairy

    2017-05-01

    Full Text Available Background Deliberate hypotension is one way to achieve a bloodless surgical field in endoscopic sinus surgery (ESS. We compared two anaesthesia regimens to induce deliberate hypotension and attempted to determine the most efficient one. Methods Fifty-nine patients undergoing ESS were minimized into two groups. In the CLO group, patients received I.V. sufentanil 0.15 µg/kg together with I.V. clonidine 2–3 µg/kg. In the REMI group, patients received remifentanil at a rate of up to 1 µg/kg/min. Fromme scores were collected 15 min after the incision and at the end of the procedure. Mean arterial pressure readings (MAP, heart rate readings, time to eyes opening, time to extubation, pain scores, analgesic requirements, and oxygen needs were collected and compared. Results There were no significant differences in Fromme scores between the two groups. The averaged MAP from 15 min to the end of the procedure was significantly lower in the REMI group; these patients also received more ephedrine. Significantly fewer patients in the CLO group needed oxygen therapy to keep their Pulse Oximeter Oxygen Saturation within 3% of their preoperative values. Patients in this group also needed less piritramide in the recovery room, and their pain scores were lower at discharge from the recovery room. Discussion Although both anaesthesia regimens offered a similar quality of surgical field, this study suggests that clonidine had a better average safety profile. Furthermore, patients who received this regimen required fewer painkillers immediately after surgery.

  6. Pharmacokinetics and pharmacodynamics of rocuronium in young adult and elderly patients undergoing elective surgery.

    Science.gov (United States)

    Varrique, Renan M; Lauretti, Gabriela R; Matsumoto, Julia A; Lanchote, Vera L; de Moraes, Natalia V

    2016-11-01

    To evaluate the impact of advanced age on rocuronium kinetic disposition in ASA I-III patients undergoing elective surgeries. Young adult (20-50 years, n = 15) and elderly patients (65-85 years, n = 14) submitted to surgery under general anaesthesia were investigated. All patients were induced with individual intravenous doses of midazolam, rocuronium, fentanyl and propofol. Rocuronium-induced neuromuscular block was monitored by train of four stimulations of the adductor muscle of the thumb on the ulnar nerve. The pharmacokinetic parameters were calculated by non-compartmental analysis. The relationship between rocuronium plasma concentration and the neuromuscular blockade was described by a sigmoidal Emax model. Elderly patients presented decreased Cl (2.1 ml/kg per min vs 2.8 ml/kg per min; P = 0.0123); increased AUC/dose (507.8 μg min/ml (mg/kg) vs 392.2 μg min/ml/(mg/kg); P = 0.0168) and reduced volume of distribution (285.4 ml/kg vs 435.6 ml/kg, P = 0.0434) compared to young adults. The concentrations required to achieve 50% of maximum neuromuscular block (EC50) were similar for young adult (338.8 ng/ml) and elderly (462.7 ng/ml) patients (P > 0.05). Elderly patients showed increased AUC/D and reduced total Cl compared to young adult patients due to the age-related reduced renal function. Differences in the PK-PD properties of rocuronium in elderly population are due to changes in drug disposition rather than to alterations in the sensitivity to the drug. © 2016 Royal Pharmaceutical Society.

  7. Use of Fentanyl in Adolescents with Clinically Severe Obesity Undergoing Bariatric Surgery: A Pilot Study.

    Science.gov (United States)

    Vaughns, Janelle D; Ziesenitz, Victoria C; Williams, Elaine F; Mushtaq, Alvina; Bachmann, Ricarda; Skopp, Gisela; Weiss, Johanna; Mikus, Gerd; van den Anker, Johannes N

    2017-06-01

    The number of obese pediatric patients requiring anesthesia is rapidly increasing. Although fentanyl is a commonly used narcotic during surgery, there are no pharmacokinetic (PK) data available for optimal dosing of fentanyl in adolescents with clinically severe obesity. An institutional review board-approved exploratory pilot study was conducted in six adolescents aged 14-19 years undergoing bariatric surgery. Mean total body weight (TBW) and mean BMI were 137.4 ± 14.3 kg and 49.6 ± 6.4 kg/m 2 (99.5th BMI percentile), respectively. Fentanyl was administered intravenously for intraoperative analgesia based on ideal body weight per standard of care. PK blood samples were drawn over a 24-h post-dose period. Fentanyl PK parameters were calculated by non-compartmental analysis. Mean fentanyl AUC 0-∞ was 1.5 ± 0.5 h·ng/mL. Systemic clearance of fentanyl was 1522 ± 310 mL/min and 11.2 ± 2.6 mL/min·kg TBW. Volume of distribution was 635 ± 282 L and 4.7 ± 2.1 L/kg TBW. While absolute clearance was increased, absolute volume of distribution was comparable to previously established adult values. These results suggest that fentanyl clearance is enhanced in adolescents with clinically severe obesity while volume of distribution is comparable to previously published studies. NCT01955993 (clinicaltrials.gov).

  8. Outcomes of hospitalized patients undergoing emergency general surgery remote from admission.

    Science.gov (United States)

    Sharoky, Catherine E; Bailey, Elizabeth A; Sellers, Morgan M; Kaufman, Elinore J; Sinnamon, Andrew J; Wirtalla, Christopher J; Holena, Daniel N; Kelz, Rachel R

    2017-09-01

    Emergency general surgery during hospitalization has not been well characterized. We examined emergency operations remote from admission to identify predictors of postoperative 30-day mortality, postoperative duration of stay >30 days, and complications. Patients >18 years in The American College of Surgeons National Surgical Quality Improvement Program (2011-2014) who had 1 of 7 emergency operations between hospital day 3-18 were included. Patients with operations >95th percentile after admission (>18 days; n = 581) were excluded. Exploratory laparotomy only (with no secondary procedure) represented either nontherapeutic or decompressive laparotomy. Multivariable logistic regression was used to identify predictors of study outcomes. Of 10,093 patients with emergency operations, most were elderly (median 66 years old [interquartile ratio: 53-77 years]), white, and female. Postoperative 30-day mortality was 12.6% (n = 1,275). Almost half the cohort (40.1%) had a complication. A small subset (6.8%) had postoperative duration of stay >30 days. Postoperative mortality after exploratory laparotomy only was particularly high (>40%). In multivariable analysis, an operation on hospital day 11-18 compared with day 3-6 was associated with death (odds ratio 1.6 [1.3-2.0]), postoperative duration of stay >30 days (odds ratio 2.0 [1.6-2.6]), and complications (odds ratio 1.5 [1.3-1.8]). Exploratory laparotomy only also was associated with death (odds ratio 5.4 [2.8-10.4]). Emergency general surgery performed during a hospitalization is associated with high morbidity and mortality. A longer hospital course before an emergency operation is a predictor of poor outcomes, as is undergoing exploratory laparotomy only. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Cardiopulmonary bypass alters the pharmacokinetics of propranolol in patients undergoing cardiac surgery

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    M.J.C. Carmona

    2005-05-01

    Full Text Available The pharmacokinetics of propranolol may be altered by hypothermic cardiopulmonary bypass (CPB, resulting in unpredictable postoperative hemodynamic responses to usual doses. The objective of the present study was to investigate the pharmacokinetics of propranolol in patients undergoing coronary artery bypass grafting (CABG by CPB under moderate hypothermia. We evaluated 11 patients, 4 women and 7 men (mean age 57 ± 8 years, mean weight 75.4 ± 11.9 kg and mean body surface area 1.83 ± 0.19 m², receiving propranolol before surgery (80-240 mg a day and postoperatively (10 mg a day. Plasma propranolol levels were measured before and after CPB by high-performance liquid chromatography. Pharmacokinetic Solutions 2.0 software was used to estimate the pharmacokinetic parameters after administration of the drug pre- and postoperatively. There was an increase of biological half-life from 4.5 (95% CI = 3.9-6.9 to 10.6 h (95% CI = 8.2-14.7; P < 0.01 and an increase in volume of distribution from 4.9 (95% CI = 3.2-14.3 to 8.3 l/kg (95% CI = 6.5-32.1; P < 0.05, while total clearance remained unchanged 9.2 (95% CI = 7.7-24.6 vs 10.7 ml min-1 kg-1 (95% CI = 7.7-26.6; NS after surgery. In conclusion, increases in drug distribution could be explained in part by hemodilution during CPB. On the other hand, the increase of biological half-life can be attributed to changes in hepatic metabolism induced by CPB under moderate hypothermia. These alterations in the pharmacokinetics of propranolol after CABG with hypothermic CPB might induce a greater myocardial depression in response to propranolol than would be expected with an equivalent dose during the postoperative period.

  10. The effect of an integrated education model on anxiety and uncertainty in patients undergoing cervical disc herniation surgery.

    Science.gov (United States)

    Chuang, Mei-Fang; Tung, Heng-Hsin; Clinciu, Daniel L; Huang, Jing-Shan; Iqbal, Usman; Chang, Chih-Ju; Su, I-Chang; Lai, Fu-Chih; Li, Yu-Chuan

    2016-09-01

    Educating patients about receiving surgical procedures is becoming an important issue, as it can reduce anxiety and uncertainty while helping to hasten decisions for undergoing time sensitive surgeries. We evaluated a new integrated education model for patients undergoing cervical disc herniation surgery using a quasi-experimental design. The participants were grouped into either the new integrated educational model (n = 32) or the standard group (n = 32) on the basis of their ward numbers assigned at admission. Anxiety, uncertainty, and patient satisfaction were measured before (pre-test) and after the educational intervention (post-test-1) and post-surgery (post-test-2) to assess the effectiveness of the model in this intervention. We found that the generalized estimating equation modeling demonstrated this new integrated education model was more effective than the conventional model in reducing patients' anxiety and uncertainty (p approach to individual health. This novel systemic educational model enhances patient's understanding of the medical condition and surgery while promoting patient-caregiver interaction for optimal patient health outcomes. We present a comprehensive and consistent platform for educational purposes in patients undergoing surgery as well as reducing the psychological burden from anxiety and uncertainty. Integrating medicine, nursing, and new technologies into an e-practice and e-learning platform offers the potential of easier understanding and usage. It could revolutionize patient education in the future. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. Dipyridamole thallium imaging may not be a reliable screening test for coronary artery disease in patients undergoing vascular surgery

    International Nuclear Information System (INIS)

    Marwick, T.H.; Underwood, D.A.

    1990-01-01

    Dipyridamole thallium imaging has been proposed for cardiac risk stratification in patients undergoing peripheral vascular surgery. The purpose of this study was to define the benefit of this investigation in routine preoperative evaluation of these patients. The outcome of 86 patients undergoing vascular surgery procedures was examined in light of preoperative clinical assessment and dipyridamole SPECT thallium imaging (DST). Fifty-one patients (59%) were considered at high risk on clinical grounds, and 22 patients (26%) had perfusion defects. Ten patients suffered a perioperative coronary event, including unstable angina, myocardial infarction, or cardiac death. Seven of the patients with such events were among the 51 clinically high-risk subjects (14%). Three perioperative events occurred in the group of 19 patients with positive DST images who underwent surgery (16%), but the DST test failed to identify 7 patients who suffered coronary events. The frequency of abnormal thallium imaging was similar to the prevalence of angiographically significant coronary disease reported previously at this center, but considerably less than the rate of abnormal thallium imaging in past studies of vascular surgery patients. The application of the test to a low to moderate risk population is probably responsible for its lower predictive accuracy for coronary events. DST is not an ideal routine noninvasive technique for risk stratification in patients undergoing vascular surgery

  12. A novel index for quantifying the risk of early complications for patients undergoing cervical spine surgeries.

    Science.gov (United States)

    Passias, Peter G; Diebo, Bassel G; Marascalchi, Bryan J; Jalai, Cyrus M; Horn, Samantha R; Zhou, Peter L; Paltoo, Karen; Bono, Olivia J; Worley, Nancy; Poorman, Gregory W; Challier, Vincent; Dixit, Anant; Paulino, Carl; Lafage, Virginie

    2017-11-01

    OBJECTIVE It is becoming increasingly necessary for surgeons to provide evidence supporting cost-effectiveness of surgical treatment for cervical spine pathology. Anticipating surgical risk is critical in accurately evaluating the risk/benefit balance of such treatment. Determining the risk and cost-effectiveness of surgery, complications, revision procedures, and mortality rates are the most significant limitations. The purpose of this study was to determine independent risk factors for medical complications (MCs), surgical complications (SCs), revisions, and mortality rates following surgery for patients with cervical spine pathology. The most relevant risk factors were used to structure an index that will help quantify risk and anticipate failure for such procedures. METHODS The authors of this study performed a retrospective review of the National Inpatient Sample (NIS) database for patients treated surgically for cervical spine pathology between 2001 and 2010. Multivariate models were performed to calculate the odds ratio (OR) of the independent risk factors that led to MCs and repeated for SCs, revisions, and mortality. The models controlled for age ( 65 years old), sex, race, revision status (except for revision analysis), surgical approach, number of levels fused/re-fused (2-3, 4-8, ≥ 9), and osteotomy utilization. ORs were weighted based on their predictive category: 2 times for revision surgery predictors and 4 times for mortality predictors. Fifty points were distributed among the predictors based on their cumulative OR to establish a risk index. RESULTS Discharges for 362,989 patients with cervical spine pathology were identified. The mean age was 52.65 years, and 49.47% of patients were women. Independent risk factors included medical comorbidities, surgical parameters, and demographic factors. Medical comorbidities included the following: pulmonary circulation disorder, coagulopathy, metastatic cancer, renal failure, congestive heart failure

  13. Risk of post-operative pneumocephalus in patients with obstructive sleep apnea undergoing transsphenoidal surgery.

    Science.gov (United States)

    White-Dzuro, Gabrielle A; Maynard, Ken; Zuckerman, Scott L; Weaver, Kyle D; Russell, Paul T; Clavenna, Matthew J; Chambless, Lola B

    2016-07-01

    Patients undergoing transsphenoidal surgery (TSS) have an anterior skull base defect that limits the use of positive pressure ventilation post-operatively. Obstructive sleep apnea (OSA) can be seen in these patients and is treated with continuous positive airway pressure (CPAP). In our study we documented the incidence of pre-existing OSA and reported the incidence of diagnosed pneumocephalus and its relationship to OSA. A retrospective review was conducted from a surgical outcomes database. Electronic medical records were reviewed, with an emphasis on diagnosis of OSA and documented symptomatic pneumocephalus. A total of 324 patients underwent 349 TSS for sellar mass resection. The average body mass index of the study cohort was 32.5kg/m(2). Sixty-nine patients (21%) had documented OSA. Only 25 out of 69 (36%) had a documented post-operative CPAP plan. Out of all 349 procedures, there were two incidents of pneumocephalus diagnosed. Neither of the patients had pre-existing OSA. One in five patients in our study had pre-existing OSA. Most patients returned to CPAP use within several weeks of TSS for resection of a sellar mass. Neither of the patients with pneumocephalus had pre-existing OSA and none of the patients with early re-initiation of CPAP developed this complication. This study provides preliminary evidence that resuming CPAP early in the post-operative period might be less dangerous than previously assumed. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Assessment of presurgical psychological screening in patients undergoing spine surgery: use and clinical impact.

    Science.gov (United States)

    Young, Arthur K; Young, Benjamin K; Riley, Lee H; Skolasky, Richard L

    2014-04-01

    Prospective survey. To determine the prevalence of use of presurgical psychological screening (PPS) among spine surgeons in the United States, identify factors associated with PPS use, evaluate surgeons' opinions of PPS, and investigate how PPS is applied in clinical practice. The United States Preventive Services Task Force recommends PPS for patients undergoing back surgery. The prevalence of PPS is unknown. Thus, it may be difficult to improve preoperative care for such patients with psychological conditions. An online survey invitation was emailed to 340 spine surgeons. Questions addressed surgeon characteristics (eg, number of years in practice), practice characteristics (eg, practice type), inclusion of integrated rehabilitation and psychological services, and use of PPS. The impact of psychological factors on rehabilitation and recovery was assessed using an 11-point Likert scale (0, no impact; 10, highest impact). We analyzed the 110 (32%) responses with a χ(2) test (significance, Ppsychological factors on pain relief, adherence to therapy, and return to work (mean impact rating, >7.0); however, impact on return for follow-up was only moderate (mean rating, 5.8). A minority of surgeons reported using PPS. Surgeons were less likely to use PPS if they had completed residency or begun practice within 14 years, had fewer than 200 cases annually, or were university affiliated. This study highlights the need to advocate for the use of North American Spine Society guidelines regarding the use of PPS.

  15. The modified Glasgow prognostic score in patients undergoing surgery for bone and soft tissue sarcoma.

    Science.gov (United States)

    Morhij, Rossel; Mahendra, Ashish; Jane, Mike; McMillan, Donald C

    2017-05-01

    The prognostic significance of markers of the systemic inflammatory response in patients with soft tissue and bone sarcomas remains unclear. Therefore, the present study aimed to compare the prognostic value of markers of the systemic inflammatory response in patients undergoing surgery for primary soft tissue and bone sarcoma. Patients who underwent resection of primary soft tissue/bone sarcoma between 2008 and 2012 and had pre-operative measurements of the systemic inflammatory response [C-reactive protein, albumin, white cell, neutrophil, lymphocyte and platelet counts, and the combination of C-reactive protein and albumin (mGPS)] were included in the study (n = 111). The majority of the patients were ≤50 years old (84%), were female (63%), had soft tissue sarcoma (62%), and had tumours >10 cm (52%), mostly of high grade (85%). The median follow-up of survivors was 50 months (range 34-78); 24 (21%) developed local recurrence, 35 (31%) developed distant metastases and 30 (30%) died of their cancer. On univariate analysis, tumour size (P sarcoma. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  16. Dosage effect of rocuronium on intraoperative neuromonitoring in patients undergoing thyroid surgery.

    Science.gov (United States)

    Han, Yang-dong; Liang, Feng; Chen, Peng

    2015-01-01

    The effect of different concentrations of rocuronium bromide used for anesthesia induction during thyroid surgery on the intraoperative recurrent laryngeal nerve monitoring was evaluated. One hundred patients undergoing thyroid operation were randomized into five groups (20 patients per group). Patients in group I were operated and monitored without the use of rocuronium bromide. Patients in groups II-V were respectively injected with 0.5x, 1x, 1.5x, and 2x ED95 rocuronium bromide intravenously. The time from injecting the rocuronium bromide to the beginning of tube insertion was recorded, the conditions of tracheal intubation were evaluated, and the changes in blood pressure and pulse during the intubation process were monitored. Vagus nerve/recurrent laryngeal nerve evoked muscle potential was monitored using the NIM-Response3.0 nerve electromyography monitor. The amplitude of electromyography signal was recorded every 5 min during 30 min after successful tracheal intubation. The tracheal intubation success rate was 100% in all groups. Compared with group I, intubating condition scores (Cooper scores) in the patients of groups II-V were higher (P rocuronium bromide during the anesthesia induction can improve the tracheal tube conditions without affecting the intraoperative recurrent laryngeal nerve monitoring. The use of 1x ED95 rocuronium bromide induction was associated with the best results.

  17. Comfort and hope in the preanesthesia stage in patients undergoing surgery.

    Science.gov (United States)

    Seyedfatemi, Naima; Rafii, Forough; Rezaei, Mahboubeh; Kolcaba, Katharine

    2014-06-01

    Comfort and hope have been identified as important components in the care of perianesthesia patients. The purpose of this study was to explore the relationship between comfort and hope in the preanesthesia stage in patients undergoing surgery. A descriptive cross-sectional survey was conducted with 191 surgical patients. Data were collected using the Perianesthesia Comfort Questionnaire and Herth Hope Index. Direct and significant relationships were observed between comfort and hope (P≤.001, r=0.65). Also, significant relationships were observed between educational level and marital status with comfort (P≤.01). The relationship between educational level and hope was significant (P≤.001). Significant relationships were also observed between gender and marital status with hope (P≤.01). Overall, this study showed that a significant relationship exists between comfort and hope. Additionally, some demographic characteristics influenced comfort and hope in these patients. Health care providers should arrange the environment in a way that allows the surgical patients to experience comfort and hope and recognize the impact of personal characteristics when caring for surgical patients, particularly in the preanesthesia stage. Copyright © 2014 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  18. Systematic Review: Audiovisual Interventions for Reducing Preoperative Anxiety in Children Undergoing Elective Surgery

    Science.gov (United States)

    Van Lieshout, Ryan J.; Schmidt, Louis A.; Dobson, Kathleen G.; Buckley, Norman

    2016-01-01

    Objective To examine the effectiveness of Audiovisual (AV) interventions at reducing preoperative anxiety and its associated outcomes in children undergoing elective surgery. Methods A systematic review of randomized controlled trials (RCTs) and nonrandomized studies where the primary outcome was children’s preoperative anxiety was conducted. Secondary outcomes included postoperative pain, behavioral changes, recovery, induction compliance, satisfaction, and cost-effectiveness. The risk of bias of each study was assessed. Results In all, 18 studies were identified. A meta-analytic approach and narrative synthesis of findings were used to summarize the results of the studies. Conclusions This systematic review suggests that AV interventions can be effective in reducing children’s preoperative anxiety. Videos, multi-faceted programs, and interactive games appear to be most effective, whereas music therapy and Internet programs are less effective. While AV interventions appear potentially useful, adequately powered RCTs are required to conclusively pinpoint the components and mechanisms of the most effective AV interventions and guide practice. PMID:26476281

  19. Subjective evaluation of uncorrected vision in patients undergoing cataract surgery with (diffractive multifocal lenses and monovision

    Directory of Open Access Journals (Sweden)

    Stock RA

    2017-07-01

    Full Text Available Ricardo Alexandre Stock, Thaís Thumé, Luan Gabriel Paese, Elcio Luiz Bonamigo Universidade do Oeste de Santa Catarina, Rua Getúlio Vargas, Joaçaba, Santa Catarina, Brazil Purpose: To analyze patient satisfaction and difficulties with bilateral multifocal intraocular lenses (IOLs implantation and aspheric monofocal IOLs implantation using monovision, after cataract surgery.Materials and methods: A total of 61 participants were included in the study, 29 with monovision and 32 with multifocal lenses. The inclusion criteria were patients undergoing phacoemulsification for bilateral visual impairment due to cataracts and presenting with postoperative visual acuity of 20/30 or better for distance and line J3 or better for near vision.Results: The 2 groups had similar results regarding difficulties with daily activities such as distance vision, near vision, watching television, reading, cooking, using a computer or cellphone, shaving/putting on makeup and shopping. There were differences in responses between the groups regarding difficulty with night vision (P=0.0565 and night driving (P=0.0291. Degree of satisfaction in terms of distance vision without glasses was statistically significantly better in monovision group (P=0.0332, but not for near (P=0.9101.Conclusion: Both techniques yielded satisfactory results regarding visual acuity for different activities without the need to use glasses. Multifocal lenses are a good option for patients with the exception of night driving, and who desire independence from glasses. Keywords: cataract extraction, aphakia, postcataract, patient satisfaction, night vision

  20. Psychological, behavioral, and weight-related aspects of patients undergoing reoperative bariatric surgery after gastric band: comparison with primary surgery patients.

    Science.gov (United States)

    Conceição, Eva; Pinto-Bastos, Ana; de Lourdes, Marta; Brandão, Isabel; Teixeira, Cristina; Machado, Paulo P P

    2018-02-15

    Patients experiencing insufficient weight loss or weight regain in their first bariatric surgery may represent a high-risk group with greater problematic eating and general psychopathology levels, which may compromise the success of a reoperative procedure. This study seeks to describe and compare disordered eating-related psychological and behavioral features of primary and reoperative surgery candidates after gastric band. Hospital center and university in Portugal. The baseline (preoperative) data from a longitudinal observational study are presented. Patients were interviewed by trained psychologists to identify binge-eating episodes and grazing and responded to a set of self-report measures: disordered eating, grazing, negative urgency, depression, anxiety, and stress. Two hundred twenty-five patients were undergoing primary surgery, and 166 were undergoing reoperative (REOP group) surgery. The groups did not differ in body mass index preoperatively, but the REOP group had greater weight suppression (t 387 = -5.35, P = .001), higher highest (t 387 = -3.40, P = .001) and lower lowest body mass index (t 381 = 2.22, P = .03). The main reasons for reoperative surgery were weight regain/poor weight loss (42.8%) or medical complications (32.5%). REOP patients with objective binge eating reported a higher frequency of these episodes (t 47 = 2.15, P = .04). No significant difference was found for the self-report measures assessed (only shape concern was higher for REOP group, F 1,216 = 8.30, Psurgeries, the differences in binge eating and weight-related variables may associate with postoperative difficulties. The link between binge eating, weight suppression, and weight gain found in other samples suggests that patients undergoing reoperative surgery may be at increased risk for poor weight outcomes. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  1. Acute normovolemic hemodilution is not beneficial in patients undergoing primary elective valve surgery

    Directory of Open Access Journals (Sweden)

    Virmani Sanjula

    2010-01-01

    Full Text Available The objective of this study was to evaluate the effectiveness of acute normovolemic hemodilution (ANH as a sole method of reducing allogenic blood requirement in patients undergoing primary elective valve surgery. One hundred eighty eight patients undergoing primary elective valve surgery were prospectively randomized into two groups: Group I (n=100 acted as control and in Group II (n=88 autologous blood was removed (10% of estimated blood volume in patients with hemoglobin (Hb > 12g% and 7% when the Hb was < 12g% in the pre-cardiopulmonary bypass (CPB period for subsequent re-transfusion after protamine administration. The autologous blood withdrawn was replaced simultaneously with an equal volume of hydroxyl-ethyl starch solution. Banked blood was transfused in both the groups when Hb was ≤6g % on CPB and ≤8g% after CPB. Platelets were transfused when the count fell to < 100´10 9 /L and fresh frozen plasma (FFP was transfused whenever there was diffuse bleeding with laboratory evidence of coagulopathy. The two groups were comparable as regards demographic data, type of surgical procedures performed, duration of CPB and ischemia, duration of elective ventilation and re-exploration for excessive bleeding. The autologous blood withdrawn in patients with Hb≥12g% was 288.3±69.4 mL and 244.4±41.3 mL with Hb < 12g% (P=NS. The Hb concentration (g % was comparable pre-operatively (Group I= 12.1±1.6, Group II= 12.4±1.4, on postoperative day 1 (Group I =10.3±1.1, Group II= 10.6±1.2 and day 7 (Group I = 10.9±1.5, Group II=10.4±1.5. However, the lowest Hb recorded on CPB was significantly lower in Group II (Group I =7.7±1.2, Group II=6.7±0.9, P < 0.05. There was no difference in the chest tube drainage (Group I =747.2±276.5 mL, Group II=527.6±399.5 mL, blood transfusion (Group I=1.1±1.0 units vs. Group II=1.3±1.0 units intra-operatively and Group I=1.7±1.2 units vs. Group II=1.7±1.4 units post-operatively and FFP transfusion (Group I

  2. Risk factors for postoperative delirium in patients undergoing major head and neck cancer surgery: a meta-analysis.

    Science.gov (United States)

    Zhu, Yun; Wang, Gangpu; Liu, Shengwen; Zhou, Shanghui; Lian, Ying; Zhang, Chenping; Yang, Wenjun

    2017-06-01

    Postoperative delirium is common after extensive surgery. This study aimed to collate and synthesize published literature on risk factors for delirium in patients with head and neck cancer surgery. Three databases were searched (MEDLINE, Embase, and Cochrane Library) between January 1987 and July 2016. The Newcastle Ottawa Scale (NOS) was adopted to evaluate the study quality. Pooled odds ratios or mean differences for individual risk factors were estimated using the Mantel-Haenszel and inverse-variance methods. They provided a total of 1940 patients (286 with delirium and 1654 without), and predominantly included patients undergoing head and neck cancer surgery. The incidence of postoperative delirium ranged from 11.50% to 36.11%. Ten statistically significant risk factors were identified in pooled analysis. Old age, age >70 years, male sex, duration of surgery, history of hypertension, blood transfusions, tracheotomy, American Society of Anesthesiologists physical status grade at least III, flap reconstruction and neck dissection were more likely to sustain delirium after head and neck cancer surgery. Delirium is common in patients undergoing major head neck cancer surgery. Several risk factors were consistently associated with postoperative delirium. These factors help to highlight patients at risk of developing delirium and are suitable for preventive action. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  3. Long-Term Survival of Dialysis Patients with Bacterial Endocarditis Undergoing Valvular Replacement Surgery in the United States

    Science.gov (United States)

    Leither, Maxwell D.; Shroff, Gautam R.; Ding, Shu; Gilbertson, David T.; Herzog, Charles A.

    2013-01-01

    Background Bacterial endocarditis in dialysis patients is associated with high mortality rates. The literature is limited regarding long-term outcomes of valvular replacement surgery and choice of prosthesis in dialysis patients with bacterial endocarditis. Methods and Results Dialysis patients hospitalized for bacterial endocarditis, 2004-2007, were studied retrospectively using data from the US Renal Data System. Long-term survival of patients undergoing valve replacement surgery with tissue or non-tissue valves was compared using the Kaplan-Meier method. A Cox proportional hazards model was used to identify independent predictors of mortality in patients undergoing valvular replacement surgery. During the study period, 11,156 dialysis patients were hospitalized for bacterial endocarditis and 1267 (11.4%) underwent valvular replacement surgery (tissue valve 44.3%, non-tissue valve 55.7%). In the valve replacement cohort, 60% were men, 50% white, 54% aged 45-64 years, and 36% diabetic. Estimated survival with tissue and non-tissue valves, respectively, at 0.5, 1, 2, and 3 years was 59% and 60%, 48% and 50%, 35% and 37%, and 25% and 30% (log rank P = 0.42). Staphylococcus was the predominant organism (66% of identified organisms). Independent predictors of mortality in patients undergoing valve replacement surgery included older age, diabetes as cause of end-stage renal disease, surgery during index hospitalization, staphylococcus as the causative organism, and dysrhythmias as a comorbid condition. Conclusions Valve replacement surgery is appropriate for well-selected dialysis patients with bacterial endocarditis, but is associated with high mortality rates. Survival does not differ with tissue or non-tissue prosthesis. PMID:23785002

  4. [Anaesthetic management of patients in the third trimester of pregnancy undergoing urgent laparoscopic surgery. Experience in a general hospital].

    Science.gov (United States)

    López-Collada Estrada, María; Olvera Martínez, Rosalba

    2016-01-01

    Laparoscopic surgery is well accepted as a safe technique when performed on a third trimester pregnant woman. The aim is to describe the anaesthetic management of a group of patients undergoing this type of surgery. An analysis was made of records of 6 patients in their third trimester of pregnancy and who underwent urgent laparoscopic surgery from 2011 to 2013. The study included 6 patients, with a diagnosis of acute cholecystitis in 4 of them. The other 2 patients had acute appendicitis, both of who presented threatened preterm labour. The most frequent indications for laparoscopic surgery during the last trimester of birth were found to be acute cholecystitis and acute appendicitis. Acute appendicitis is related to an elevated risk of presenting threatened preterm labour. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  5. Perioperative Complications in Obstructive Sleep Apnea Patients Undergoing Surgery: A Review of the Legal Literature.

    Science.gov (United States)

    Fouladpour, Nick; Jesudoss, Rajinish; Bolden, Norman; Shaman, Ziad; Auckley, Dennis

    2016-01-01

    Obstructive sleep apnea (OSA) is common in patients undergoing surgery. OSA, known or suspected, has been associated with significant perioperative adverse events, including severe neurologic injury and death. This study was undertaken to assess the legal consequences associated with poor outcomes related to OSA in the perioperative setting. A retrospective review of the legal literature was performed by searching 3 primary legal databases between the years 1991 and 2010 for cases involving adults with known or suspected OSA who underwent a surgical procedure associated with an adverse perioperative outcome. OSA had to be directly implicated in the outcome, and surgical mishaps (i.e., uncontrolled bleeding) were excluded. The adverse perioperative outcome had to result in a lawsuit that was then adjudicated in a court of law with a final decision rendered. Data were abstracted from each case regarding patient demographics, type of surgery, type and location of adverse event, associated anesthetic and opioid use, and legal outcome. Twenty-four cases met the inclusion criteria. The majority (83%) occurred in or after 2007. Patients were young (average age, 41.7 years), male (63%), and had a known diagnosis of OSA (96%). Ninety-two percent of cases were elective with 33.3% considered general procedures, 37.5% were ears, nose and throat procedures for the treatment of OSA, and 29.1% were considered miscellaneous interventions. Complications occurred intraoperatively (21%), in the postanesthesia care unit (33%), and on the surgical floors (46%). The most common complications were respiratory arrest in an unmonitored setting and difficulty in airway management. Immediate adverse outcomes included death (45.6%), anoxic brain injury (45.6%), and upper airway complications (8%). Overall, 71% of the patients died, with 6 of the 11 who suffered anoxic brain injury dying at an average of 113 days later. The use of opioids and general anesthetics was believed to play a role in

  6. Frequency of hepatitis B and C in patients undergoing elective surgery

    International Nuclear Information System (INIS)

    Memon, M.R.; Arshad, S.; Shah, Q.A.; Soomro, A.A.

    2010-01-01

    Background: Viral Hepatitis (HBV and HCV) is a major health problem affecting approximately two billion population worldwide. It is one of the single most important cause of chronic liver disease and hepato-cellular carcinoma in Pakistan and worldwide and is now spreading beyond endemic dimensions. This study was carried out to assess the frequency of Hepatitis B and C infection in patients undergoing elective surgical operations, and to evaluate the associated risk factors. Methods: This was a descriptive study, conducted at Surgical Department of Ghulam Muhammad Mahar Medical College Hospital, Sukkur, from April 2009 to March 2010. All patients who were admitted in the Surgical Department for elective surgical operations were included in the study. The patients were screened for HBsAg and Anti-HCV using immunochromatography (ICT) method. Those who were weak positive by ICT were further confirmed by ELISA. Results: Total 913 patients were admitted in Surgical Department during study period for elective operations and were screened for HBsAg and Anti-HCV. Out of these, 572 (62.65%) were male and 341 (37.34%) were female. Mean age of these patients was 40 years. After screening, 33 (3.61%) patients were found HBsAg positive and 117 (12.8%) were Anti-HCV positive, while 9 (0.98%) were positive for both. Hepatitis-B was found in 21 (2.3%) males and 12 (1.3%) females, and Hepatitis-C was found in 68 (7.44%) males and 49 (5.36%) female patients. Parenteral injections by quacks, previous surgery, blood transfusion and shaving by barbers were found to be the risk factors. Conclusion: Our message is: 'Prevention is better than cure'. It is essential to prevent spread of Hepatitis B and C by screening every patient before surgery and counselling the patients. The doctors and paramedical staff must follow proper ethical practice ensuring use of sterile disposable where indicated and protecting patients and themselves from these viral infections. (author)

  7. The impact of available anti-glaucoma therapy on the volume and age profile of patients undergoing glaucoma filtration surgery.

    LENUS (Irish Health Repository)

    Keane, P A

    2012-02-01

    PURPOSE: To investigate whether new classes of glaucoma medication have influenced glaucoma filtration surgery over a 20-year period in the southeast region of Ireland. METHODS: All patients undergoing glaucoma filtration surgery between January 1986 and December 2005 in Waterford Regional Hospital were identified. The following data were recorded for each patient: age; sex; and type of filtration procedure. RESULTS: Over the 20-year study period two consultant ophthalmic surgeons performed a total of 760 glaucoma filtration procedures on patients aged over 20 years. The annual average number of glaucoma surgeries declined steadily, defined by availability of different topical anti-glaucoma medications, from an average of 23.75 surgeries per surgeon per year in the subperiod 1986-1995, to 21 in 1996, 20 in 1997, and 12.69 surgeries per surgeon per year in 1998-2005, these differences being statistically significant (general linear model, P<0.001). The age profile of patients did not change significantly over the course of the study period. CONCLUSIONS: The volume of patients requiring glaucoma filtration surgery under the care of two consultant ophthalmic surgeons decreased over the 20-year study period, an era in which three classes of anti-glaucoma medications were made available. However, an increase in the age profile of patients undergoing glaucoma filtration surgery during the same period was not observed. Further study is required to resolve whether introduction of the new topical anti-glaucoma medications has led to a real reduction in the demand for glaucoma filtration surgery, or has just led to the deferral of such a demand.

  8. Proximal mandibular nerve block using electrolocation in 10 dogs undergoing mandibular surgery: a case series report.

    Directory of Open Access Journals (Sweden)

    Giuliano Ravasio

    2016-06-01

    Full Text Available Peripheral nerve block performed using electrical stimulation (i.e. electrolocation is widely used for perioperative pain management during several surgical procedures in dogs (Campoy 2008, but few data are reported concerning its application to invasive maxillofacial surgery (Carotenuto et al 2011. The aim of this case series report is to evaluate the efficacy of proximal mandibular nerve block (PMNB in perioperative pain management in dogs undergoing mandibulectomy. Ten dogs of various breeds, (six spayed females and four neutered males of 10.353.09 years and mean weight of 19.5615.19 kg presenting either neoplasia or mandibular fracture and scheduled for mandibulectomy were premedicated with intramuscular acepromazine maleate (0.02 mg/kg; after induction of general anaesthesia, bilateral PMNB was performed with ropivacaine 0.75% (2 mg/kg inserting the stimulated needle in temporomandibular joint direction. Whenever intraoperative nociception occurred, intravenous rescue analgesia was provided (fentanyl 3 g/kg. Carprofen was administered subcutaneously as a sole postoperative treatment (3 mg/kg and postoperative analgesia was assessed for at least 24 hours by a blind operator, accordingly to the Glasgow composite pain scale (Reid et al 2007; when it overcame a threshold of 5/24, intravenous rescue analgesia was administered (methadone, 0.2 mg/kg. In eight out of ten dogs no intraoperative nociception was shown, while in two dogs a single intravenous fentanyl administration was sufficient to provide additional analgesia. No acute and medium term complications were observed and postoperative analgesia lasted for 20.5±6.1 hours. PMNB seems to provide effective perioperative long-lasting analgesia leading to a reduction in intra- and postoperative drug administration.

  9. Postoperative pain assessment using four behavioral scales in Pakistani children undergoing elective surgery

    Directory of Open Access Journals (Sweden)

    Faisal Shamim

    2015-01-01

    Full Text Available Background: Several measurement tools have been used for assessment of postoperative pain in pediatric patients. Self-report methods have limitations in younger children and parent, nurse or physician assessment can be used as a surrogate measure. These tools should be tested in different cultures as pain can be influenced by sociocultural factors. The objective was to assess the inter-rater agreement on four different behavioral pain assessment scales in our local population. Materials and Methods: This prospective, descriptive, observational study was conducted in Pakistan. American Society of Anesthesiologists I and II children, 3-7 years of age, undergoing elective surgery were enrolled. Four pain assessment scales were used, Children′s Hospital of Eastern Ontario Pain Scale (CHEOPS, Toddler Preschool Postoperative Pain Scale (TPPPS, objective pain scale (OPS, and Face, Legs, Activity, Cry, Consolability (FLACC. After 15 and 60 min of arrival in the postanesthesia care unit (PACU, each child evaluated his/her postoperative pain by self-reporting and was also independently assessed by the PACU nurse, PACU anesthetist and the parent. The sensitivity and specificity of the responses of the four pain assessment scales were compared to the response of the child. Results: At 15 min, sensitivity and specificity were >60% for doctors and nurses on FLACC, OPS, and CHEOPS scales and for FLACC and CHEOPS scale for the parents. Parents showed poor agreement on OPS and TPPS. At 60 min, sensitivity was poor on the OPS scale by all three observers. Nurses showed a lower specificity on FLACC tool. Parents had poor specificity on CHEOPS and rate of false negatives was high with TPPS. Conclusions: We recommend the use of FLACC scale for assessment by parents, nurses, and doctors in Pakistani children aged between 3 and 7.

  10. Comparison of intraoperative volume and pressure-controlled ventilation modes in patients who undergo open heart surgery.

    Science.gov (United States)

    Hoşten, Tülay; Kuş, Alparslan; Gümüş, Esra; Yavuz, Şadan; İrkil, Serhat; Solak, Mine

    2017-02-01

    Respiratory problems occur more frequently in patients who undergo open heart surgery. Intraoperative and postoperative ventilation strategies can prevent these complications and reduce mortality. We hypothesized that PCV would have better effects on gas exchange, lung mechanics and hemodynamics compared to VCV in CABG surgery. Our primary outcome was to compare the PaO 2 /FiO 2 ratio. Patients were randomized into two groups, (VCV, PCV) consisting of 30 individuals each. Two patients were excluded from the study. I/E ratio was adjusted to 1:2 and, RR:10/min fresh air gas flow was set at 3L/min in all patients. In the VCV group TV was set at 8 mL/kg of the predicted body weight. In the PCV group, peak inspiratory pressure was adjusted to the same tidal volume with the VCV group. PaO2/FiO2 was found to be higher with PCV at the end of the surgery. Time to extubation and ICU length of stay was shorter with PCV. Ppeak was similar in both groups. Pplateau was lower and Pmean was higher at the and of the surgery with PCV compared to VCV. The hemodynamic effects of both ventilation modes were found to be similar. PVC may be preferable to VCV in patients who undergo open heart surgery. However, it would be convenient if our findings are supported by similar studies.

  11. A randomized study comparing outcomes of stapled and hand-sutured anastomoses in patients undergoing open gastrointestinal surgery.

    Science.gov (United States)

    Chandramohan, S M; Gajbhiye, Raj Narenda; Agwarwal, Anil; Creedon, Erin; Schwiers, Michael L; Waggoner, Jason R; Tatla, Daljit

    2013-08-01

    Although stapling is an alternative to hand-suturing in gastrointestinal surgery, recent trials specifically designed to evaluate differences between the two in surgery time, anastomosis time, and return to bowel activity are lacking. This trial compared the outcomes of the two in subjects undergoing open gastrointestinal surgery. Adult subjects undergoing emergency or elective surgery requiring a single gastric, small, or large bowel anastomosis were enrolled into this open-label, prospective, randomized, interventional, parallel, multicenter, controlled trial. Randomization was assigned in a 1:1 ratio between the hand-sutured group (n = 138) and the stapled group (n = 142). Anastomosis time, surgery time, and time to bowel activity were collected and compared as primary endpoints. A total of 280 subjects were enrolled from April 2009 to September 2010. Only the time of anastomosis was significantly different between the two arms: 17.6 ± 1.90 min (stapled) and 20.6 ± 1.90 min (hand-sutured). This difference was deemed not clinically or economically meaningful. Safety outcomes and other secondary endpoints were similar between the two arms. Mechanical stapling is faster than hand-suturing for the construction of gastrointestinal anastomoses. Apart from this, stapling and hand-suturing are similar with respect to the outcomes measured in this trial.

  12. Postoperative cognitive dysfunction and neuroinflammation; Cardiac surgery and abdominal surgery are not the same

    NARCIS (Netherlands)

    Hovens, Iris B.; van Leeuwen, Barbara L.; Mariani, Massimo A.; Kraneveld, Aletta D.; Schoemaker, Regien G.

    Postoperative cognitive dysfunction (POCD) is a debilitating surgical complication, with cardiac surgery patients at particular risk. To gain insight in the mechanisms underlying the higher incidence of POCD after cardiac versus non-cardiac surgery, systemic and central inflammatory changes,

  13. Assessing the Risk of Occult Cancer and 30-day Morbidity in Women Undergoing Risk-reducing Surgery: A Prospective Experience.

    Science.gov (United States)

    Bogani, Giorgio; Tagliabue, Elena; Signorelli, Mauro; Chiappa, Valentina; Carcangiu, Maria Luisa; Paolini, Biagio; Casarin, Jvan; Scaffa, Cono; Gennaro, Massimiliano; Martinelli, Fabio; Borghi, Chiara; Ditto, Antonino; Lorusso, Domenica; Raspagliesi, Francesco

    To investigate the incidence and predictive factors of 30-day surgery-related morbidity and occult precancerous and cancerous conditions for women undergoing risk-reducing surgery. A prospective study (Canadian Task Force classification II-1). A gynecologic oncology referral center. Breast-related cancer antigen (BRCA) mutation carriers and BRCAX patients (those with a significant family history of breast and ovarian cancer). Minimally invasive risk-reduction surgery. Overall, 85 women underwent risk-reducing surgery: 30 (35%) and 55 (65%) had hysterectomy plus bilateral salpingo-oophorectomy (BSO) and BSO alone, respectively. Overall, in 6 (7%) patients, the final pathology revealed unexpected cancer: 3 early-stage ovarian/fallopian tube cancers, 2 advanced-stage ovarian cancers (stage IIIA and IIIB), and 1 serous endometrial carcinoma. Additionally, 3 (3.6%) patients had incidental finding of serous tubal intraepithelial carcinoma. Four (4.7%) postoperative complications within 30 days from surgery were registered, including fever (n = 3) and postoperative ileus (n = 1); no severe (grade 3 or more) complications were observed. All complications were managed conservatively. The presence of occult cancer was the only factor predicting the development of postoperative complications (p = .02). Minimally invasive risk-reducing surgery is a safe and effective strategy to manage BRCA mutation carriers. Patients should benefit from an appropriate counseling about the high prevalence of undiagnosed cancers observed at the time of surgery. Copyright © 2017 AAGL. Published by Elsevier Inc. All rights reserved.

  14. Effect of flurbiprofen aretilon on serum hs-CRP, IL-6 levels in patients undergoing esophageal cancer surgery

    International Nuclear Information System (INIS)

    Li Jiakai

    2011-01-01

    Objective: To investigate the effect of flurbiprofen axetil on serum high sensitivity C reactive protein (hs-CRP) and interleukin-6 (IL-6) in the patients undergoing esophageal cancer surgery. Methods: Thirty patients were divided into 2 groups with 15 cases each. The patients in groups A were given flurbiprofen axetil and those in group B were not as the controls. Serum hs-CRP (immuno-turbidity method) and IL-6 (RIA) levels were determined before anesthesia induction and after extubation. Results: The levels of serum hs-CRP, IL-6 were significantly higher in group B than those in group A (P<0.05). Conclusion: Flurbiprofen axetil could reduce serum hs-CRP, IL-6 levels in patients undergoing Esophageal cancer surgery. (authors)

  15. The effect of tourniquet deflation on hemodynamics and regional cerebral oxygen saturation in aged patients undergoing total knee replacement surgery

    OpenAIRE

    Song, Inkyung; Kim, Dong Yeon; Kim, Youn Jin

    2012-01-01

    Background Inflation and deflation of a pneumatic tourniquet used in total knee replacement surgery induces various changes in patient's hemodynamic and metabolic status, which may result in serious complications, especially in aged patients. Near-infrared spectroscopy (NIRS) is a monitoring device designed to estimate the regional cerebral oxygen saturation. We evaluated the effect of tourniquet deflation on hemodynamics and regional cerebral oxygen saturation in aged patients undergoing tot...

  16. Granisetron plus dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery: A meta-analysis

    OpenAIRE

    Zhu, Min; Zhou, Chengmao; Huang, Bing; Ruan, Lin; Liang, Rui

    2017-01-01

    Objective This study was designed to compare the effectiveness of granisetron plus dexamethasone for preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic surgery. Methods We searched the literature in the Cochrane Library, PubMed, EMBASE, and CNKI. Results In total, 11 randomized controlled trials were enrolled in this analysis. The meta-analysis showed that granisetron in combination with dexamethasone was significantly more effective than granisetron alone...

  17. Single bolus dose of epidural magnesium prolongs the duration of analgesia in cardiac patients undergoing vascular surgeries

    Directory of Open Access Journals (Sweden)

    Amarja Sachin Nagre

    2017-01-01

    Full Text Available Background and Aims: Magnesium, a physiological antagonist of calcium and N-methyl-d-aspartate, has a role in the prevention of pain in patients undergoing surgery for peripheral vascular diseases with cardiac comorbidities such as ischaemic heart disease and coronary artery disease. The objective of our study was assessment of effects of epidural magnesium in cardiac patients undergoing vascular surgery. Methods: Sixty patients of either sex American Society of Anesthesiologists physical status III undergoing surgeries for peripheral vascular diseases were enrolled. The control group had 30 patients who received levobupivacaine 0.25% 10 ml with fentanyl 50 μg while 30 patients in study group received levobupivacaine 0.25% 10 ml with fentanyl 50 μg and magnesium 100 mg. The primary outcome was duration of analgesia. Sedation score, pain assessment using visual analogue scale (VAS, systolic blood pressure (SBP and diastolic blood pressure (DBP, heart rate (HR, respiratory rate (RR and fentanyl consumption were also recorded. Statistical analyses were performed using Minitab 15 statistical software. Results: Both groups were similar demographically and with respect to baseline HR, SBP, DBP and RR. In the study group, compared to the control group, duration of analgesia was 4.17 ± 1.07 h versus 1.55 ± 0.47 h (P < 0.01, sedation score were\\ better (P = 0.003 and the VAS scores was lower (P < 0.01. sConclusion: Epidural magnesium, added to levobupivacaine and fentanyl as a single bolus dose effectively prolongs the duration of analgesia in high-risk cardiac patients undergoing peripheral vascular surgery.

  18. Risk factors associated with postoperative seizures in patients undergoing cardiac surgery who received tranexamic acid: A case-control study

    Directory of Open Access Journals (Sweden)

    Felix R Montes

    2012-01-01

    Full Text Available Antifibrinolytic agents are used during cardiac surgery to minimize bleeding and reduce exposure to blood products. Several reports suggest that tranexamic acid (TA can induce seizure activity in the postoperative period. To examine factors associated with postoperative seizures in patients undergoing cardiac surgery who received TA. University-affiliated hospital. Case-control study. Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB between January 2008 and December 2009 were identified. During this time, all patients undergoing heart surgery with CPB received TA. Cases were defined as patients who developed seizures that required initiation of anticonvulsive therapy within 48 h of surgery. Exclusion criteria included subjects with preexisting epilepsy and patients in whom the convulsive episode was secondary to a new ischemic lesion on brain imaging. Controls who did not develop seizures were randomly selected from the initial cohort. From an initial cohort of 903 patients, we identified 32 patients with postoperative seizures. Four patients were excluded. Twenty-eight cases and 112 controls were analyzed. Cases were more likely to have a history of renal impairment and higher preoperative creatinine values compared with controls (1.39 ± 1.1 vs. 0.98 ± 0.02 mg/dL, P = 0.02. Significant differences in the intensive care unit, postoperative and total lengths of stay were observed. An association between high preoperative creatinine value and postoperative seizure was identified. TA may be associated with the development of postoperative seizures in patients with renal dysfunction. Doses of TA should be reduced or even avoided in this population.

  19. Early symptoms in the prodromal phase of delirium: a prospective cohort study in elderly patients undergoing hip surgery.

    Science.gov (United States)

    de Jonghe, Jos F M; Kalisvaart, Kees J; Dijkstra, Marty; van Dis, Huib; Vreeswijk, Ralph; Kat, Martin G; Eikelenboom, Piet; van der Ploeg, Tjeerd; van Gool, Willem A

    2007-02-01

    The authors investigated prodromal delirium symptoms in elderly patients undergoing hip surgery. This was a prospective cohort study in the setting of a large medical school-affiliated general hospital in Alkmaar, The Netherlands. Participants were patients undergoing hip surgery aged 70 and older at risk for delirium. Before surgery, patients were randomized to low-dose prophylactic haloperidol treatment or placebo. Daily assessments were based on patient interviews with the Mini-Mental State Examination and Digit Span test. The Delirium Rating Scale-Revised (DRS-R-98) was used to measure early symptoms during the prodromal phase before the onset of delirium. Data of 66 patients with delirium were compared with those of 35 at-risk patients who did not develop delirium: 14 of 66 patients (21%) had delirium on the day of surgery or early the day after, 32 of 66 (48%) on the second day, 14 of 66 on the third, and six of 66 (9%) on the fourth. The average DRS-R-98 total scores on day -4 to day -1 before delirium were 1.9 for the comparison group patients and 5.0, 4.3, 5.8, and 10.7 for patients with postoperative delirium. Multivariate analysis showed that the early symptoms memory impairments, incoherence, disorientation, and underlying somatic illness predict delirium. Most elderly patients undergoing hip surgery with postoperative delirium already have early symptoms in the prodromal phase of delirium. These findings are potentially useful for screening purposes and for optimizing prevention strategies targeted at reducing the incidence of postoperative delirium.

  20. The efficacy of tolvaptan in the perioperative management of chronic kidney disease patients undergoing open-heart surgery.

    Science.gov (United States)

    Yamada, Mitsutomo; Nishi, Hiroyuki; Sekiya, Naosumi; Horikawa, Kohei; Takahashi, Toshiki; Sawa, Yoshiki

    2017-04-01

    The perioperative management of chronic kidney disease (CKD) patients undergoing open-heart surgery is challenging. In this study, we evaluated the effects of tolvaptan in CKD patients after open-heart surgery. Between 2010 to 2015, 731 patients underwent open-heart surgery in our hospital. We consecutively selected 71 patients with stage IIIa-IV CKD and divided them into two groups. Those who received tolvaptan postoperatively were defined as the "Tolvaptan group" (n = 25) and those who did not were defined as the "Non-tolvaptan group" (n = 46). We compared the urine volume of postoperative days (POD) 1 and 2, the number of days to return to preoperative body weight (BW), and the change in the postoperative estimated glomerular filtration rate (eGFR). In the tolvaptan group, the urine volume was significantly larger (P = .04) and the duration to preoperative BW tended to be shorter. Overall, the postoperative change in the eGFR tended to be better in the tolvaptan group (P = .008). In particular, we found a significantly better trend in CKD stage IV (P = .04) patients and in the patients, whose cardiopulmonary bypass (CPB) time was longer than 120 min (P = .03). Tolvaptan can safely be used for CKD patients undergoing open-heart surgery and can provide a feasible urine volume without leading to a deterioration of their renal function.

  1. Increasing Severity of Malnutrition Is Associated With Poorer 30-Day Outcomes in Patients Undergoing Hip Fracture Surgery.

    Science.gov (United States)

    Chung, Andrew S; Hustedt, Joshua W; Walker, Robert; Jones, Clifford; Lowe, Jason; Russell, George V

    2018-04-01

    Low serum albumin levels (hypoalbuminemia) have classically been used to identify malnutrition. The effect of increasing severity of malnutrition on postoperative outcomes in patients undergoing hip fracture surgery has not been well delineated on a large scale. Retrospective. Multicenter. A total of 12,373 patients undergoing hip fracture surgery from 2006 to 2013 National Surgery Quality Improvement Project data were identified. Patient demographic, comorbidity, and preoperative laboratory data and complication, reoperation, and readmission data were collected. Multivariate logistic regression was used to determine the effect of increasing severity of malnutrition on rates of 30-day postoperative complications, readmissions, and reoperations. A total of 12,373 hip fractures met inclusion criteria. A total of 6506 (52.6%) patients had normal albumin levels (albumin ≥3.5 g/dL), 3205 (25.9%) patients were mildly malnourished (albumin 3.1-3.49 g/dL), 2265 (18.3%) were moderately malnourished (albumin 2.4-3.1 g/dL), and 397 (3.2%) patients were severely malnourished (albumin malnutrition was associated with a 2-fold increase in the odds of postoperative complications and mortality when compared with mild malnutrition (P malnutrition was associated with significantly longer lengths of stay and higher odds of experiencing a related readmission (P hip fracture surgery. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

  2. Heated wire humidification circuit attenuates the decrease of core temperature during general anesthesia in patients undergoing arthroscopic hip surgery.

    Science.gov (United States)

    Park, Sooyong; Yoon, Seok-Hwa; Youn, Ann Misun; Song, Seung Hyun; Hwang, Ja Gyung

    2017-12-01

    Intraoperative hypothermia is common in patients undergoing general anesthesia during arthroscopic hip surgery. In the present study, we assessed the effect of heating and humidifying the airway with a heated wire humidification circuit (HHC) to attenuate the decrease of core temperature and prevent hypothermia in patients undergoing arthroscopic hip surgery under general anesthesia. Fifty-six patients scheduled for arthroscopic hip surgery were randomly assigned to either a control group using a breathing circuit connected with a heat and moisture exchanger (HME) (n = 28) or an HHC group using a heated wire humidification circuit (n = 28). The decrease in core temperature was measured from anesthetic induction and every 15 minutes thereafter using an esophageal stethoscope. Decrease in core temperature from anesthetic induction to 120 minutes after induction was lower in the HHC group (-0.60 ± 0.27℃) compared to the control group (-0.86 ± 0.29℃) (P = 0.001). However, there was no statistically significant difference in the incidence of intraoperative hypothermia or the incidence of shivering in the postanesthetic care unit. The use of HHC may be considered as a method to attenuate intraoperative decrease in core temperature during arthroscopic hip surgery performed under general anesthesia and exceeding 2 hours in duration.

  3. Incidence of Diabetes Insipidus in Postoperative Period among the Patients Undergoing Pituitary Tumour Surgery.

    Science.gov (United States)

    Kadir, M L; Islam, M T; Hossain, M M; Sultana, S; Nasrin, R; Hossain, M M

    2017-07-01

    Post operative complications after pituitary tumour surgery vary according to procedure. There are several surgical procedures being done such as transcranial, transsphenoidal microsurgical and transsphenoidal endoscopic approaches. One of the commonest complications is diabetes insipidus (DI). Our main objective was to find out the incidence of diabetes insipidus in post operative period among patients undergoing surgical intervention for pituitary tumour in our institute. The presence of diabetes insipidus in the postoperative period was established by measuring serum Na+ concentration, hourly urine output and urinary specific gravity to find out the incidence of diabetes insipidus in postoperative period in relation to age, gender, tumour diameter, function of tumour (i.e., either hormone secreting or not) and operative procedure used for surgical resection of pituitary tumor. As it is the most common postoperative complication so, in this study we tried to find out how many of the patients develop diabetes insipidus in postoperative period following surgical resection of pituitary tumour. This cross sectional type of observational study was carried out in the department of Neurosurgery, BSMMU from May 2014 to October 2015 on 33 consecutive patients who underwent surgical intervention for pituitary tumour for the first time. Data was collected by using a data collection sheet. The incidence of diabetes insipidus was found 23.1% of patients in diabetes insipidus (p=0.073). Regarding tumour size 30.8% and 69.2% of patients developed diabetes insipidus having tumour diameter diabetes insipidus who was operated by transsphenoidal endoscopic approach, 23.1% and 7.7% of patients developed diabetes insipidus who underwent pituitary tumour resection through transsphenoidal microscopic approach and transcranial microscopic approach respectively (p=0.432). 17.6% of patients develop DI having functioning pituitary macroadenoma and 62.5% of patients develop DI having

  4. Estimation of utility values from visual analog scale measures of health in patients undergoing cardiac surgery

    Directory of Open Access Journals (Sweden)

    Oddershede L

    2014-01-01

    Full Text Available Lars Oddershede,1,2 Jan Jesper Andreasen,1 Lars Ehlers2 1Department of Cardiothoracic Surgery, Center for Cardiovascular Research, Aalborg University Hospital, Aalborg, Denmark; 2Danish Center for Healthcare Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg University, Aalborg East, Denmark Introduction: In health economic evaluations, mapping can be used to estimate utility values from other health outcomes in order to calculate quality adjusted life-years. Currently, no methods exist to map visual analog scale (VAS scores to utility values. This study aimed to develop and propose a statistical algorithm for mapping five dimensions of health, measured on VASs, to utility scores in patients suffering from cardiovascular disease. Methods: Patients undergoing coronary artery bypass grafting at Aalborg University Hospital in Denmark were asked to score their health using the five VAS items (mobility, self-care, ability to perform usual activities, pain, and presence of anxiety or depression and the EuroQol 5 Dimensions questionnaire. Regression analysis was used to estimate four mapping models from patients' age, sex, and the self-reported VAS scores. Prediction errors were compared between mapping models and on subsets of the observed utility scores. Agreement between predicted and observed values was assessed using Bland–Altman plots. Results: Random effects generalized least squares (GLS regression yielded the best results when quadratic terms of VAS scores were included. Mapping models fitted using the Tobit model and censored least absolute deviation regression did not appear superior to GLS regression. The mapping models were able to explain approximately 63%–65% of the variation in the observed utility scores. The mean absolute error of predictions increased as the observed utility values decreased. Conclusion: We concluded that it was possible to predict utility scores from VAS scores of the five

  5. Development of a teaching tool for women with a gynecologic malignancy undergoing minimally invasive robotic-assisted surgery.

    Science.gov (United States)

    Castiglia, Luisa Luciani; Drummond, Nancy; Purden, Margaret A

    2011-08-01

    Women undergoing minimally invasive robotic-assisted surgery for a gynecologic malignancy have many questions and concerns related to the cancer diagnosis and surgery. The provision of information enhances coping with such illness-related challenges. A lack of print materials for these patients prompted the creation of a written teaching tool to improve informational support. A booklet was developed using guidelines for the design of effective patient education materials, including an iterative process of collaboration with healthcare providers and women who had undergone robotic-assisted surgery, as well as attention to readability. The 52-page booklet covers the trajectory of the woman's experience and includes the physical, psychosocial, and sexual aspects of recovery.

  6. Management of factor VII-deficient patients undergoing joint surgeries--preliminary results of locally developed treatment regimen.

    Science.gov (United States)

    Windyga, J; Zbikowski, P; Ambroziak, P; Baran, B; Kotela, I; Stefanska-Windyga, E

    2013-01-01

    Inherited factor VII (FVII) deficiency is a rare coagulation disorder with variable haemorrhagic manifestations. In severely affected cases spontaneous haemarthroses leading to advanced arthropathy have been observed. Such cases may require surgery. Therapeutic options for bleeding prevention in FVII deficient patients undergoing surgery comprise various FVII preparations but the use of recombinant activated factor VII (rFVIIa) seems to be the treatment of choice. To present the outcome of orthopaedic surgery under haemostatic coverage of rFVIIa administered according to the locally established treatment regimen in five adult patients with FVII baseline plasma levels below 10 IU dL(-1). Two patients required total hip replacement (THR); three had various arthroscopic procedures. Recombinant activated factor VII was administered every 8 h on day of surgery (D0) followed by every 12-24 h for the subsequent 9-14 days, depending on the type of surgery. Factor VII plasma coagulation activity (FVII:C) was determined daily with no predefined therapeutic target levels. Doses of rFVIIa on D0 ranged from 18 to 37 μg kg(-1) b.w. and on the subsequent days--from 13 to 30 μg kg(-1) b.w. Total rFVIIa dose per procedure ranged from 16 to 37.5 mg, and the total number of doses per procedure was 16-31. None of our patients developed excessive bleeding including those in whom FVII:C trough levels returned nearly to the baseline level on the first post-op day. Preliminary results demonstrate that rFVIIa administered according to our treatment regimen is an effective and safe haemostatic agent for hypoproconvertinaemia patients undergoing orthopaedic surgery. © 2012 Blackwell Publishing Ltd.

  7. The pharmacokinetics of cefazolin in patients undergoing elective & semi-elective abdominal aortic aneurysm open repair surgery

    Directory of Open Access Journals (Sweden)

    Roberts Michael S

    2011-02-01

    Full Text Available Abstract Background Surgical site infections are common, so effective antibiotic concentrations at the sites of infection are required. Surgery can lead to physiological changes influencing the pharmacokinetics of antibiotics. The aim of the study is to evaluate contemporary peri-operative prophylactic dosing of cefazolin by determining plasma and subcutaneous interstitial fluid concentrations in patients undergoing elective of semi-elective abdominal aortic aneurysm (AAA open repair surgery. Methods/Design This is an observational pharmacokinetic study of patients undergoing AAA open repair surgery at the Royal Brisbane and Women's Hospital. All patients will be administered 2-g cefazolin by intravenous injection within 30-minutes of the procedure. Participants will have samples from blood and urine, collected at different intervals. Patients will also have a microdialysis catheter inserted into subcutaneous tissue to measure interstitial fluid penetration by cefazolin. Participants will be administered indocyanine green and sodium bromide as well as have cardiac output monitoring performed and tetrapolar bioimpedance to determine physiological changes occurring during surgery. Analysis of samples will be performed using validated liquid chromatography tandem mass-spectrometry. Pharmacokinetic analysis will be performed using non-linear mixed effects modeling to determine individual and population pharmacokinetic parameters and the effect of peri-operative physiological changes on cefazolin disposition. Discussion The study will describe cefazolin levels in plasma and the interstitial fluid of tissues during AAA open repair surgery. The effect of physiological changes to the patient mediated by surgery will also be determined. The results of this study will guide clinicians and pharmacists to effectively dose cefazolin in order to maximize the concentration of antibiotics in the tissues which are the most common site of surgical site infections.

  8. Setting up pre-admission visits for children undergoing day surgery: a practice development initiative.

    Science.gov (United States)

    O'Shea, Maria; Cummins, Ann; Kelleher, Ann

    2010-06-01

    The hospital experience can bring about a range of negative emotions for children. The literature clearly states that children who are prepared for surgery recover faster and have fewer negative effects. Pre-admission programmes seek to prepare children (and their parents) for surgery. This paper describes in detail how a pre-admission programme was established for children and their families who were scheduled for day case surgery.

  9. Levosimendan in Patients with Left Ventricular Dysfunction Undergoing Cardiac Surgery: An Update Meta-Analysis and Trial Sequential Analysis

    Directory of Open Access Journals (Sweden)

    Benji Wang

    2018-01-01

    Full Text Available Background. Recent studies suggest that levosimendan does not provide mortality benefit in patients with low cardiac output syndrome undergoing cardiac surgery. These results conflict with previous findings. The aim of the current study is to assess whether levosimendan reduces postoperative mortality in patients with impaired left ventricular function (mean EF ≤ 40% undergoing cardiac surgery. Methods. We conducted a comprehensive search of PubMed, EMBASE, and Cochrane Library Database through November 20, 2017. Inclusion criteria were random allocation to treatment with at least one group receiving levosimendan and another group receiving placebo or other treatments and cardiac surgery patients with a left ventricular ejection fraction of 40% or less. The primary endpoint was postoperative mortality. Secondary outcomes were cardiac index, pulmonary capillary wedge pressure (PCWP, length of intensive care unit (ICU stay, postoperative atrial fibrillation, and postoperative renal replacement therapy. We performed trial sequential analysis (TSA to evaluate the reliability of the primary endpoint. Results. Data from 2,152 patients in 15 randomized clinical trials were analyzed. Pooled results demonstrated a reduction in postoperative mortality in the levosimendan group [RR = 0.53, 95% CI (0.38–0.73, I2=0]. However, the result of TSA showed that the conclusion may be a false positive. Secondary outcomes demonstrated that PCWP, postoperative renal replacement therapy, and length of ICU stay were significantly reduced. Cardiac index was greater in the levosimendan group. No difference was found in the rate of postoperative atrial fibrillation. Conclusions. Levosimendan reduces the rate of death and other adverse outcomes in patients with low ejection fraction who were undergoing cardiac surgery, but results remain inconclusive. More large-volume randomized clinical trials (RCTs are warranted.

  10. The role of blood lactate clearance as a predictor of mortality in children undergoing surgery for tetralogy of Fallot

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    Suruchi Ladha

    2016-01-01

    Full Text Available Background: The identification of biomarkers for predicting morbidity and mortality, particularly in pediatric population undergoing cardiac surgery will contribute toward improving the patient outcome. There is an increasing body of literature establishing the clinical utility of hyperlactatemia and lactate clearance as prognostic indicator in adult cardiac surgical patients. However, the relationship between lactate clearance and mortality risk in the pediatric population remains to be established. Objective: To assess the role of lactate clearance in determining the outcome in children undergoing corrective surgery for tetralogy of Fallot (TOF. Methods and Study Design: A prospective, observational study. Setting: A tertiary care center. Study Population: Two hundred children undergoing elective surgery for TOF. Study Method: Blood lactate levels were obtained as baseline before operation (T0, postoperatively at admission to the cardiac intensive care unit after surgery (T1, and then at every 6 h for the first 24 h of Intensive Care Unit (ICU stay (T6, T12, T18, and T24, respectively. The lactate clearance in the study is defined by the equation ([lactate initial - lactate delayed]/lactate initial ×100%. Lactate clearance was determined at T1-T6, T1-T12, T1-T18, and T1-T24 time interval, respectively. The primary outcome measured was mortality. Secondary outcomes measured were the duration of mechanical ventilation, duration of inotropic requirement, and duration of ICU stay. Results: Eleven out of the two hundred patients enrolled in the study died. Nonsurvivors had higher postoperative lactate concentration (P 10%, relative to patients with a lactate clearance 10% after 6 h have improved outcome compared with those with lower lactate clearance.

  11. Pectoral Fascial (PECS) I and II Blocks as Rescue Analgesia in a Patient Undergoing Minimally Invasive Cardiac Surgery.

    Science.gov (United States)

    Yalamuri, Suraj; Klinger, Rebecca Y; Bullock, W Michael; Glower, Donald D; Bottiger, Brandi A; Gadsden, Jeffrey C

    Patients undergoing minimally invasive cardiac surgery have the potential for significant pain from the thoracotomy site. We report the successful use of pectoral nerve block types I and II (Pecs I and II) as rescue analgesia in a patient undergoing minimally invasive mitral valve repair. In this case, a 78-year-old man, with no history of chronic pain, underwent mitral valve repair via right anterior thoracotomy for severe mitral regurgitation. After extubation, he complained of 10/10 pain at the incision site that was minimally responsive to intravenous opioids. He required supplemental oxygen because of poor pulmonary mechanics, with shallow breathing and splinting due to pain, and subsequent intensive care unit readmission. Ultrasound-guided Pecs I and II blocks were performed on the right side with 30 mL of 0.2% ropivacaine with 1:400,000 epinephrine. The blocks resulted in near-complete chest wall analgesia and improved pulmonary mechanics for approximately 24 hours. After the single-injection blocks regressed, a second set of blocks was performed with 266 mg of liposomal bupivacaine mixed with bupivacaine. This second set of blocks provided extended analgesia for an additional 48 hours. The patient was weaned rapidly from supplemental oxygen after the blocks because of improved analgesia. Pectoral nerve blocks have been described in the setting of breast surgery to provide chest wall analgesia. We report the first successful use of Pecs blocks to provide effective chest wall analgesia for a patient undergoing minimally invasive cardiac surgery with thoracotomy. We believe that these blocks may provide an important nonopioid option for the management of pain during recovery from minimally invasive cardiac surgery.

  12. Dexmedetomidine as an adjuvant for perioperative pain management in adolescents undergoing bariatric surgery: An observational cohort study.

    Science.gov (United States)

    Vaughns, Janelle D; Martin, Celeste; Nelson, Jonathon; Nadler, Evan; Quezado, Zenaide M

    2017-11-01

    The anesthetic management of adolescents undergoing bariatric surgery presents a number of challenges, including increased risk of postoperative opioid-related respiratory depression. These patients could benefit from adjunctive analgesics with opioid-sparring effects to optimize perioperative pain control. Dexmedetomidine, a selective α2-adrenoreceptor agonist, has sedative and analgesic properties with no respiratory depressant effects. To determine the effect of intraoperative dexmedetomidine on opioid requirement and perioperative pain management in obese adolescents undergoing bariatric surgery. An observational study of 26 consecutive patients treated with and without dexmedetomidine during the intraoperative period was conducted. The dexmedetomidine treated patients received a loading dose over 30min and a continuous infusion thereafter. The standard group represented patients who received an institutional standard anesthetic without dexmedetomidine. The primary outcome was total perioperative intravenous morphine equivalent (MEq). We also examined reported pain scores during the perioperative period. While there were no significant differences in age, height and weight category, there were imbalances on race distribution between the two groups. Both groups received similar doses of ketorolac and acetaminophen perioperatively. Overall, during 48h postoperatively, the dexmedetomidine group received significantly less total MEq administration compared with the standard group. Three patients in the dexmedetomidine group required ephedrine to treat an episode of hypotension. These results suggest that the use of dexmedetomidine during bariatric surgery in the morbidly obese adolescent population is associated with decreased opioid utilization during the perioperative period. Future randomized studies will determine the role of dexmedetomidine in the pain management of obese adolescents undergoing bariatric surgery. Therapeutic, Level III. Copyright © 2017

  13. [Effect of dexmedetomidine on emergence agitation after general anesthesia in children undergoing odontotherapy in day-surgery operating room].

    Science.gov (United States)

    Lin, Luo; Yueming, Zhang; Meisheng, Li; Jiexue, Wang; Yang, Ji

    2017-12-01

    To study the effectiveness of dexmedetomidine used for general anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room in reducing the incidence of emergence agitation (EA). Eighty children undergoing odontotherapy and under general anesthesia in day-surgery operating room were randomized into two groups, group A (n=40) and group B (n=40). Each patient in group A was administered with a bolus dose of dexmedetomidine (1.0 μg·kg⁻¹, saline diluted to 10 mL) pump-infused after intubation and a maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Each patient in group B was administered with a bolus dose of normal saline 10 mL pump-infused after intubation and maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Gender, age, weight, physical status according to the American Society of Anesthesiologists, perioperative heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO₂), sufentanil dosage, duration of surgery, time of extubation, time of regaining consciousness, and time to reach modified Aldrete's score≥12 were recorded. Behavior in postanesthesia care unit was rated on the four-point agitation scale. Compared with group B, decreases were observed in HR and MAP at the beginning of operation, in 10 and 30 min, 1 and 2 h after the beginning of operation, and after extubation of group A (Pgeneral anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room, dexmedetomidine results in low incidence of EA during recovery and more stable vital signs.

  14. A Multidisciplinary Approach on the Perioperative Antithrombotic Management of Patients With Coronary Stents Undergoing Surgery: Surgery After Stenting 2.

    Science.gov (United States)

    Rossini, Roberta; Tarantini, Giuseppe; Musumeci, Giuseppe; Masiero, Giulia; Barbato, Emanuele; Calabrò, Paolo; Capodanno, Davide; Leonardi, Sergio; Lettino, Maddalena; Limbruno, Ugo; Menozzi, Alberto; Marchese, U O Alfredo; Saia, Francesco; Valgimigli, Marco; Ageno, Walter; Falanga, Anna; Corcione, Antonio; Locatelli, Alessandro; Montorsi, Marco; Piazza, Diego; Stella, Andrea; Bozzani, Antonio; Parolari, Alessandro; Carone, Roberto; Angiolillo, Dominick J

    2018-03-12

    Perioperative management of antithrombotic therapy in patients treated with coronary stents undergoing surgery remains poorly defined. Importantly, surgery represents a common reason for premature treatment discontinuation, which is associated with an increased risk in mortality and major adverse cardiac events. However, maintaining antithrombotic therapy to minimize the incidence of perioperative ischemic complications may increase the risk of bleeding complications. Although guidelines provide some recommendations with respect to the perioperative management of antithrombotic therapy, these have been largely developed according to the thrombotic risk of the patient and a definition of the hemorrhagic risk specific to each surgical procedure, key to defining the trade-off between ischemia and bleeding, is not provided. These observations underscore the need for a multidisciplinary collaboration among cardiologists, anesthesiologists, hematologists and surgeons to reach this goal. The present document is an update on practical recommendations for standardizing management of antithrombotic therapy management in patients treated with coronary stents (Surgery After Stenting 2) in various types of surgery according to the predicted individual risk of thrombotic complications against the anticipated risk of surgical bleeding complications. Cardiologists defined the thrombotic risk using a "combined ischemic risk" approach, while surgeons classified surgeries according to their inherent hemorrhagic risk. Finally, a multidisciplinary agreement on the most appropriate antithrombotic treatment regimen in the perioperative phase was reached for each surgical procedure. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  15. Adverse cardiac events in children with Williams syndrome undergoing cardiovascular surgery: An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database.

    Science.gov (United States)

    Hornik, Christoph P; Collins, Ronnie Thomas; Jaquiss, Robert D B; Jacobs, Jeffrey P; Jacobs, Marshall L; Pasquali, Sara K; Wallace, Amelia S; Hill, Kevin D

    2015-06-01

    Patients with Williams syndrome (WS) undergoing cardiac surgery are at risk for major adverse cardiac events (MACE). Prevalence and risk factors for such events have not been well described. We sought to define frequency and risk of MACE in patients with WS using a multicenter clinical registry. We identified cardiac operations performed in patients with WS using the Society of Thoracic Surgeons Congenital Heart Surgery Database (2000-2012). Operations were divided into 4 groups: isolated supravalvular aortic stenosis, complex left ventricular outflow tract (LVOT), isolated right ventricular outflow tract (RVOT), and combined LVOT/RVOT procedures. The proportion of patients with MACE (in-hospital mortality, cardiac arrest, or postoperative mechanical circulatory support) was described and the association with preoperative factors was examined. Of 447 index operations (87 centers), median (interquartile range) age and weight at surgery were 2.4 years (0.6-7.4 years) and 10.6 kg (6.5-21.5 kg), respectively. Mortality occurred in 20 patients (5%). MACE occurred in 41 patients (9%), most commonly after combined LVOT/RVOT (18 out of 87; 21%) and complex LVOT (12 out of 131; 9%) procedures, but not after isolated RVOT procedures. Odds of MACE decreased with age (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98-0.99), weight (OR, 0.97; 95% CI, 0.93-0.99), but increased in the presence of any preoperative risk factor (OR, 2.08; 95% CI, 1.06-4.00), and in procedures involving coronary artery repair (OR, 5.37; 95% CI, 2.05-14.06). In this multicenter analysis, MACE occurred in 9% of patients with WS undergoing cardiac surgery. Demographic and operative characteristics were associated with risk. Further study is needed to elucidate mechanisms of MACE in this high-risk population. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  16. Rapid reversal of neuromuscular blockade by sugammadex after continuous infusion of rocuronium in patients with liver dysfunction undergoing hepatic surgery.

    Science.gov (United States)

    Fujita, Ai; Ishibe, Natsuki; Yoshihara, Tatsuya; Ohashi, Jun; Makino, Hideichi; Ikeda, Mizuko; Setoguchi, Hidekazu

    2014-06-01

    Sugammadex rapidly reverses neuromuscular blockade (NMB) induced by rocuronium. NMB induced by rocuronium is prolonged in patients with liver dysfunction, because the drug is mainly excreted into the bile. However, the efficacy and safety of sugammadex in terms of reversing rocuronium-induced NMB in patients with liver dysfunction undergoing hepatic surgery have not been evaluated. This observational study investigated the efficacy and safety of sugammadex after continuous infusion of rocuronium in patients with liver dysfunction undergoing hepatic surgery. Remifentanil/propofol anesthesia was administered to 31 patients: 15 patients in the control group, and 16 patients from a group with liver dysfunction. Rocuronium (0.6 mg/kg) was administered, followed by continuous infusion. The enrolled patients were then subdivided into two groups according to the dose of sugammadex. In the first group a single dose of sugammadex (2.0 mg/kg) was given at the reappearance of the second twitch (T2). In the second group a single dose of sugammadex (4.0 mg/kg) was given at the first twitch response if T2 did not reappear in 15 minutes after stopping rocuronium. The primary outcome was time from administration of sugammadex to recovery of a train-of-four ratio to 0.9. The dose of rocuronium required in the liver dysfunction group was lower than that in the control group (6.2 vs. 8.2 μg/kg/min, p = 0.002). The mean time from the administration of sugammadex to recovery of the train-of-four ratio to 0.9 was not significantly different between the liver dysfunction group and the control group (2.2 minutes vs. 2.0 minutes in the 2 mg/kg administration group, p = 0.44 and 1.9 minutes vs. 1.7 minutes in the 4 mg/kg administration group, p = 0.70, respectively). No evidence of recurarization was observed in any of the patients. Most of the adverse events were found to be mild and such events were not related to the use of sugammadex. None of the patients was eliminated from the study

  17. Effect of a preoperative decontamination protocol on surgical site infections in patients undergoing elective orthopedic surgery with hardware implantation.

    Science.gov (United States)

    Bebko, Serge P; Green, David M; Awad, Samir S

    2015-05-01

    Surgical site infections (SSIs), commonly caused by methicillin-resistant Staphylococcus aureus (MRSA), are associated with significant morbidity and mortality, specifically when hardware is implanted in the patient. Previously, we have demonstrated that a preoperative decontamination protocol using chlorhexidine gluconate washcloths and intranasal antiseptic ointment is effective in eradicating MRSA in the nose and on the skin of patients. To examine the effect of a decontamination protocol on SSIs in patients undergoing elective orthopedic surgery with hardware implantation. A prospective database of patients undergoing elective orthopedic surgery with hardware implantation at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, was analyzed from October 1, 2012, to December 31, 2013. Cohort groups before and after the intervention were compared. Starting in May 2013, during their preoperative visit, all of the patients watched an educational video about MRSA decontamination and were given chlorhexidine washcloths and oral rinse and nasal povidone-iodine solution to be used the night before and the morning of scheduled surgery. Thirty-day SSI rates were collected according to the definitions of the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance. Data on demographics, comorbidities such as chronic obstructive pulmonary disease and coronary artery disease, tobacco use, alcohol use, and body mass index were also collected. Univariate analysis was performed between the 2 groups of patients. Multivariate analysis was used to identify independent predictors of SSI. A total of 709 patients were analyzed (344 controls and 365 patients who were decolonized). Both groups were well matched with no significant differences in age, body mass index, sex, or comorbidities. All of the patients (100%) completed the MRSA decontamination protocol. The SSI rate in the intervention group was significantly lower (1.1%; 4 of

  18. Association Between ABO Blood Type and Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Unilateral Total Hip Arthroplasty Surgery in China.

    Science.gov (United States)

    Li, Jie; Zhou, Jun; Wan, Yunqiang; Liu, Li; Ou, Cehua

    2017-05-28

    BACKGROUND Postoperative cognitive dysfunction (POCD) is a postoperative complication after surgery and anesthesia. Whether ABO blood types are associated with POCD in elderly patients undergoing unilateral total hip arthroplasty surgery in China is unclear. MATERIAL AND METHODS Firstly, 142 elderly patients were divided into a POCD group and a non-POCD group according to the Mini Mental State Examination (MMSE) scores and ABO blood types were analyzed. Secondly, according to ABO blood type, the selected 226 patients were divided into 4 groups: type A group, type B group, type AB group, and type O group. Then, all patients completed the MMSE before and after surgery. Finally, the occurrence of POCD was recorded and related data were analyzed. RESULTS Firstly, there was a significant difference in both groups in terms of distribution of ABO blood types, and elderly patients who developed POCD were more likely to have type A blood and less likely to have type O blood. Secondly, compared with elderly patients with type A blood, those with type O had higher MMSE scores on the first day and the seventh day after surgery. Finally, the risk of developing POCD was significantly higher in patients with type A blood and on the first day and the seventh day after surgery the risk of developing POCD was significantly lower in patients with type O blood. CONCLUSIONS Elderly patients with type A blood have higher risk of developing early POCD and those with type O blood have less risk of developing early POCD.

  19. Role of routine pre-operative screening venous duplex ultrasound in morbidly obese patients undergoing bariatric surgery

    Directory of Open Access Journals (Sweden)

    P Praveen Raj

    2017-01-01

    Full Text Available Background/Aims: It is well established that obesity is a strongly associated risk factor for post-operative deep vein thrombosis (DVT. Physical effects and pro-thrombotic, pro-inflammatory and hypofibrinolytic effects of severe obesity may predispose to idiopathic DVT (pre-operatively because of which bariatric patients are routinely screened before surgery. The aim of this study was to audit the use of routine screening venous duplex ultrasound in morbidly obese patients before undergoing bariatric surgery. Methods: We retrospectively reviewed 180 patients who underwent bariatric surgery from August 2013 to August 2014 who had undergone pre-operative screening bilateral lower-extremity venous duplex ultrasound for DVT. Data were collected on patient's demographics, history of venous thromboembolism, prior surgeries and duplex ultrasound details of the status of the deep veins and superficial veins of the lower limbs. Results: No patients had symptoms or signs of DVT pre-operatively. No patient gave history of DVT. No patient was found to have iliac, femoral or popliteal vein thrombosis. Superficial venous disease was found in 17 (8%. One patient had a right lower limb venous ulcer. Conclusion: Thromboembolic problems in the morbidly obese before bariatric surgery are infrequent, and screening venous duplex ultrasound can be done in high-risk patients only.

  20. Effects of using WeChat-assisted perioperative care instructions for parents of pediatric patients undergoing day surgery for herniorrhaphy.

    Science.gov (United States)

    Liu, Jun; Zheng, Xin; Chai, Shouxia; Lei, Meirong; Feng, Zehui; Zhang, Xuelin; Lopez, Violeta

    2018-02-19

    This study examined the effects of WeChat-assisted perioperative instructions for parents whose children were to undergo herniorrhaphy. A randomized controlled trial was conducted in a day surgery center in China. Participants were randomly assigned to the intervention (WeChat) group (n = 209) and the control (Leaflet) group (n = 209). The primary outcomes of this study were parents' knowledge regarding hernia and rate of cancellation of children's surgery. The secondary outcomes were the rate of lost-to-follow-up and the rate of complications and adverse events during the seventh postoperative follow-up day. There was a significant difference in the rate of cancelling the surgery and the mean knowledge score between the WeChat group and leaflet groups. The lost-to-follow-up rate was significantly lower in the WeChat group (0.54%) than in the leaflet group (3.66%). The incidence of postoperative complications were higher in the control group. WeChat-assisted perioperative care instructions enhanced parents' knowledge on perioperative instructions and promoted the preparation of their children for day surgery resulting in lower rate of cancelling the surgery. WeChat has the ability to expand health services outside the hospital confines and could be used as an important low-cost health educational medium in China. Copyright © 2018 Elsevier B.V. All rights reserved.

  1. Comparison of pain and postoperative stress in dogs undergoing natural orifice transluminal endoscopic surgery, laparoscopic, and open oophorectomy.

    Science.gov (United States)

    Freeman, Lynetta J; Rahmani, Emad Y; Al-Haddad, Mohammad; Sherman, Stuart; Chiorean, Michael V; Selzer, Don J; Snyder, Paul W; Constable, Peter D

    2010-08-01

    Few studies are available to compare the potential benefits of natural orifice transluminal endoscopic surgery (NOTES) approaches to traditional surgery. To compare complications, surgical stress, and postoperative pain. Prospective study in dogs. Research laboratory. Thirty dogs. Oophorectomy procedures were performed via NOTES and laparoscopic and traditional open surgery. Operative time, pain scores, systemic stress parameters (cortisol, glucose), surgical stress markers (interleukin 6, C-reactive protein), 3-day observation. Median operative times were 76, 44, and 35 minutes for the NOTES, laparoscopic, and open procedures, respectively, with the NOTES procedure being significantly longer than the other 2 procedures. All ovaries were completely excised, and all the animals survived without complications. The NOTES animals had greater increases in serum cortisol concentrations at 2 hours but no statistically significant differences in glucose concentrations compared with the other groups. Serum interleukin 6 and C-reactive protein concentrations were significantly increased at specific times compared with baseline in the NOTES group, but not in the open or laparoscopic surgery groups. Based on the cumulative pain score and nociceptive thresholds, the animals in the NOTES group demonstrated less evidence of pain. Small sample size, limited follow-up. Although the NOTES oophorectomy procedures took approximately twice as long and there may be more evidence of tissue damage as judged by increases in serum cortisol and interleukin 6 concentrations, the dogs in the NOTES group had lower pain scores, especially when compared with animals undergoing open surgery. Copyright 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  2. Are there any benefits from minimizing fasting and optimization of nutrition and fluid management for patients undergoing day surgery?

    Science.gov (United States)

    Nygren, Jonas; Thorell, Anders; Ljungqvist, Olle

    2007-12-01

    As a result of advances in anaesthesia and surgery, an increasing number of surgical procedures are currently possible in the ambulatory setting. Nausea/vomiting and sedation/drowsiness are often associated with delayed discharge and readmission. These symptoms are also related to pharmacological treatment as well as dehydration and fasting. The evidence that preoperative fasting and dehydration not only reduces preoperative well being, but may also affect postoperative recovery is currently being reviewed. In association with minor surgical procedures, rehydration with approximately 1 l fluid, and in cases with a moderate degree of surgery, such as laparoscopic surgery, 1-3 l fluid, given perioperatively will improve postoperative well being and recovery. Administration of a carbohydrate-rich beverage not only provides fluid but also counteracts the negative effects of preoperative fasting, which in turn reduces preoperative hunger and improves well being. Postoperatively, this treatment reduces insulin resistance, which may be relevant in surgery with significant postoperative stress response. Two studies on laparoscopic cholecystectomy demonstrate different results regarding effects on postoperative outcome and nausea/vomiting and further evaluation is required. When preoperative dehydration is corrected, postoperative well being and clinical outcome improves. Avoiding preoperative fasting by administration of carbohydrate-rich beverages improves preoperative well being while effects on postoperative recovery in patients undergoing ambulatory surgery need to be further evaluated.

  3. The Brazilian Registry of Adult Patient Undergoing Cardiovascular Surgery, the BYPASS Project: Results of the First 1,722 Patients

    Directory of Open Access Journals (Sweden)

    Walter J. Gomes

    Full Text Available Abstract Objective: To report the early results of the BYPASS project - the Brazilian registrY of adult Patient undergoing cArdiovaScular Surgery - a national, observational, prospective, and longitudinal follow-up registry, aiming to chart a profile of patients undergoing cardiovascular surgery in Brazil, assessing the data harvested from the initial 1,722 patients. Methods: Data collection involved institutions throughout the whole country, comprising 17 centers in 4 regions: Southeast (8, Northeast (5, South (3, and Center-West (1. The study population consists of patients over 18 years of age, and the types of operations recorded were: coronary artery bypass graft (CABG, mitral valve, aortic valve (either conventional or transcatheter, surgical correction of atrial fibrillation, cardiac transplantation, mechanical circulatory support and congenital heart diseases in adults. Results: 83.1% of patients came from the public health system (SUS, 9.6% from the supplemental (private insurance healthcare systems; and 7.3% from private (out-of -pocket clinic. Male patients comprised 66%, 30% were diabetics, 46% had dyslipidemia, 28% previously sustained a myocardial infarction, and 9.4% underwent prior cardiovascular surgery. Patients underwent coronary artery bypass surgery were 54.1% and 31.5% to valve surgery, either isolated or combined. The overall postoperative mortality up to the 7th postoperative day was 4%; for CABG was 2.6%, and for valve operations, 4.4%. Conclusion: This first report outlines the consecution of the Brazilian surgical cardiac database, intended to serve primarily as a tool for providing information for clinical improvement and patient safety and constitute a basis for production of research protocols.

  4. Differential effects of aprotinin and tranexamic acid on outcomes and cytokine profiles in neonates undergoing cardiac surgery.

    Science.gov (United States)

    Graham, Eric M; Atz, Andrew M; Gillis, Jenna; Desantis, Stacia M; Haney, A Lauren; Deardorff, Rachael L; Uber, Walter E; Reeves, Scott T; McGowan, Francis X; Bradley, Scott M; Spinale, Francis G

    2012-05-01

    Factors contributing to postoperative complications include blood loss and a heightened inflammatory response. The objective of this study was to test the hypothesis that aprotinin would decrease perioperative blood product use, reduce biomarkers of inflammation, and result in improved clinical outcome parameters in neonates undergoing cardiac operations. This was a secondary retrospective analysis of a clinical trial whereby neonates undergoing cardiac surgery received either aprotinin (n = 34; before May 2008) or tranexamic acid (n = 42; after May 2008). Perioperative blood product use, clinical course, and measurements of cytokines were compared. Use of perioperative red blood cells, cryoprecipitate, and platelets was reduced in neonates receiving aprotinin compared with tranexamic acid (P factor VII use (2/34 [6%] vs 18/42 [43%]; P Production of tumor necrosis factor and interleukin-2 activation were attenuated in the aprotinin group at 24 hours postoperatively. No differential effects on renal function were seen between agents. Aprotinin, compared with tranexamic acid, was associated with reduced perioperative blood product use, improved early indices of postoperative recovery, and attenuated indices of cytokine activation, without early adverse effects. These findings suggest that aprotinin may have unique effects in the context of neonatal cardiac surgery and challenge contentions that antifibrinolytics are equivalent with respect to early postoperative outcomes. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  5. Comparison of the Efficacy of Subtenon with Peribulbar Local Anesthesia without Hyaluronidase in Patients Undergoing Cataract Surgery

    International Nuclear Information System (INIS)

    Khan, S. A.; Aftab, A. M.; Iqbal, M.

    2014-01-01

    Objective: To compare the efficacy of subtenon with peribulbar local anesthesia without hyaluronidase in patients undergoing cataract surgery. Study Design: A randomized controlled trial. Place and Duration of Study: Eye B Unit, Khyber Teaching Hospital, Peshawar, from October 2009 to October 2010. Methodology: Patients undergoing cataract surgery were divided into two groups. Group A received subtenon anesthesia and group B received peribulbar anesthesia. Pain score, akinesia and intraocular pressure were compared in the two groups. Statistical Package for Social Sciences-14.0 was used for data analysis. Results: There were 304 patients, 152 patients in each group. At the time of injection, there was less pain in group A as compared to group B (p < 0.001). At the time of surgery and till 90 minutes after administration of anesthesia, there was no significant difference in pain between the 2 groups (p = 0.999 and 0.59 respectively). Group A had better akinesia as compared to group B (p = 0.04). There was a greater rise in mean intraocular pressure just after injection in group B as compared to group A (p < 0.001); in both groups, the intraocular pressure declined to its base level 10 minutes after the injection (p = 0.52). Conclusion: Subtenon anesthesia is less painful at the time of its administration, provides better akinesia and leads to smaller rise in intraocular pressure just after the injection than peribulbar anesthesia. (author)

  6. The effect of tourniquet deflation on hemodynamics and regional cerebral oxygen saturation in aged patients undergoing total knee replacement surgery.

    Science.gov (United States)

    Song, Inkyung; Kim, Dong Yeon; Kim, Youn Jin

    2012-11-01

    Inflation and deflation of a pneumatic tourniquet used in total knee replacement surgery induces various changes in patient's hemodynamic and metabolic status, which may result in serious complications, especially in aged patients. Near-infrared spectroscopy (NIRS) is a monitoring device designed to estimate the regional cerebral oxygen saturation. We evaluated the effect of tourniquet deflation on hemodynamics and regional cerebral oxygen saturation in aged patients undergoing total knee replacement surgery, using NIRS. Twenty-eight American Society of Anesthesiologists physical status I or II patients, over the age of sixty-five years undergoing total knee replacement surgery, were included. Under general anesthesia, the mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), stroke volume (SV), and regional cerebral oxygen saturation (rSO(2)) were recorded before induction of anesthesia and every 2 min after tourniquet deflation for 20 min. Arterial blood gas analysis was performed 5 min before, in addition to 0, and 10 min after tourniquet deflation. The decrease of rSO(2) was not significant during 20-min deflation period. MAP, CO and SV showed significant decrease during 2 to 12, 4 to 6 and 2 to 6-min period after tourniquet deflation, respectively (P deflation caused significant changes in hemodynamic and metabolic status, but not in regional cerebral oxygen saturation. It is recommended to monitor neurologic status, as well as hemodynamic and metabolic status to avoid serious complications, especially in aged patients.

  7. Efficacy of clonidine as an adjuvant to bupivacaine for caudal analgesia in children undergoing sub-umbilical surgery

    Directory of Open Access Journals (Sweden)

    Aruna Parameswari

    2010-01-01

    Full Text Available Caudal epidural analgesia with bupivacaine is very popular in paediatric anaesthesia for providing intra- and postoperative analgesia. Several adjuvants have been used to prolong the action of bupivacaine. We evaluated the efficacy of clonidine added to bupivacaine in prolonging the analgesia produced by caudal bupivacaine in children undergoing sub-umbilical surgery. One hundred children, age one to three years, undergoing sub-umbilical surgery, were prospectively randomized to one of two groups: caudal analgesia with 1 ml/kg of 0.25% bupivacaine in normal saline (Group A or caudal analgesia with 1 ml/kg of 0.25% bupivacaine with 1 μg/kg of clonidine in normal saline (Group B. Post-operative pain was assessed for 24 hours using the FLACC scale. The mean duration of analgesia was significantly longer in Group B (593.4 ± 423.3 min than in Group A (288.7 ± 259.1 min; P < 0.05. The pain score assessed using FLACC scale was compared between the two groups, and children in Group B had lower pain scores, which was statistically significant. The requirement of rescue medicine was lesser in Group B. Clonidine in a dose of 1 μg/kg added to 0.25% bupivacaine for caudal analgesia, during sub-umbilical surgeries, prolongs the duration of analgesia of bupivacaine, without any side effects.

  8. Effect of piracetam on the cognitive performance of patients undergoing coronary bypass surgery: A meta-analysis

    Science.gov (United States)

    FANG, YU; QIU, ZHANDONG; HU, WENTAO; YANG, JIA; YI, XIYAN; HUANG, LIANGJIANG; ZHANG, SUMING

    2014-01-01

    Cognitive impairments are observed in numerous patients following coronary bypass surgery, and piracetam are nootropic compounds that modulate cerebral functions by directly enhancing cognitive processes. The present meta-analysis was conducted to evaluate the protective effect of piracetam on the cognitive performance of patients undergoing coronary bypass surgery. The relevant studies were identified by searching Medline, EMBASE, PubMed and the Cochrane Library up to June 2013 and the pertinent bibliographies from the retrieved studies were reviewed. Data were selected from the studies according to predefined criteria. The meta-analysis included two randomized control trials involving 184 patients and including the Syndrom-Kurz test (SKT). Findings of the meta-analysis showed that following treatment the change from baseline observed in five SKT subtest scores, conducted with piracetam patients, indicated a significant advantage over those patients that were in the placebo group. The subtests included immediate pictured object recall, weighted mean difference (WMD)=0.91, 95% confidence interval (CI) 0.51–1.31, Ppiracetam may have been effective in improving the short-term cognitive performance of patients undergoing coronary bypass surgery. High quality, well-controlled and longer randomized trials are required to corroborate this result. PMID:24396419

  9. A comparative analysis of online education resources for patients undergoing endoscopic transsphenoidal surgery.

    Science.gov (United States)

    Fahey, Natalie; Patel, Vimal; Rosseau, Gail

    2014-12-01

    Endoscopic transsphenoidal surgery has become the most commonly performed surgical procedure for pituitary tumor removal. As such, there are many patient-oriented educational materials on the technique available online for members of the public who desire to learn more about the surgery. It has been recommended that educational resources be written to the national average reading level, which in the United States is between sixth and seventh grade. This study assesses the reading level of the educational materials currently available online for endoscopic transsphenoidal surgery and determines whether these resources are written at a suitable comprehension level for most readers. Sixteen patient educational resources describing endoscopic transsphenoidal surgery were identified online and assessed using 4 standard readability assessments. Patient educational resources written for endoscopic transsphenoidal surgery are written far above the recommended reading level of sixth grade. The online educational resources written for patients about endoscopic transsphenoidal surgery are above the recommended reading level for patient education materials. Further revisions to simplify these resources on endoscopic transsphenoidal surgery are needed to ensure that most patients can comprehend this important material and make informed decisions about their health care. Copyright © 2014. Published by Elsevier Inc.

  10. Review of fondaparinux sodium injection for the prevention of venous thromboembolism in patients undergoing surgery

    Directory of Open Access Journals (Sweden)

    David Bergqvist

    2006-12-01

    Full Text Available David BergqvistDepartment of Surgery, University Hospital, Uppsala, SwedenAbstract: The antithrombin binding sequence of heparin, a pentasaccharide, has been synthesized as fondaparinux, an indirect, selective, and reversible factor Xa inhibitor. It can be administered subcutaneously, is well absorbed, and has a half-life of c. 17 hours permitting once-daily injection. It has been evaluated in an extensive study program in major orthopedic surgery, including hip fracture, and in major abdominal surgery with a large proportion of surgery for cancer. The effect is at least as effective as for low-molecular-weight heparins and it has also been shown effective for extended prophylaxis in hip fracture patients. Several thousands of patients have been studied and the substance is safe, although a slightly higher frequency of bleedings is found than in patients on low-molecular-weight heparins. There is no specific antidote but if necessary, recombinant activated factor VII can be used. Other side-effects are rare. Fondaparinux is cost saving and sometimes cost neutral when compared with enoxaparin. Keywords: fondaparinux, venous thrombosis, venous thromboembolism, surgery, orthopedic surgery, major abdominal surgery, bleeding complications

  11. Effect of darbepoetin alfa on physical function in patients undergoing surgery for colorectal cancer

    DEFF Research Database (Denmark)

    Nørager, C B; Jensen, M B; Madsen, M R

    2007-01-01

    OBJECTIVE: To study whether perioperative treatment with darbepoetin alfa (DA) improves physical performance following colorectal cancer surgery. METHODS: Patients admitted for planned colorectal cancer surgery were randomized to receive either weekly placebo or DA 300 or 150 microg depending...... on the hemoglobin (Hb) concentration. Patients were assessed 10 days before, as well as 7 and 30 days after surgery for work capacity, postural sway, muscle strength, fatigue and quality of life (QoL). The primary outcome measure were the changes in patients' physical performance from preoperative to postoperative...... differences between the 2 groups on days 7 or 30 for fatigue, postural sway and QoL. DA treatment significantly (p

  12. Preoperative Risk Factors for Subsyndromal Delirium in Older Adults Who Undergo Joint Replacement Surgery.

    Science.gov (United States)

    Denny, Dawn L; Lindseth, Glenda

    Older adults with subsyndromal delirium have similar risks for adverse outcomes following joint replacement surgery as those who suffer from delirium. This study examined relationships among subsyndromal delirium and select preoperative risk factors in older adults following major orthopaedic surgery. Delirium assessments of a sample of 62 adults 65 years of age or older were completed on postoperative Days 1, 2, and 3 following joint replacement surgery. Data were analyzed for relationships among delirium symptoms and the following preoperative risk factors: increased comorbidity burden, cognitive impairment, fall history, and preoperative fasting time. Postoperative subsyndromal delirium occurred in 68% of study participants. A recent fall history and a longer preoperative fasting time were associated with delirium symptoms (p ≤ .05). Older adults with a recent history of falls within the past 6 months or a longer duration of preoperative fasting time may be at higher risk for delirium symptoms following joint replacement surgery.

  13. Utilising cardiopulmonary bypass for cancer surgery. Malignancy-induced protein C deficiency and thrombophilia.

    LENUS (Irish Health Repository)

    Marshall, C

    2012-02-03

    Cardiopulmonary bypass has evolved over the last 30 years. It is an important tool for the cardiac surgeon today and also has applications in non-cardiac operations such as surgery to extract tumours. Such patients undergoing surgery for cancer may be at an increased risk of a thromboembolic event post surgery, due to disturbances in the normal clotting pathway leading to hypercoagulability. One such disturbance is malignancy-induced Protein C deficiency. A deficiency of Protein C can cause hypercoagulabitity. Recent studies have examined cardiopulmonary bypass and inherited Protein C deficiency. However, surgery for cancer patients with a malignancy-induced Protein C deficiency involving cardiopulmonary bypass has not been reported. Surgery using CPB in these patients may result in increased morbidity and mortality. The objective of this article is to review the literature in order to discuss the occurrence, the aetiology and possible management of cancer patients with malignancy-induced Protein C deficiencies that require cardiopulmonary bypass for their surgery.

  14. Comparison between sevoflurane and desflurane on emergence and recovery characteristics of children undergoing surgery for spinal dysraphism

    Directory of Open Access Journals (Sweden)

    Priyanka Gupta

    2015-01-01

    Full Text Available Background and Aims: Rapid recovery is desirable after neurosurgery as it enables early post-operative neurological evaluation and prompt management of complications. Studies have been rare comparing the recovery characteristics in paediatric neurosurgical patients. Hence, this study was carried out to compare the effect of sevoflurane and desflurane anaesthesia on emergence and extubation in children undergoing spinal surgery. Methods: Sixty children, aged 1-12 years, undergoing elective surgery for lumbo-sacral spinal dysraphism were enrolled. Anaesthesia was induced with sevoflurane using a face mask. The children were then randomised to receive either sevoflurane or desflurane with oxygen and nitrous oxide, fentanyl (1 μg/kg/h and rocuronium. The anaesthetic depth was guided by bispectral index (BIS ® monitoring with a target BIS ® between 45 and 55. Perioperative data with regard to demographic profile, haemodynamics, emergence and extubation times, modified Aldrete score (MAS, pain (objective pain score, agitation (Cole′s agitation score, time to first analgesic and complications, thereof, were recorded. Statistical analysis was done using STATA 11.2 (StataCorp., College Station, TX, USA and data are presented as median (range or mean ± standard deviation. Results: The demographic profile, haemodynamics, MAS, pain and agitation scores and time to first analgesic were comparable in between the two groups (P > 0.05. The emergence time was shorter in desflurane group (2.75 [0.85-12] min as compared to sevoflurane (8 [2.5-14] min (P < 0.0001. The extubation time was also shorter in desflurane group (3 [0.8-10] min as compared to the sevoflurane group (5.5 [1.2-14] min (P = 0.0003. Conclusion: Desflurane provided earlier tracheal extubation and emergence as compared to sevoflurane in children undergoing surgery for lumbo-sacral spinal dysraphism.

  15. Investigating the Effect of Swedish massage on Thoracic Pain in Patients Undergoing Coronary Artery Bypass Graft Surgery

    Directory of Open Access Journals (Sweden)

    Zahra Pishkarmofrad

    2016-05-01

    Full Text Available Pain is one of the common complications after coronary artery bypass graft surgery. The current study aimed to investigate the effect of Swedish massage on thoracic pain in patients undergoing coronary artery bypass graft surgery at Ali-ibn Abi Talib Hospital of Zahedan, Iran in 2015. This study was performed on 50 patients undergoing coronary artery bypass graft surgery at Ali-ibn Abi Talib Hospital of Zahedan in 2015 in a randomized controlled clinical trial method. The patients were randomly divided into two massage and control groups with 25 cases in each group. The intervention group received Swedish massage for 20 minutes on the first day of transferring to cardiac surgical ward; however, the control group went under the routine control of the ward. Patients’ pain intensity were measured and recorded 15 minutes before and after the intervention using Visual Analog Scale (VAS. Statistical analysis was done using Chi-square test, independent t-test and paired t-test and SPSS Software version 21. There was no statistical significant difference between the two groups in terms of pain intensity before the intervention. The mean pain score before and after intervention was 60.80±11.46 and 44.32±11.58 in the massage group and 58.64±14.42 and 58.60±14.40 in th e control group, respectively. The result of covariance test showed that the mean pain score after intervention was significantly lower in the massage group than the control group (P=0.0001. Considering the effect of Swedish massage on reducing pain in patients undergoing coronary artery bypass graft, massage therapy can be used as a safe and low-cost non-drug method for reducing pain in these patients.

  16. Women undergoing aortic surgery are at higher risk for unplanned readmissions compared with men especially when discharged home.

    Science.gov (United States)

    Flink, Benjamin J; Long, Chandler A; Duwayri, Yazan; Brewster, Luke P; Veeraswamy, Ravi; Gallagher, Katherine; Arya, Shipra

    2016-06-01

    Women undergoing vascular surgery have higher morbidity and mortality. Our study explores gender-based differences in patient-centered outcomes such as readmission, length of stay (LOS), and discharge destination (home vs nonhome facility) in aortic aneurysm surgery. Patients were identified from the American College of Surgeons National Surgical Quality Improvement Project database (2011-2013) undergoing abdominal, thoracic, and thoracoabdominal aortic aneurysms (N = 17,763), who were discharged and survived their index hospitalization. The primary outcome was unplanned readmission, and secondary outcomes were discharge to a nonhome facility, LOS, and reasons for unplanned readmission. Univariate, multivariate, and stratified analyses based on gender and discharge destination were used. Overall, 1541 patients (8.7%) experienced an unplanned readmission, with a significantly higher risk in women vs men (10.8% vs 8%; P women compared with men persisted in multivariate analysis after controlling for covariates (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.05-1.4). Similarly, the rate of discharge to a nonhome facility was nearly double in women compared with men (20.6% vs 10.7%; P women compared with men occurred in patients who were discharged home (OR, 1.2; 95% CI, 1.02-1.4) but not in those who were discharged to a nonhome facility (OR, 1.06; 95% CI, 0.8-1.4). Significant differences in LOS were seen in patients who were discharged home. No gender differences were found in reasons for readmission with the three most common reasons being thromboembolic events, wound infections, and pneumonia. Gender disparity exists in the risk of unplanned readmission among aortic aneurysm surgery patients. Women who were discharged home have a higher likelihood of unplanned readmission despite longer LOS than men. These data suggest that further study into the discharge planning processes, social factors, and use of rehabilitation services is needed for women

  17. Thoracic spinal anesthesia is safe for patients undergoing abdominal cancer surgery

    OpenAIRE

    Ellakany, Mohamed Hamdy

    2014-01-01

    Aim: A double-blinded randomized controlled study to compare discharge time and patient satisfaction between two groups of patients submitted to open surgeries for abdominal malignancies using segmental thoracic spinal or general anesthesia. Background: Open surgeries for abdominal malignancy are usually done under general anesthesia, but many patients with major medical problems sometimes can’t tolerate such anesthesia. Regional anesthesia namely segmental thoracic spinal anesthesia may be b...

  18. The economic implications of a multimodal analgesic regimen for patients undergoing major orthopedic surgery: a comparative study of direct costs.

    Science.gov (United States)

    Duncan, Christopher M; Hall Long, Kirsten; Warner, David O; Hebl, James R

    2009-01-01

    Total knee and total hip arthoplasty (THA) are 2 of the most common surgical procedures performed in the United States and represent the greatest single Medicare procedural expenditure. This study was designed to evaluate the economic impact of implementing a multimodal analgesic regimen (Total Joint Regional Anesthesia [TJRA] Clinical Pathway) on the estimated direct medical costs of patients undergoing lower extremity joint replacement surgery. An economic cost comparison was performed on Mayo Clinic patients (n = 100) undergoing traditional total knee or total hip arthroplasty using the TJRA Clinical Pathway. Study patients were matched 1:1 with historical controls undergoing similar procedures using traditional anesthetic (non-TJRA) techniques. Matching criteria included age, sex, surgeon, type of procedure, and American Society of Anesthesiologists (ASA) physical status (PS) classification. Hospital-based direct costs were collected for each patient and analyzed in standardized inflation-adjusted constant dollars using cost-to-charge ratios, wage indexes, and physician services valued using Medicare reimbursement rates. The estimated mean direct hospital costs were compared between groups, and a subgroup analysis was performed based on ASA PS classification. The estimated mean direct hospital costs were significantly reduced among TJRA patients when compared with controls (cost difference, 1999 dollars; 95% confidence interval, 584-3231 dollars; P = 0.0004). A significant reduction in hospital-based (Medicare Part A) costs accounted for the majority of the total cost savings. Use of a comprehensive, multimodal analgesic regimen (TJRA Clinical Pathway) in patients undergoing lower extremity joint replacement surgery provides a significant reduction in the estimated total direct medical costs. The reduction in mean cost is primarily associated with lower hospital-based (Medicare Part A) costs, with the greatest overall cost difference appearing among patients

  19. The older patient's experience of the healthcare chain and information when undergoing colorectal cancer surgery according to the enhanced recovery after surgery concept.

    Science.gov (United States)

    Samuelsson, Katja Schubert; Egenvall, Monika; Klarin, Inga; Lökk, Johan; Gunnarsson, Ulf; Iwarzon, Marie

    2018-04-01

    To describe how older patients experience the healthcare chain and information given before, during and after colorectal cancer surgery. Most persons with colorectal cancer are older than 70 years and undergo surgery with subsequent enhanced recovery programmes aiming to quickly restore preoperative function. However, adaptation of such programmes to suit the older patient has not been made. Qualitative descriptive study. Semi-structured interviews were conducted on 16 patients undergoing colorectal cancer surgery at a Swedish University Hospital. The inductive content analysis was employed. During the period of primary investigation and diagnosis, a paucity of information regarding the disease and management, and lack of help in coping with the diagnosis of cancer and its impact on future life, leads to a feeling of vulnerability. During their stay in hospital, the patient's negative perception of the hospital environment, their need for support, and uncertainty and anxiety about the future are evident. After discharge, rehabilitation is perceived as lacking in structure and individual adaptation, leading to disappointment. Persistent difficulty with nutrition delays recovery, and confusion regarding division of responsibility between primary and specialist care leads to increased anxiety and feelings of vulnerability. Information on self-care is perceived as inadequate. Furthermore, provided information is not always understood and therefore not useful. Information before and after surgery must be tailored to meet the needs of older persons, considering the patient's knowledge and ability to understand. Furthermore, individual nutritional requirements and preoperative physical activity and status must be taken into account when planning rehabilitation. Patient information must be personalised and made understandable. This can improve self-preparation and participation in the own recovery. Special needs must be addressed early and followed up. © 2018 John Wiley

  20. Chemoradiation Therapy for Potentially Resectable Gastric Cancer: Clinical Outcomes Among Patients Who Do Not Undergo Planned Surgery

    International Nuclear Information System (INIS)

    Kim, Michelle M.; Mansfield, Paul F.; Das, Prajnan; Janjan, Nora A.; Badgwell, Brian D.; Phan, Alexandria T.; Delclos, Marc E.; Maru, Dipen; Ajani, Jaffer A.; Crane, Christopher H.; Krishnan, Sunil

    2008-01-01

    Purpose: We retrospectively analyzed treatment outcomes among resectable gastric cancer patients treated preoperatively with chemoradiation therapy (CRT) but rendered ineligible for planned surgery because of clinical deterioration or development of overt metastatic disease. Methods and Materials: Between 1996 and 2004, 39 patients with potentially resectable gastric cancer received preoperative CRT but failed to undergo surgery. At baseline clinical staging, 33 (85%) patients had T3-T4 disease, and 27 (69%) patients had nodal involvement. Most patients received 45 Gy of radiotherapy with concurrent 5-fluorouracil-based chemotherapy. Twenty-one patients underwent induction chemotherapy before CRT. Actuarial times to local control (LC), distant control (DC), and overall survival (OS) were calculated by the Kaplan-Meier method. Results: The cause for surgical ineligibility was development of metastatic disease (28 patients, 72%; predominantly peritoneal, 18 patients), poor performance status (5 patients, 13%), patient/physician preference (4 patients, 10%), and treatment-related death (2 patients, 5%). With a median follow-up of 8 months (range, 1-95 months), actuarial 1-year LC, DC, and OS were 46%, 12%, and 36%, respectively. Median LC and OS were 11.0 and 10.1 months, respectively. Conclusions: Patients with potentially resectable gastric cancer treated with preoperative CRT are found to be ineligible for surgery principally because of peritoneal progression. Patients who are unable to undergo planned surgery have outcomes comparable to that of patients with advanced gastric cancer treated with chemotherapy alone. CRT provides durable LC for the majority of the remaining life of these patients

  1. Effects of beach-chair position and induced hypotension on cerebral oxygen saturation in patients undergoing arthroscopic shoulder surgery.

    Science.gov (United States)

    Lee, Jae Hoon; Min, Kyeong Tae; Chun, Yong-Min; Kim, Eun Jung; Choi, Seung Ho

    2011-07-01

    We investigated the effects of the beach-chair position and induced hypotension on regional cerebral oxygen saturation (rSO(2)) in patients undergoing arthroscopic shoulder surgery by using near-infrared spectroscopy. Twenty-eight patients scheduled for arthroscopic shoulder surgery were enrolled prospectively. After induction of anesthesia, mechanical ventilation was controlled to maintain Paco(2) at 35 to 40 mm Hg. Anesthesia was maintained with sevoflurane and remifentanil. After radial artery cannulation, mean arterial pressure (MAP) was measured at the external auditory meatus level and maintained between 60 and 65 mm Hg. The rSO(2) was measured by use of near-infrared spectroscopy. MAP and rSO(2) were recorded at the following times: before induction (T(0)), immediately after induction (T(1) [baseline]), after beach-chair position (T(2)), immediately after induced hypotension (T(3)), 1 hour after induced hypotension (T(4)), and after supine position at the end of surgery (T(5)). Cerebral desaturation was defined as a reduction in rSO(2) to less than 80% of baseline value for 15 seconds or greater. A total of 27 patients were evaluated until the end of this study. The MAP at T(2) was significantly lower than that at T(1). The MAP values at T(3) and T(4) were significantly lower than those at T(1) and T(2). The rSO(2) at T(2) was significantly lower than that at T(1). Unlike the pattern of change in the MAP, there was no additional decrease in rSO(2) at T(3) and T(4). There were 2 patients who had an episode of cerebral desaturation. The beach-chair position combined with induced hypotension significantly decreases rSO(2) in patients undergoing shoulder arthroscopic surgery under general anesthesia. Level IV, study of nonconsecutive patients without consistently applied reference gold standard. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  2. Effect of Pre-Operative Use of Medications on the Risk of Surgical Site Infections in Patients Undergoing Cardiac Surgery.

    Science.gov (United States)

    Eton, Vic; Sinyavskaya, Liliya; Langlois, Yves; Morin, Jean François; Suissa, Samy; Brassard, Paul

    2016-10-01

    Median sternotomy, the most common means of accessing the heart for cardiac procedures, is associated with higher risk of surgical site infections (SSIs). A limited number of studies reporting the impact of medication use prior to cardiac surgery on the subsequent risk of SSIs usually focused on antibacterial prophylaxis. The objective of the current study was to evaluate the effect of medications prescribed commonly to cardiac patients on the risk of incident SSIs. The study analyzed data on consecutive cardiac surgery patients undergoing median sternotomy at a McGill University teaching hospital between April 1, 2011 and October 31, 2013. Exposure of interest was use of medications for heart disease and cardiovascular conditions in the seven days prior to surgery and those for comorbid conditions. The main outcome was SSIs occurring within 90 d after surgery. Univariate and multivariate logistic regression (adjusted odds ratio [AOR]) was used to evaluate the effect. The cohort included 1,077 cardiac surgery patients, 79 of whom experienced SSIs within 90 d of surgery. The rates for sternal site infections and harvest site infections were 5.8 (95% confidence interval [CI]: 4.4-7.3) and 2.5 (95% CI: 1.4-3.7) per 100 procedures, respectively. The risk of SSI was increased with the pre-operative use of immunosuppressors/steroids (AOR 3.47, 95% CI: 1.27-9.52) and α-blockers (AOR 3.74, 95% CI: 1.21-1.47). Our findings support the effect of immunosuppressors/steroids on the risk of SSIs and add evidence to the previously reported association between the use of anti-hypertensive medications and subsequent development of infection/sepsis.

  3. COMPARISON OF INTRAOPERATIVE KETAMINE VS. FENTANYL USE DECREASES POSTOPERATIVE OPIOID REQUIREMENTS IN TRAUMA PATIENTS UNDERGOING CERVICAL SPINE SURGERY.

    Science.gov (United States)

    Berkowitz, Aviva C; Ginsburg, Aryeh M; Pesso, Raymond M; Angus, George L D; Kang, Amiee; Ginsburg, Dov B

    2016-02-01

    Postoperative airway compromise following cervical spine surgery is a potentially serious adverse event. Residual effects of anesthesia and perioperative opioids that can cause both sedation and respiratory depression further increase this risk. Ketamine is an N-methyl-d-aspartate (NMDA) receptor antagonist that provides potent analgesia without noticeable respiratory depression. We investigated whether intraoperative ketamine administration could decrease perioperative opioid requirements in trauma patients undergoing cervical spine surgery. We retrospectively reviewed anesthesia records identifying cervical spine surgeries performed between March 2014 and February 2015. All patients received a balanced anesthetic technique utilizing sevoflurane 0.5 minimum alveolar concentration (MAC) and propofol infusion (50-100 mcg/kg/min). For intraoperative analgesia, one group of patients received ketamine (N=25) and a second group received fentanyl (N=27). Cumulative opioid doses in the recovery room and until 24 hours postoperatively were recorded. Fewer patients in the ketamine group (11/25 [44%] vs. 20/27 [74%], respectively; p = 0.03) required analgesics in the recovery room. Additionally, the total cumulative opioid requirements in the ketamine group decreased postoperatively at both 3 and 6 hours (p = 0.01). Ketamine use during cervical spine surgery decreased opioid requirements in both the recovery room and in the first 6 hours postoperatively. This may have the potential to minimize opioid induced respiratory depression in a population at increased risk of airway complications related to the surgical procedure.

  4. [Randomized controlled trial on the effectiveness of Corpitolinol 60 in the prevention of pressure sores in patients undergoing surgery].

    Science.gov (United States)

    Chiari, Paolo; Giorgi, Sabina; Ugolini, Daniela; Montanari, Morena; Giudanella, Pietro; Gramantieri, Antonella; Collesi, Franca; Pau, Michelina; Smaldone, Maddalena; Matarasso, Maddalena; Mazzini, Cinzia; Russo, Francesca; Gazineo, Domenica; Fontana, Mirella; Taddia, Patrizia

    2012-01-01

    Randomized controlled trial on the effectiveness of Corpitolinol 60 in the prevention of pressure sores in surgical patients. The risk of pressure sores in surgical patients is widely recognised. The Corpitolinol 60 (Sanyréne®) applied on compressed areas seems to reduce the risk of pressure sores. To assess the efficacy of Corpitolinol 60 in preventing pressure sores in the operatory theatre. The open label randomized clinical trial was conducted in 5 operating theatres of Northen Italy. Patients were randomized to receive Corpitolinol 60 in areas undergoing compression. Experimental group and controls were treated with usual measures for preventing pressure sores. The lesions were staged according to NPUAP up to 24 hours after surgery. Three-hundred-one patients were randomized (155 in the Sanyréne® group and 143 controls). The main variables predictive of pressure sores risk (ASA class, sex, age, duration of the surgery, and BMI) were comparable across groups. At the end of the surgery 71 patients (23.8%) in the experimental group and 47 controls (30.8%) had a pressure sore (p 0.006; RR 1.81 IC95% 1.17-2.79). Twelve and 24 hours after surgery the differences between groups were not significant. The aim of reducing pressure sores was not reached for patients treated with Corpitolinol 60.

  5. Ovarian preservation in locally advanced cervical cancer undergoing neoadjuvant chemotherapy and radical surgery: our experience and analysis of the literature.

    Science.gov (United States)

    Signorelli, Mauro; Bogani, Giorgio; Chiappa, Valentina; Ditto, Antonino; Scaffa, Cono; Martinelli, Fabio; Lorusso, Domenica; Raspagliesi, Francesco

    2018-03-30

    The aim of this study was to estimate the rate of ovarian metastases and recurrences among patients affected by locally advanced stage cancer patients (LACC), undergoing neoadjuvant chemotherapy (NACT) and radical surgery with conservation of ovaries. Retrospective evaluation of consecutive patients affected by LACC (stage IB2- IIB), treated by NACT followed by radical surgery at National Cancer Institute, Milan, Italy, between 1990-2015. Overall, 331 patients were included. Stage at presentation included stage IB2, IIA and IIB in 120 (36.3%), 63 (19%) and 148 (44.7%) patients, respectively. Main histotype was squamous cell carcinoma (n=265, 80.1%) followed by adenocarcinoma/adenosquamous (n=51, 15.4%), and more than half of patients had a grade 3 carcinoma . Overall, 102 (30.8%) women had at least one ovary preserved during surgery, while 229 (69.2%) had bilateral salpingo-oophorectomy. Comparing patients who had ovarian preservation with patients who had not, we observed that the two groups were comparable in terms of baseline characteristics. Survival outcomes were not influenced by ovarian preservation (disease-free (p=0.93) and overall (p=0.65) survivals). One (1%) woman had a localized ovarian recurrence. Our data suggest that ovarian preservation at the time of surgery is a safe option among women with LACC after NACT with no detrimental impact on oncologic outcome. Further prospective studies are warranted.

  6. [Evaluation of upper urinary tract function in patients undergoing autoplastic surgery for hydronphrosis of the intrarenal pelvis].

    Science.gov (United States)

    Kurbanaliev, R M; Usupbaev, A Ch; Kolesnichenko, I V; Sadyrbekov, N Zh; Sultanov, B M

    2018-05-01

    To investigate the functional state of the upper urinary tract in patients undergoing autoplastic surgery for a hydronophrosis of the intrarenal pelvis. The study comprised 78 patients with the intrarenal pelvis and impaired urinary outflow due to stricture of the ureteropelvic junction and vascular conflict (interatrial and arteriovenous narrowing), who underwent pyeloplasty using autologous tunica vaginalis. All patients underwent an incision of ureteropelvic stricture and resection of the parietal layer of the tunica vaginalis which was used to repair the obstruction site and internal stenting of the upper urinary tract. The patients were examined at baseline and during follow-up ranging from 3 months to 3 years. At three months after surgery, there was a decrease in the size of the renal pelvis and calyces with an improvement of all parameters of uro- and hemodynamics. At three years after surgery, the structural and functional parameters of the upper urinary tract were completely restored. Obstructive uropathy, resulting from the intrarenal pelvis, leads to persistently impaired urinary outflow from the upper urinary tract. Surgical intervention is the only curative treatment able to restore the urinary flow. In men with the intrarenal pelvis, the autoplastic surgery of the ureteropelvic junction obstruction using a parietal layer of the tunica vaginalis is an effective surgical modality improving renal pelvis capacity and contributing to the recovery of urinary outflow from the upper urinary tract.

  7. Respiratory muscle strength is not decreased in patients undergoing cardiac surgery.

    Science.gov (United States)

    Urell, Charlotte; Emtner, Margareta; Hedenstrom, Hans; Westerdahl, Elisabeth

    2016-03-31

    Postoperative pulmonary impairments are significant complications after cardiac surgery. Decreased respiratory muscle strength could be one reason for impaired lung function in the postoperative period. The primary aim of this study was to describe respiratory muscle strength before and two months after cardiac surgery. A secondary aim was to describe possible associations between respiratory muscle strength and lung function. In this prospective observational study 36 adult cardiac surgery patients (67 ± 10 years) were studied. Respiratory muscle strength and lung function were measured before and two months after surgery. Pre- and postoperative respiratory muscle strength was in accordance with predicted values; MIP was 78 ± 24 cmH2O preoperatively and 73 ± 22 cmH2O at two months follow-up (p = 0.19). MEP was 122 ± 33 cmH2O preoperatively and 115 ± 38 cmH2O at two months follow-up (p = 0.18). Preoperative lung function was in accordance with predicted values, but was significantly decreased postoperatively. At two-months follow-up there was a moderate correlation between MIP and FEV1 (r = 0.43, p = 0.009). Respiratory muscle strength was not impaired, either before or two months after cardiac surgery. The reason for postoperative lung function alteration is not yet known. Interventions aimed at restore an optimal postoperative lung function should focus on other interventions then respiratory muscle strength training.

  8. Inpatient cardiac rehabilitation programs' exercise therapy for patients undergoing cardiac surgery: National Korean Questionnaire Survey.

    Science.gov (United States)

    Seo, Yong Gon; Jang, Mi Ja; Park, Won Hah; Hong, Kyung Pyo; Sung, Jidong

    2017-02-01

    Inpatient cardiac rehabilitation (ICR) has been commonly conducted after cardiac surgery in many countries, and has been reported a lots of results. However, until now, there is inadequacy of data on the status of ICR in Korea. This study described the current status of exercise therapy in ICR that is performed after cardiac surgery in Korean hospitals. Questionnaires modified by previous studies were sent to the departments of thoracic surgery of 10 hospitals in Korea. Nine replies (response rate 90%) were received. Eight nurses and one physiotherapist completed the questionnaire. Most of the education on wards after cardiac surgery was conducted by nurses. On postoperative day 1, four sites performed sitting on the edge of bed, sit to stand, up to chair, and walking in the ward. Only one site performed that exercise on postoperative day 2. One activity (stairs up and down) was performed on different days at only two sites. Patients received education preoperatively and predischarge for preventing complications and reducing muscle weakness through physical inactivity. The results of the study demonstrate that there are small variations in the general care provided by nurses after cardiac surgery. Based on the results of this research, we recommended that exercise therapy programs have to conduct by exercise specialists like exercise physiologists or physiotherapists for patients in hospitalization period.

  9. Exploring Partners' Experiences in Living with Patients Who Undergo Bariatric Surgery.

    Science.gov (United States)

    Wallwork, Anna; Tremblay, Lynn; Chi, Monica; Sockalingam, Sanjeev

    2017-08-01

    Bariatric surgery is effective in assisting persons with severe obesity in achieving significant weight loss and improved health; however, success depends on one's lifelong commitment to lifestyle modifications post-operatively. Life partners can be essential to the success of bariatric patients as they can serve as a primary resource to patients and healthcare teams. This study aimed to explore bariatric patients' partner's experiences in order to help inform clinical practice in bariatric care to better address patient and partner needs. This study utilized a grounded theory analysis of ten semi-structured interviews of male partners of bariatric surgery patients to form a general explanatory framework of the partner experience. Participants described three interconnected processes of change that followed after their spouses surgeries: (1) effort put forth to engage in the surgical process with their spouses, (2) adoption of the behavioural changes made by their spouses and (3) adjustment to a "new normal". For those who engaged in all three processes, optimism for the future and an enriching and synergistic harmonized lifestyle with their spouse was reached. Bariatric surgery in one partner can impact couples' dietary behaviours, physical and leisure activities, physical and emotional intimacy and relationship quality as a whole. Pursuing bariatric surgery as a couple is a unique process. This study highlights the necessity to approach bariatric care in a way that targets the whole spousal unit as engaging both members in lifestyle modification may improve the quality of both their health and relationship overall.

  10. Noncardiac findings on cardiac CT part I: Pros and cons.

    LENUS (Irish Health Repository)

    Killeen, Ronan P

    2012-02-01

    Cardiac computed tomography (CT) has evolved into an effective imaging technique for the evaluation of coronary artery disease in selected patients. Two distinct advantages over other noninvasive imaging modalities include its ability to evaluate directly the coronary arteries and to provide an opportunity to evaluate extracardiac structures, such as the lungs and mediastinum. Some centers reconstruct a small field of view (FOV) cropped around the heart, but a full FOV (from skin to skin in the irradiated area) is obtainable in the raw data of every scan so that clinically relevant noncardiac findings are identifiable. Debate in the scientific community has centered on the necessity for this large FOV evaluation. A review of noncardiac structures provides the opportunity to make alternative diagnoses that may account for the patient\\'s presentation or to detect important but clinically silent problems such as lung cancer. Critics argue that the yield of biopsy-proven cancers is low and that the follow-up of incidental noncardiac findings is expensive, resulting in increased radiation exposure and possibly unnecessary further testing. In this two-part review we outline the issues surrounding the concept of the noncardiac read looking for noncardiac findings on cardiac CT. Part I focuses on the pros and cons of the practice of identifying noncardiac findings on cardiac CT.

  11. Cancer risk coefficient for patient undergoing kyphoplasty surgery using Monte Carlo method

    Science.gov (United States)

    Santos, Felipe A.; Santos, William S.; Galeano, Diego C.; Cavalcante, Fernanda R.; Silva, Ademir X.; Souza, Susana O.; Júnior, Albérico B. Carvalho

    2017-11-01

    Kyphoplasty surgery is widely used for pain relief in patients with vertebral compression fracture (VCF). For this surgery, an X-ray emitter that provides real-time imaging is employed to guide the medical instruments and the surgical cement used to fill and strengthen the vertebra. Equivalent and effective doses related to high temporal resolution equipment has been studied to assess the damage and more recently cancer risk. For this study, a virtual scenario was prepared using MCNPX code and a pair of UF family simulators. Two projections with seven tube voltages for each one were simulated. The organ in the abdominal region were those who had higher cancer risk because they receive the primary beam. The risk of lethal cancer is on average 20% higher in AP projection than in LL projection. This study aims at estimating the risk of cancer in organs and the risk of lethal cancer for patient submitted to kyphoplasty surgery.

  12. Surgery for ventricular tachycardia in patients undergoing surgical ventricular restoration: the Karolinska approach.

    Science.gov (United States)

    Sartipy, Ulrik; Albåge, Anders; Insulander, Per; Lindblom, Dan

    2007-09-01

    This article presents a review on the efficacy of surgical ventricular restoration and direct surgery for ventricular tachycardia in patients with left ventricular aneurysm or dilated ischemic cardiomyopathy. The procedure includes a non-electrophysiologically guided subtotal endocardiectomy and cryoablation in addition to endoventricular patch plasty of the left ventricle. Coronary artery bypass surgery and mitral valve repair are performed concomitantly as needed. In our experience, this procedure yielded a 90% success rate in terms of freedom from spontaneous ventricular tachycardia, with an early mortality rate of 3.8%. A practical guide to the pre- and postoperative management of these patients is provided.

  13. Adult patient with Becker dystrophy undergoing orthopedic surgery: an anesthesia challenge

    Directory of Open Access Journals (Sweden)

    Parish M

    2018-02-01

    Full Text Available Masoud Parish, Haleh Farzin Anesthesiology Department, Tabriz University of Medical Sciences, Shohada Teaching Hospital, Tabriz, Iran Abstract: Muscular dystrophies are considered to be a series of neuromuscular diseases with genetic causes and are characterized by progressive muscle weakness and degeneration of the skeletal muscle. The case of an adult man with Becker dystrophy referred for repair of the patella tendon tearing and patella fracture is described. He underwent successful surgery using total intravenous anesthesia without any complications. Keywords: Becker dystrophy, orthopedic surgery, adult, intravenous anesthesia

  14. Safety of intravenous tranexamic acid in patients undergoing majororthopaedic surgery: a meta-analysis of randomised controlled trials

    Science.gov (United States)

    Franchini, Massimo; Mengoli, Carlo; Marietta, Marco; Marano, Giuseppe; Vaglio, Stefania; Pupella, Simonetta; Mannucci, Pier Mannuccio; Liumbruno, Giancarlo M.

    2018-01-01

    Among the various pharmacological options to decrease peri-operative bleeding, tranexamic acid appears to be one of the most interesting. Several trials have consistently documented the efficacy of this synthetic drug in reducing the risk of blood loss and the need for allogeneic blood transfusion in patients undergoing total hip and knee arthroplasty. The safety of intravenous tranexamic acid in major orthopaedic surgery, particularly regarding the risk of venous thromboembolism, was systematically analysed in this review. A systematic search of the literature identified 73 randomised controlled trials involving 4,174 patients and 2,779 controls. The raw overall incidence of venous thromboembolism was 2.1% in patients who received intravenous tranexamic acid and 2.0% in controls. A meta-analytic pooling showed that the risk of venous thromboembolism in tranexamic acid-treated patients was not significantly different from that of controls (risk difference: 0.01%, 95% confidence interval [CI]: −0.05%, 0.07%; risk ratio: 1.067, 95% CI: 0.760–1.496). Other severe drug-related adverse events occurred very rarely (0.1%). In conclusion, the results of this systematic review and meta-analysis show that intravenous tranexamic acid is a safe pharmacological treatment to reduce blood loss and transfusion requirements in patients undergoing major orthopaedic surgery. PMID:29337665

  15. Racing performance of Standardbred trotting horses undergoing surgery of the carpal flexor sheath and age- and sex-matched control horses.

    Science.gov (United States)

    Carmalt, James L; Johansson, Bengt C; Zetterström, Sandra M; McOnie, Rebecca C

    2017-07-01

    OBJECTIVE To determine factors affecting race speed in Swedish Standardbred horses undergoing surgery of the carpal flexor sheath (CFS), to investigate whether preoperative racing speed was associated with specific intraoperative findings and whether horses returned to racing, and to compare the performance of horses undergoing surgery of the CFS with that of age- and sex-matched control horses. ANIMALS 149 Swedish Standardbred trotters undergoing surgery of the CFS and 274 age- and sex-matched control horses. PROCEDURES Medical records of CFS horses were examined. Racing data for CFS and control horses were retrieved from official online records. Generalizing estimating equations were used to examine overall and presurgery racing speeds and the association of preoperative clinical and intraoperative findings with preoperative and postoperative speeds. Multivariable regression analysis was used to examine career earnings and number of career races. Kaplan-Meier survival analysis was used to compare career longevity between CFS and control horses. RESULTS CFS horses were significantly faster than control horses. The CFS horses that raced before surgery were slower as they approached the surgery date, but race speed increased after surgery. There were 124 of 137 (90.5%) CFS horses that raced after surgery. No intrathecal pathological findings were significantly associated with preoperative racing speed. Career longevity did not differ between CFS and control horses. CONCLUSIONS AND CLINICAL RELEVANCE Horses undergoing surgery of the CFS had a good prognosis to return to racing after surgery. Racing careers of horses undergoing surgery of the CFS were not significantly different from racing careers of control horses.

  16. Adult patient with Becker dystrophy undergoing orthopedic surgery: an anesthesia challenge.

    Science.gov (United States)

    Parish, Masoud; Farzin, Haleh

    2018-01-01

    Muscular dystrophies are considered to be a series of neuromuscular diseases with genetic causes and are characterized by progressive muscle weakness and degeneration of the skeletal muscle. The case of an adult man with Becker dystrophy referred for repair of the patella tendon tearing and patella fracture is described. He underwent successful surgery using total intravenous anesthesia without any complications.

  17. Coronary risk stratification of patients undergoing surgery for valvular heart disease

    DEFF Research Database (Denmark)

    Hasselbalch, Rasmus Bo; Engstrøm, Thomas; Pries-Heje, Mia

    2017-01-01

    BACKGROUND: Multislice computed tomography (MSCT) is a non-invasive, less expensive, low-radiation alternative to coronary angiography (CAG) prior to valvular heart surgery. MSCT has a high negative predictive value for coronary artery disease (CAD) but previous studies of patients with valvular ...

  18. Long-Term Follow-Up of Individuals Undergoing Sex-Reassignment Surgery

    DEFF Research Database (Denmark)

    Simonsen, Rikke Kildevæld; Hald, Gert Martin; Kristensen, Ellids

    2016-01-01

    Introduction: Studies of mortality and somatic well-being after sex-reassignment surgery (SRS) of transsexual individuals are equivocal. Accordingly, the present study investigated mortality and somatic morbidity using a sample of transsexual individuals who comprised 98% (n = 104) of all surgica......, specific types of hormonal or surgical treatment received and somatic morbidity and mortality....

  19. Child drawings and salivary cortisol in children undergoing preoperative procedures associated with day surgery.

    Science.gov (United States)

    Wennström, Berith; Törnhage, Carl-Johan; Hedelin, Hans; Nasic, Salmir; Bergh, Ingrid

    2013-12-01

    Perioperative procedures in children can impair their emotional status negatively with stress and/or anxiety. Cortisol concentrations and drawings could be helpful in gaining information about a child's levels of stress and/or anxiety when attending the hospital for surgery. The purpose of this study was to determine the degree of anxiety and stress as well as to explore the association between objective measures of stress (cortisol concentration in saliva) and subjective assessment of hospital anxiety (children's drawings) as interpreted by the Swedish version of the Child Drawing: Hospital manual. A total of 93 children scheduled for day surgery were included. Salivary cortisol was sampled preoperatively on the day of surgery at which time the children were also requested to make a drawing of a person at the hospital. Results showed no association between salivary cortisol concentration and the CD:H score. The drawings and salivary cortisol concentration preoperatively on the day of surgery reflect different components of the conditions of fear, anxiety, or stress emerging in the situation. Copyright © 2013 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  20. Association between baseline cognitive impairment and postoperative delirium in elderly patients undergoing surgery for adult spinal deformity.

    Science.gov (United States)

    Adogwa, Owoicho; Elsamadicy, Aladine A; Vuong, Victoria D; Fialkoff, Jared; Cheng, Joseph; Karikari, Isaac O; Bagley, Carlos A

    2018-01-01

    OBJECTIVE Postoperative delirium is common in elderly patients undergoing spine surgery and is associated with a longer and more costly hospital course, functional decline, postoperative institutionalization, and higher likelihood of death within 6 months of discharge. Preoperative cognitive impairment may be a risk factor for the development of postoperative delirium. The aim of this study was to investigate the relationship between baseline cognitive impairment and postoperative delirium in geriatric patients undergoing surgery for degenerative scoliosis. METHODS Elderly patients 65 years and older undergoing a planned elective spinal surgery for correction of adult degenerative scoliosis were enrolled in this study. Preoperative cognition was assessed using the validated Saint Louis University Mental Status (SLUMS) examination. SLUMS comprises 11 questions, with a maximum score of 30 points. Mild cognitive impairment was defined as a SLUMS score between 21 and 26 points, while severe cognitive impairment was defined as a SLUMS score of ≤ 20 points. Normal cognition was defined as a SLUMS score of ≥ 27 points. Delirium was assessed daily using the Confusion Assessment Method (CAM) and rated as absent or present on the basis of CAM. The incidence of delirium was compared in patients with and without baseline cognitive impairment. RESULTS Twenty-two patients (18%) developed delirium postoperatively. Baseline demographics, including age, sex, comorbidities, and perioperative variables, were similar in patients with and without delirium. The length of in-hospital stay (mean 5.33 days vs 5.48 days) and 30-day hospital readmission rates (12.28% vs 12%) were similar between patients with and without delirium, respectively. Patients with preoperative cognitive impairment (i.e., a lower SLUMS score) had a higher incidence of postoperative delirium. One- and 2-year patient reported outcomes scores were similar in patients with and without delirium. CONCLUSIONS

  1. Trajectory of sleep disturbances in patients undergoing lung cancer surgery: a prospective study.

    Science.gov (United States)

    Halle, Ingrid Helene; Westgaard, Therese Krystad; Wahba, Alexander; Oksholm, Trine; Rustøen, Tone; Gjeilo, Kari Hanne

    2017-08-01

    Patients with lung cancer report sleep difficulties to be frequent and bothersome symptoms. This study describes the trajectory of sleep from before and up to 12 months after surgery for lung cancer. Further, it investigates possible associations between sleep disturbance, demographic and clinical characteristics before surgery. This study is part of a longitudinal multicentre study. Sleep disturbance was measured by The General Sleep Disturbance Scale (GSDS) that investigates frequencies of sleep difficulties (21 items) and a total sum score ≥43 indicates a clinically meaningful level of sleep disturbance (score range 0-147). Linear mixed models were used to study changes in sleep from baseline to 1, 5, 9 and 12 months after surgery. The percentage of patients (n = 264) reporting sleep disturbances was 60.9% at baseline, 68.5% at Month 1, 55.4% at Month 5, 51.3% at Month 9 and 49.7% at Month 12. The increase to and decrease from Month 1 was the only significant alteration in the occurrence of sleep disturbance. The patients reported most problems within the subscales sleep quantity, early awakenings and sleep quality. Factors associated with sleep disturbance were lower age, use of pain medication and psychotropic medication and higher comorbidity score. Lung cancer patients sleep poorly, before as well as after surgery. There is a need to address sleeping disturbance routinely in clinical practice and screening for sleeping problems is indicated. Further studies are warranted concerning factors that contribute to sleep disturbance and how they best can be treated. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  2. PREVALENCE AND PREDICTORS OF CORONARY ARTERY DISEASE IN SEVERE AORTIC STENOSIS PATIENTS UNDERGOING SURGERY

    Directory of Open Access Journals (Sweden)

    Narayanapilai Jayaprasad

    2017-09-01

    Full Text Available BACKGROUND The present study is to find out the prevalence of CAD in severe Aortic Stenosis (AS patients undergoing aortic valve replacement and the relation between the conventional risk factors and CAD in them. Calcific aortic stenosis is associated with the same risk factors as coronary artery disease. Studies on calcific aortic stenosis and CAD are rarely reported from India. The aim of the study is to find out the predictive value of angina for presence of CAD in severe aortic stenosis. MATERIALS AND METHODS All cases of isolated severe aortic stenosis undergoing CAG before aortic valve replacement were included in the study. Data regarding various risk factors, symptoms, echocardiographic parameters and angiographic profile were collected. RESULTS Among a total of 94 patients who have undergone aortic valve replacement for severe AS 40 (42.6% had CAD. Risk factors like advanced age, hypertension, diabetes and smoking were more in patients with CAD compared to isolate AS. Mean gradient was more in the AS + CAD group compared with AS group. Presence of angina had a sensitivity of 82.5% and specificity of 51.85% for predicting coexisting CAD. CONCLUSION Among severe aortic stenosis, patients undergoing AVR 42.6% of patients had significant obstructive CAD. The conventional risk factors predict presence of coronary artery disease. Angina has got a fairly good sensitivity, but moderate specificity for CAD.

  3. Effects of levosimendan on mortality in patients undergoing cardiac surgery: A systematic review and meta-analysis.

    Science.gov (United States)

    Chen, Peili; Wu, Xiaoqiang; Wang, Zhiwei; Li, Zhenya; Tian, Xiangyong; Wang, Junpeng; Yan, Tianzhong

    2018-06-01

    We sought to determine the impact of levosimendan on mortality following cardiac surgery based on large-scale randomized controlled trials (RCTs). We searched PubMed, Web of Science, Cochrane databases, and ClinicalTrials.gov for RCTs published up to December 2017, on levosimendan for patients undergoing cardiac surgery. A total of 25 RCTs enrolling 2960 patients met the inclusion criteria; data from 15 placebo-controlled randomized trials were included for meta-analysis. Pooled analysis showed that the all-cause mortality rate was 6.4% (71 of 1106) in the levosimendan group and 8.4% (93 of 1108) in the placebo group (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.55-1.04; P = 0.09). There were no significant differences between the two groups in the rates of myocardial infarction (OR: 0.91; 95% CI, 0.68-1.21; P = 0.52), serious adverse events (OR: 0.84; 95% CI, 0.66-1.07; P = 0.17), hypotension (OR: 1.69; 95% CI, 0.94-3.03; P = 0.08), and low cardiac output syndrome (OR: 0.47; 95% CI, 0.22-1.02; P = 0.05). Levosimendan did not result in a reduction in mortality in adult cardiac surgery patients. Well designed, adequately powered, multicenter trials are necessary to determine the role of levosimendan in adult cardiac surgery. © 2018 The Authors. Journal of Cardiac Surgery Published by Wiley Periodicals Inc.

  4. Evaluation of the Effect of a Preoperative Single Dose of Gabapentin on Emergence Agitation in Patients Undergoing Breast Cancer Surgery

    Directory of Open Access Journals (Sweden)

    Simin Azemati

    2013-10-01

    Full Text Available Background: Emergence agitation is a transient confusional state that usuallyoccurs within 10 to 30 minutes of recovery from general anesthesia. It may lead to seriousconsequences and increasing hospital costs. This study evaluates the effect of gabapentinon emergence agitation in patients undergoing breast cancer surgery.Methods: This randomized, double blind controlled trial enrolled 100 femalepatients with American Society of Anesthesiologists' classifications I and II who werecandidates for breast cancer surgery. Patients were randomly assigned into two groups(n=50 that received either oral gabapentin 600 mg or placebo. Induction andmaintenance of anesthesia were similar in both groups. At the end of surgery, patient'sagitation score, pain score, and presence of nausea or vomiting were reported. In theward, the presence of headache or dizziness was checked during the first 8 h. Mann-Whitney test was used for comparison of agitation and pain scores between two groups.Chi-square test was used for comparing occurrence of nausea, vomiting and qualitative.The qualitative demographic variable and t-test compared quantitative demographicvariables.Results: There was a significantly lower incidence of emergence agitation in thegabapentin group before (P<0.001 and after (P=0.029 extubation. There weresignificantly lower mean agitation scores before (P<001 and after (P=0.006 extubationand in the pain score (P=0.005 in the gabapentin group. The need for remifentanilinfusion (P<0.05 during surgery was significantly lower in the gabapentin groupcompared with the placebo group. Occurrence of nausea and vomiting and gabapentinside effects that included headache or dizziness did not significantly differ between twogroups (P=0.126, P=1, P=0.629 respectively.Conclusion: Gabapentin not only decreased postoperative pain but also effectivelyreduced emergence agitation without any significant side effects in patients undergoingbreast cancer surgery.

  5. Endovascular Embolization of Intracranial Infectious Aneurysms in Patients Undergoing Open Heart Surgery Using n-Butyl Cyanoacrylate.

    Science.gov (United States)

    Cheng-Ching, Esteban; John, Seby; Bain, Mark; Toth, Gabor; Masaryk, Thomas; Hui, Ferdinand; Hussain, Muhammad Shazam

    2017-03-01

    Mycotic aneurysms are a serious complication of infective endocarditis with increased risk of intracranial hemorrhage. Patients undergoing open heart surgery for valve repair or replacement are exposed to anticoagulants, increasing the risk of aneurysm bleeding. These patients may require endovascular or surgical aneurysm treatment prior to heart surgery, but data on this approach are scarce. Retrospective review of consecutive patients with infectious endocarditis and mycotic aneurysms treated endovascularly with Trufill n-butyl cyanoacrylate (n-BCA) at the Cleveland Clinic between January 2013 and December 2015. Nine patients underwent endovascular treatment of mycotic aneurysms with n-BCA (mean age of 39 years). On imaging, 4 patients had intracerebral hemorrhage, 2 had multiple embolic infarcts, and the rest had no imaging findings. Twelve mycotic aneurysms were detected (3 patients with 2 aneurysms). Seven aneurysms were in the M4 middle cerebral artery segment, 4 in the posterior cerebral artery distribution, and 1 in the callosomarginal branch. n-BCA was diluted in ethiodized oil (1:1 to 1:2). Embolization was achieved in a single rapid injection with immediate microcatheter removal. Complete aneurysm exclusion was achieved in all cases without complications. All patients underwent open heart surgery and endovascular embolization within a short interval, 2 with both procedures on the same day. There were no new hemorrhages after aneurysm embolization. Endovascular embolization of infectious intracranial aneurysms with liquid embolics can be performed successfully in critically ill patients requiring immediate open heart surgery and anticoagulation. Early embolization prior to and within a short interval from open heart surgery is feasible.

  6. THE EFFECTS OF INTRATHECAL NEOSTIGMINE ADDED TO BUPIVACAINE ON POSTOPERATIVE ANALGESIC REQUIREMENT IN PATIENTS UNDERGOING LOWER LIMB ORTHOPEDIC SURGERY.

    Science.gov (United States)

    Kayalha, Hamid; Mousavi, Zinat; Sadat Barikani, Ameneh; Yaghoobi, Siamak; Khezri, Marzieh Beigom

    2015-06-01

    Several additives have been suggested to enhance analgesic effect of local anesthetic agents to decrease the adverse effects of them and increase the degree of satisfaction. We designed this randomized double-blind controlled study to evaluate the analgesic efficacy of the neostigmine added to bupivacaine using spinal anesthesia in patients undergoing lower limb orthopedic surgery. Sixty patients 18-80 yr old American Society of Anesthesiologists (ASA) physical status I or II, scheduled for femur surgery under spinal anesthesia, were recruited in a prospective, double-blinded, randomized way. The patients were randomly allocated to one of two groups of 30 each. The neostigmine group (group N) received bupivacaine 20 mg combined with 25 µg neostigmine, and the placebo group (group C) received bupivacaine 20 mg combined with 0.5ml distilled water (intrathecally) 5 minutes prior to surgery. The time to the first analgesic request, analgesic requirement in the first 12 hours after surgery, the duration of sensory and motor blockade, the incidence of adverse effects such as nausea,vomiting,hypotension, ephedrine requirements, bradycardia, and hypoxemia were recorded. Patients receiving neostigmine had a significantly prolonged duration of motor block (C95% CI 30.27 to 87.65; P < 0.001) and sensory block (C95% CI 101.04 to 224.64; P < 0.001) compared to the control group. The difference of the mean time to the first analgesic request was also significantly longer in neostigmine group (C95% CI 83.139 to 208.526; P < 0.001). The total analgesic consumption during the first 12 hours after surgery was devoid of any significant difference between groups N and C (p = 0.41).The two groups were not significantly different in terms of intraoperative and postoperative side effects. Intrathecal neostigmine 25 µg with bupivacaine caused a prolonged time to the first analgesic request and its use was not associated with any side effects.

  7. Influence of yoga on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery

    Directory of Open Access Journals (Sweden)

    Rao Raghavendra

    2008-01-01

    Full Text Available Context : Pre- and postoperative distress in breast cancer patients can cause complications and delay recovery from surgery. Objective : The aim of our study was to evaluate the effects of yoga intervention on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery. Methods : Ninety-eight recently diagnosed stage II and III breast cancer patients were recruited in a randomized controlled trial comparing the effects of a yoga program with supportive therapy and exercise rehabilitation on postoperative outcomes and wound healing following surgery. Subjects were assessed at the baseline prior to surgery and four weeks later. Sociodemographic, clinical and investigative notes were ascertained in the beginning of the study. Blood samples were collected for estimation of plasma cytokines-soluble Interleukin (IL-2 receptor (IL-2R, tumor necrosis factor (TNF-alpha and interferon (IFN-gamma. Postoperative outcomes such as the duration of hospital stay and drain retention, time of suture removal and postoperative complications were ascertained. We used independent samples t test and nonparametric Mann Whitney U tests to compare groups for postoperative outcomes and plasma cytokines. Regression analysis was done to determine predictors for postoperative outcomes. Results : Sixty-nine patients contributed data to the current analysis (yoga: n = 33, control: n = 36. The results suggest a significant decrease in the duration of hospital stay ( P = 0.003, days of drain retention ( P = 0.001 and days for suture removal ( P = 0.03 in the yoga group as compared to the controls. There was also a significant decrease in plasma TNF alpha levels following surgery in the yoga group ( P < 0.001, as compared to the controls. Regression analysis on postoperative outcomes showed that the yoga intervention affected the duration of drain retention and hospital stay as well as TNF alpha levels. Conclusion : The results suggest

  8. Influence of yoga on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery.

    Science.gov (United States)

    Rao, Raghavendra M; Nagendra, H R; Raghuram, Nagarathna; Vinay, C; Chandrashekara, S; Gopinath, K S; Srinath, B S

    2008-01-01

    Pre- and postoperative distress in breast cancer patients can cause complications and delay recovery from surgery. The aim of our study was to evaluate the effects of yoga intervention on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery. Ninety-eight recently diagnosed stage II and III breast cancer patients were recruited in a randomized controlled trial comparing the effects of a yoga program with supportive therapy and exercise rehabilitation on postoperative outcomes and wound healing following surgery. Subjects were assessed at the baseline prior to surgery and four weeks later. Sociodemographic, clinical and investigative notes were ascertained in the beginning of the study. Blood samples were collected for estimation of plasma cytokines-soluble Interleukin (IL)-2 receptor (IL-2R), tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma. Postoperative outcomes such as the duration of hospital stay and drain retention, time of suture removal and postoperative complications were ascertained. We used independent samples t test and nonparametric Mann Whitney U tests to compare groups for postoperative outcomes and plasma cytokines. Regression analysis was done to determine predictors for postoperative outcomes. Sixty-nine patients contributed data to the current analysis (yoga: n = 33, control: n = 36). The results suggest a significant decrease in the duration of hospital stay (P = 0.003), days of drain retention (P = 0.001) and days for suture removal (P = 0.03) in the yoga group as compared to the controls. There was also a significant decrease in plasma TNF alpha levels following surgery in the yoga group (P < 0.001), as compared to the controls. Regression analysis on postoperative outcomes showed that the yoga intervention affected the duration of drain retention and hospital stay as well as TNF alpha levels. The results suggest possible benefits of yoga in reducing postoperative complications in

  9. Intravenous Dexmedetomidine Infusion Compared with that of Fentanyl in Patients Undergoing Arthroscopic Shoulder Surgery under General Anesthesia.

    Science.gov (United States)

    Abdel Hamid, Mona Hossam Eldin

    2017-01-01

    Anesthesia for arthroscopic shoulder surgery is challenging due to the need for oligaemic surgical field as well as a good postoperative recovery profile. The present study was prospective, randomized to evaluate the efficacy of dexmdetomidine infusion compared to that of fentanyl in patients undergoing arthroscopic shoulder surgery under general anesthesia. A total of 60 patients aged from thirty to fifty years, American Society of Anesthesiologists Class I/II of either sex for arthroscopic shoulder surgery, were included. The patients were divided into two groups of 30 patients each. Group I received dexmedetomidine loading 1 μg/kg over 10 min followed by maintenance 0.5 μg/kg/h and Group II Fentanyl loading 1 μg/kg followed by maintenance 0.5 μg/kg/h. Hemodynamic readings (Heart rate HR, and mean arterial blood pressure MAP) were recorded after the start of the study drug infusion (T1), after intubation (T2), then every 15 minutes till the end of surgery (T15, T30, T45, T60, T75, T90). In the PACU, MAP, and HR were recorded on arrival, after 30 min, 1 hr, and 2 hrs (R0, R30, R1 hr, R2 hr) Postoperative analgesia was assessed by visual analogue scale (VAS), Modified Observers's Assessment of Alertness and Sedation OAA/S was recorded on arrival to PACU. This study showed that in the dexmedatomidine group there was statistically significant decrease of MAP and HR after drug infusion up to two hours in the recovery period, more sedation, better control of pain and surgeon satisfaction. Iv infusion of dexamedatomidine may be an attractive option during arthroscopic shoulder surgery as it provided a better hypotensive anesthesia by lowering MAP and HR which leads to better surgical field and surgeon satisfaction than iv infusion fentanyl along with a better postoperative VAS.

  10. Comparison of Preemptive Effects of Celecoxib and Ibuprofen on Postoperative Pain in Addicted Patients Undergoing Lower Abdominal Surgery

    Directory of Open Access Journals (Sweden)

    A. Farhanchi

    2017-10-01

    Full Text Available Background and Objective: Pain is a common postoperative complaint, and the use of analgesics before surgical trauma can effectively prevent peripheral and central sensitization. We aimed to compare the preemptive effects of ibuprofen and celecoxib on post-operative pain after lower abdominal surgery in addicted patients. Materials and Methods: In this clinical trial, after obtaining informed consent, 114 addicted patients undergoing lower abdominal surgery were randomly divided into three groups of 38. The first group was given a 200 mg dose of oral celecoxib, 400 mg of ibuprofen was orally administered to patients in the second group, and the third group was given redsop hcrats as placebo by a nurse who prepared these drugs in the form of capsules. Postoperative pain was assessed by using a 10-cm ruler as the visual analogue scale at intervals of 1 and 6 hours after surgery. Postoperative opioid consumption was recorded in those periods. The obtained data were analyzed using the appropriate statistical tests in SPSS software. Results: Mean pain scores at 1 hour after surgery were not significantly different across the three groups, whereas at 6 hours after surgery, pain scores were significantly lower in the ibuprofen and celecoxib groups in comparison to the placebo group (P=0.001 and P=0.005, respectively. Postoperative nausea and vomiting was not significantly different among the three groups. Conclusion: Despite the significant difference in mean pain scores among the study groups, the opioid consumption doses were not significantly different among the groups. Thus, the preemptive prescription of nonsteroidal anti-inflammatory drugs in addicted patient does not have any noticeable effects.

  11. Predictors of ischaemic mitral regurgitation recurrence in patients undergoing combined surgery: additional value of cardiovascular magnetic resonance imaging.

    Science.gov (United States)

    Glaveckaite, Sigita; Uzdavinyte-Gateliene, Egle; Petrulioniene, Zaneta; Palionis, Darius; Valeviciene, Nomeda; Kalinauskas, Gintaras; Serpytis, Pranas; Laucevicius, Aleksandras

    2018-03-09

    We aimed to evaluate (i) the effectiveness of combined surgery (coronary artery bypass grafting with restrictive mitral valve annuloplasty) and (ii) the late gadolinium enhancement cardiovascular magnetic resonance-based predictors of ischaemic mitral regurgitation (IMR) recurrence. The prospective analysis included 40 patients with multivessel coronary artery disease, IMR >II° and left ventricular (LV) dysfunction undergoing combined surgery. The degree of IMR and LV parameters were assessed preoperatively by transthoracic echocardiography, 3D transoesophageal echocardiography and cardiovascular magnetic resonance and postoperatively by transthoracic echocardiography. The effective mitral valve repair group (n = 30) was defined as having recurrent ischaemic mitral regurgitation (RIMR) ≤II° at the end of follow-up (25 ± 11 months). The surgery was effective: freedom from RIMR >II° at 1 and 2 years after surgery was 80% and 75%, respectively. Using multivariable logistic regression, 2 independent predictors of RIMR >II° were identified: ≥3 non-viable LV segments (odds ratio 22, P = 0.027) and ≥1 non-viable segment in the LV posterior wall (odds ratio 11, P = 0.026). Using classification trees, the best combinations of cardiovascular magnetic resonance-based and 3D transoesophageal echocardiography-based predictors for RIMR >II° were (i) posterior mitral valve leaflet angle >40° and LV end-systolic volume index >45 ml/m2 (sensitivity 100%, specificity 89%) and (ii) scar transmurality >68% in the inferior LV wall and EuroSCORE II >8 (sensitivity 83%, specificity 78%). There is a clear relationship between the amount of non-viable LV segments, especially in the LV posterior and inferior walls, and the recurrence of IMR after the combined surgery.

  12. Health locus of control in patients undergoing coronary artery surgery - changes and associated outcomes: a seven-year cohort study.

    Science.gov (United States)

    Rideout, Andrew; Tolmie, Elizabeth; Lindsay, Grace

    2017-01-01

    Health locus of control is a measure of an individual's beliefs in factors that are thought to determine health experiences. Scores are generated and form a graduated linear scale from external to internal control, with respect to their views on health causality. Health locus of control has been considered to be a relatively stable entity. However, it is not clear if this status changes in the advent of serious health challenges, such as coronary artery bypass graft surgery. The aim of this study is to explore the variability of health locus of control and its association with postoperative health in this context. In a longitudinal cohort study of patients undergoing coronary artery bypass graft surgery, a purposive sample ( n=215) were recruited from the waiting list and followed up postoperatively, at approximately one year and seven years later. Patients undergoing coronary artery bypass graft surgery demonstrated marked fluctuations in health locus of control in their peri-operative and rehabilitative phases. Mean health locus of control became more external (often associated with poorer outcomes) peri-operatively, and more internal (generally associated with better health outcomes) in the rehabilitative period. Health locus of control scores were shown to be changeable during a major health care intervention, with possible consequences for patient outcomes and care needs. The significant health belief upheaval demonstrated in this cohort should be considered in assessing patients preoperatively, and managed as part of the patients' clinical journey by both acute and rehabilitation staff. It is likely to have particular importance in individualised assessment and management of future prevention advice for patients.

  13. The influence of sarcopenia on survival and surgical complications in ovarian cancer patients undergoing primary debulking surgery.

    Science.gov (United States)

    Rutten, I J G; Ubachs, J; Kruitwagen, R F P M; van Dijk, D P J; Beets-Tan, R G H; Massuger, L F A G; Olde Damink, S W M; Van Gorp, T

    2017-04-01

    Sarcopenia, severe skeletal muscle loss, has been identified as a prognostic factor in various malignancies. This study aims to investigate whether sarcopenia is associated with overall survival (OS) and surgical complications in patients with advanced ovarian cancer undergoing primary debulking surgery (PDS). Ovarian cancer patients (n = 216) treated with PDS were enrolled retrospectively. Total skeletal muscle surface area was measured on axial computed tomography at the level of the third lumbar vertebra. Optimum stratification was used to find the optimal skeletal muscle index cut-off to define sarcopenia (≤38.73 cm 2 /m 2 ). Cox-regression and Kaplan-Meier analysis were used to analyse the relationship between sarcopenia and OS. The effect of sarcopenia on the development of major surgical complications was studied with logistic regression. Kaplan-Meier analysis showed a significant survival disadvantage for patients with sarcopenia compared to patients without sarcopenia (p = 0.010). Sarcopenia univariably predicted OS (HR 1.536 (95% CI 1.105-2.134), p = 0.011) but was not significant in multivariable Cox-regression analysis (HR 1.362 (95% CI 0.968-1.916), p = 0.076). Significant predictors for OS in multivariable Cox-regression analysis were complete PDS, treatment in a specialised centre and the development of major complications. Sarcopenia was not predictive of major complications. Sarcopenia was not predictive of OS or major complications in ovarian cancer patients undergoing primary debulking surgery. However a strong trend towards a survival disadvantage for patients with sarcopenia was seen. Future prospective studies should focus on interventions to prevent or reverse sarcopenia and possibly increase ovarian cancer survival. Complete cytoreduction remains the strongest predictor of ovarian cancer survival. Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights

  14. Cushing's Syndrome in a Morbidly Obese Patient Undergoing Evaluation before Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Livia Borsoi

    2014-06-01

    Full Text Available Objective: Cushing's syndrome (CS is extremely rare in morbidly obese patients. To date, no occurrences in obese patients with BMI above 60 kg/m2 have been reported in the literature. Case Report: This case report describes a patient who was admitted to the ward of the Clinical Division of Endocrinology and Metabolism of the Medical University of Vienna in preparation for bariatric surgery. The patient was a 49-year-old female who showed morbid obesity (BMI 61.6 kg/m2, hypertension, and substituted hypothyroidism. Preoperative work-up revealed CS due to an adrenal adenoma. Therefore, the patient underwent unilateral adrenalectomy followed by bariatric surgery 6 months later. Conclusion: Since undiagnosed CS might result in severe perioperative complications in a population already at increased risk, this case report underlines the importance of careful endocrine evaluation of morbidly obese patients. After all, even rare endocrine causes should be excluded.

  15. Evidence-based management of postoperative pain in adults undergoing open inguinal hernia surgery

    DEFF Research Database (Denmark)

    Joshi, G P; Rawal, N; Kehlet, H

    2012-01-01

    BACKGROUND: Open inguinal hernia repair is associated with moderate postoperative pain, but optimal analgesia remains controversial. The aim of this systematic review was to evaluate the available literature on the management of pain after open hernia surgery. METHODS: Randomized studies......, in English, published between January 1966 and March 2009, assessing analgesic and anaesthetic interventions in adult open hernia surgery, and reporting pain scores, were retrieved from the Embase and MEDLINE databases. In addition to published evidence, clinical practice was taken into account to ensure...... and increased time to home-readiness compared with regional anaesthesia. CONCLUSION: Field block with, or without wound infiltration, either as a sole anaesthetic/analgesic technique or as an adjunct to general anaesthesia, is recommended to reduce postoperative pain. Continuous local anaesthetic infusion...

  16. Preventing bleeding and thromboembolic complications in atrial fibrillation patients undergoing surgery

    Directory of Open Access Journals (Sweden)

    Charles André

    2015-08-01

    Full Text Available Neurologists feel uneasy when asked about temporary anticoagulant interruption for surgery in patients with atrial fibrillation (AF. Rational decisions can be made based on current scientific evidence. Method Critical review of international guidelines and selected references pertaining to bleeding and thromboembolism during periods of oral anticoagulant interruption. Results Withholding oral anticoagulants leads to an increased risk of perioperative thromboembolism, depending on factors such as age, renal and liver function, previous ischemic events, heart failure etc. Surgeries are associated with a variable risk of bleeding - from minimal to very high. Individualized decisions about preoperative drug suspension, bridging therapy with heparin and time to restart oral anticoagulants after hemostasis can significantly reduce these opposing risks. Conclusion Rational decisions can be made after discussion with all Health care team professionals involved and consideration of patient fears and expectations. Formal written protocols should help managing antithrombotic treatment during this delicate period.

  17. [Effects of using an information leaflet in reducing perioperative anxiety and pain in patients undergoing urological surgery].

    Science.gov (United States)

    Miguel Romeo, M Carmen; Sagardoy Muniesa, Lorena

    2014-01-01

    The preoperative anxiety state is mainly caused by the fear of the circumstances surrounding the intervention. Anxiety causes increased postoperative pain, and a prolonged length of stay in hospital, which directly affect the cost of care. To evaluate the effects of providing an anaesthesia information leaflet on postoperative anxiety and pain in patients undergoing urological surgery in the Miguel Servet Hospital. A prospective quasi-experimental study of 100 cases, 51 of whom made up the intervention group who received the information leaflet, with the remaining 49 cases being in the control group. The Hospital Anxiety and Depression Scale and the visual analogue scale for pain were assessed in both groups, before and after surgery. Of the 100 patients, 72% were male and 28% female, with an average age of 67.3 years (standard deviation, 9.7). In the intervention group, 21.6% showed anxiety before surgery and 0% in the postoperative period. In the control group 30.6% presented anxiety during the preoperative period and 4% in the postoperative period (χ(2) Pearson 5.20, P=.023). The study showed a direct relationship between preoperative anxiety and postoperative pain (χ(2) Pearson 10.519, P=.001). Good information about the surgical process reduces anxiety levels in the postoperative period. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  18. Perioperative management of a patient with Glanzmann thrombasthenia undergoing a coronary artery bypass graft surgery: a case report.

    Science.gov (United States)

    Kurdi, Mohamad; Frère, Corinne; Amour, Julien; Brumpt, Caren; Delort, Josée; Lebreton, Guillaume; Croisille, Laure; d'Oiron, Roseline; Martin-Toutain, Isabelle

    2018-04-01

    : We report herein the successful perioperative management of a 57-year-old man with a type I Glanzmann thrombasthenia undergoing coronary artery bypass graft surgery and right carotid endarterectomy. The patient suffered from several lesions in the three major coronary arteries and in the right carotid necessitating surgery. Prophylactic human leukocyte antigen (HLA)-matched platelets transfusions were continuous administrated before, and through the immediate perioperative period. Posttransfusion platelet recovery was monitored using flow cytometry to determine the percentage of circulating platelet expressing CD61 (β3). No bleeding complications occurred during and following the procedure. The patient did not develop HLA antibodies or αIIbβ3 antibodies. Thrombophilia screening revealed a heterozygous G20210A prothrombin gene mutation. The patient also suffered from an atrial fibrillation, necessitating anticoagulation therapy. During the hospital stay, a treatment with vitamin K antagonists for stroke prevention was initiated. The patient was discharged 8 days following surgery, and no further complications occurred during the 6 months follow-up.

  19. The Efficacy of Lavender Aromatherapy in Reducing Preoperative Anxiety in Ambulatory Surgery Patients Undergoing Procedures in General Otolaryngology

    Science.gov (United States)

    Wotman, Michael; Levinger, Joshua; Leung, Lillian; Kallush, Aron; Mauer, Elizabeth

    2017-01-01

    Background Preoperative anxiety is a common problem in hospitals and other health care centers. This emotional state has been shown to negatively impact patient satisfaction and outcomes. Aromatherapy, the therapeutic use of essential oils extracted from aromatic plants, may offer a simple, low‐risk and cost‐effective method of managing preoperative anxiety. The purpose of this study was to evaluate the efficacy of lavender aromatherapy in reducing preoperative anxiety in ambulatory surgery patients undergoing procedures in general otolaryngology. Methods A prospective and controlled pilot study was conducted with 100 patients who were admitted to New York‐Presbyterian/Weill Cornell Medical Center for ambulatory surgery from January of 2015 to August of 2015. The subjects were allocated to two groups; the experimental group received inhalation lavender aromatherapy in the preoperative waiting area while the control group received standard nursing care. Both groups reported their anxiety with a visual analog scale (VAS) upon arriving to the preoperative waiting area and upon departure to the operating room. Results According to a Welch's two sample t‐test, the mean reduction in anxiety was statistically greater in the experimental group than the control group (p = 0.001). Conclusion Lavender aromatherapy reduced preoperative anxiety in ambulatory surgery patients. This effect was modest and possibly statistically significant. Future research is needed to confirm the clinical efficacy of lavender aromatherapy. Level of Evidence 2b PMID:29299520

  20. Subjective well-being, body image, and functional capacity in people candidate for or undergoing bariatric surgery

    Directory of Open Access Journals (Sweden)

    Mayra Juliana Galvis-Aparicio

    2017-07-01

    Full Text Available This paper presents two studies that aimed (1 at assessing and comparing the subjective well-being (SWB, and functional capacity and body image of people with morbid obesity, candidate for or undergoing bariatric surgery (BS, and (2 at identifying the relationship among the components of SWB, BMI, functional capacity, and body image. The sample was composed by 48 patients in pre-surgery period, and 29 in post-surgery. Instruments used were the Life Satisfaction Scale, the Positive and Negative Affect Scale, WHODAS 2.0, the Brazilian scale of figures and silhouettes, and thebateria fatorial da personalidade. Statistically significant differences were found between both groups in all the variables, except positive affect, comprehension and communication, and relationships with others. FC was correlated to all the components of SWB and contributed to explaining the variance of life satisfaction and negative affect. Personality traits turned out to be more important than other variables for explaining the variance of positive affect.

  1. The LMACTrach, a Aew Approach for Endotracheal Intubation: Apilot Study in 100 Patients Undergoing Elective Surgery

    OpenAIRE

    Valiollah Hassani; Maryam Zafarghandi; Mohammad Farhadi

    2010-01-01

    Backgroundand endotracheal intubation under direct vision in both anticipated and unexpecteddifficult intubation situations.: The LMA CTrach system is a new device for airway managementMethodsdifferent types of elective surgeries. After randomly selecting the patients for intubationwith this new device, the airway characteristics, height,weight, dental overbiteand thyromental distance were all evaluated before induction.Our goal was to exploreprimarily the success rate of intubation with LMAC...

  2. Frequency and Predictors of Cognitive Decline in Patients Undergoing Coronary Artery Bypass Graft Surgery

    International Nuclear Information System (INIS)

    Habib, S.; Khan, A. R.; Afridi, M. I.; Saeed, A.; Jan, A. F.; Amjad, N.

    2014-01-01

    Objective: To determine the frequency of cognitive impairment and its predictors in patients, who underwent first time coronary artery bypass graft surgery (CABGS). Study Design: An observational study. Place and Duration of Study: The National Institute of Cardiovascular Diseases (NICVD), Karachi, from December 2008 to December 2009. Methodology: Study included patients > 18 years, who underwent first-time elective CABGS. Emergency CABGS, with additional cardiac procedures, myocardial infarction (MI) within one month and known psychiatric illness were excluded. Patients were evaluated for their socio-demographic profile, medical history, intra-operative, anesthetic and surgical techniques and postoperative complications/therapy in ICU. Cognitive functioning, before the surgery, at discharge, 6 weeks and 6 months post-CABG was evaluated by McNair's and MMSE scales. HDRS was added to see if depression was a confounding factor for cognitive decline. Results: One hundred and thirty four patients were followed-up at discharge, 74 at 6 weeks and 73 at 6 months. There were 113 (84.3%) males and 21 (15.7%) females, with mean age of 53.7 +- 8.36 years. Prevalence of cognitive disturbance at baseline was 44.8%, which increased to 54.5% at discharge, and improvement was seen at 6 months, it was 39.7%. Older age, female gender, higher bleeding episodes, and high post-surgery creatinine level were more frequently associated with cognitive decline. Conclusion: Postoperative cognitive deficit was common and remained persistent at short-term. Older age, females and high postoperative creatinine were identified as its important predictors. There was high frequency of acute depression before surgery with significant reduction over time. (author)

  3. Improving consent in patients undergoing surgery for fractured neck of femur.

    Science.gov (United States)

    Thiruchandran, Gajendiran; McKean, Andrew R; Rudran, Branavan; Imam, Mohamed A; Yeong, Keefai; Hassan, Abdel

    2018-05-02

    Background Neck of femur fractures and their subsequent operative fixation are associated with high rates of perioperative morbidity and mortality. Consenting in this setting is suboptimal with the Montgomery court ruling changing the perspective of consent. This quality improvement project assessed the adequacy of consenting against British Orthopaedic Association-endorsed guidance and implemented a series of changes to improve the documentation of risks associated with surgery for fractured neck of femur. Methods Seventy consecutive patients who underwent any operative fixation of a neck of femur fracture were included over a 6-month period at a single centre. Patients unable to consent or without electronic notes were excluded. Consent forms were analysed and the documented potential risks or complications associated with surgery were compared to British Orthopaedic Association-endorsed guidance. A series of changes (using the plan, do study, act (PDSA) approach) was implemented to improve the adequacy of consent. Results Documentation of four out of 12 potential risks or complications was recorded in <50% of cases for patients with intracapsular fractures (n=35), and documentation of seven out of 12 potential risks or complications was recorded in <50% of cases for patients with extracapsular fractures (n=35). Re-audit following raising awareness and attaching consent guidance showed 100% documentation of potential risks or complications in patients with intracapsular and extracapsular fractures (n=70). A neck of femur fracture-specific consent form has been implemented which will hopefully lead to sustained improvement. Conclusions Consenting patients with fractured neck of femur for surgery in the authors' unit was suboptimal when compared to British Orthopaedic Association-endorsed consent guidance. This project has shown that ensuring such guidance is readily available has improved the adequacy of consent. The authors hope that introduction of a neck of

  4. Computed tomography assessment of lung structure in patients undergoing cardiac surgery with cardiopulmonary bypass

    Energy Technology Data Exchange (ETDEWEB)

    Rodrigues, R.R.; Sawada, A.Y.; Fukuda, M.J.; Neves, F.H.; Carmona, M.J.; Auler, J.O.; Malbouisson, L.M.S., E-mail: malbouisson@hcnet.usp.b [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Medicina. Hospital das Clinicas; Pelosi, P. [Universita' degli Studi dell' Insubria, Varese (Italy). Dipt. Ambiente, Salute e Sicurezza; Rouby, J.-J. [University Pierre and Marie Curie, Paris (France). La Pitie Salpetriere Hospital. Dept. of Anesthesiology and Critical Care and Medicine

    2011-06-15

    Hypoxemia is a frequent complication after coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB), usually attributed to atelectasis. Using computed tomography (CT), we investigated postoperative pulmonary alterations and their impact on blood oxygenation. Eighteen non-hypoxemic patients (15 men and 3 women) with normal cardiac function scheduled for CABG under CPB were studied. Hemodynamic measurements and blood samples were obtained before surgery, after intubation, after CPB, at admission to the intensive care unit, and 12, 24, and 48 h after surgery. Pre- and postoperative volumetric thoracic CT scans were acquired under apnea conditions after a spontaneous expiration. Data were analyzed by the paired Student t-test and one-way repeated measures analysis of variance. Mean age was 63 {+-} 9 years. The PaO{sub 2}/FiO{sub 2} ratio was significantly reduced after anesthesia induction, reaching its nadir after CPB and partially improving 12 h after surgery. Compared to preoperative CT, there was a 31% postoperative reduction in pulmonary gas volume (P < 0.001) while tissue volume increased by 19% (P < 0.001). Non-aerated lung increased by 253 {+-} 97 g (P < 0.001), from 3 to 27%, after surgery and poorly aerated lung by 72 {+-} 68 g (P < 0.001), from 24 to 27%, while normally aerated lung was reduced by 147 {+-} 119 g (P < 0.001), from 72 to 46%. No correlations (Pearson) were observed between PaO{sub 2}/FiO{sub 2} ratio or shunt fraction at 24 h postoperatively and postoperative lung alterations. The data show that lung structure is profoundly modified after CABG with CPB. Taken together, multiple changes occurring in the lungs contribute to postoperative hypoxemia rather than atelectasis alone. (author)

  5. Systemic assessment of patients undergoing dental implant surgeries: A trans- and post-operative analysis

    OpenAIRE

    Sanjay Byakodi; Sachin Kumar; Rajesh Kumar Reddy; Vipin Kumar; Shipra Sepolia; Shivangi Gupta; Harkanwal Preet Singh

    2017-01-01

    Background: Procedure-related and patient-related factors influence the prognosis of dental implants to a major extent. Hence, we aimed to evaluate and analyze various systemic factors in patients receiving dental implants. Materials and Methods: Fifty-one patients were included in the study, in which a total of 110 dental implants were placed. Complete examination of the subjects was done before and after placement of dental implants. Implant surgery was planned, and osseointegrated dental i...

  6. Systemic Assessment of Patients Undergoing Dental Implant Surgeries: A Trans- and Post-operative Analysis.

    Science.gov (United States)

    Byakodi, Sanjay; Kumar, Sachin; Reddy, Rajesh Kumar; Kumar, Vipin; Sepolia, Shipra; Gupta, Shivangi; Singh, Harkanwal Preet

    2017-01-01

    Procedure-related and patient-related factors influence the prognosis of dental implants to a major extent. Hence, we aimed to evaluate and analyze various systemic factors in patients receiving dental implants. Fifty-one patients were included in the study, in which a total of 110 dental implants were placed. Complete examination of the subjects was done before and after placement of dental implants. Implant surgery was planned, and osseointegrated dental implants were placed in the subjects. Postoperative evaluation of the dental implant patients was done after 3 weeks. Anxiety levels were determined using State-Trait Anxiety Inventory (STAI) questionnaire on the surgery day and after 1 week of surgery. The participant describes how they feel at the moment by responding to twenty items as follows: (1) absolutely not, (2) slightly, (3) somewhat, or (4) very much. All the results were recorded and statistical analyzed by SPSS software. Out of 51, 29 patients were males while 22 were females, with ratio of 1.32:1. Female patients' mean age was 50.18 years while male patients' mean age was 52.71 years, with statistically nonsignificant difference between them. Functional rehabilitation was the main purpose of choosing dental implants in more than 90% of the subjects. Diameter of 3.75 mm was the shortest implants to be placed in the present study, whereas in terms of length, 8.5 mm was the shortest length of dental implant used in the present study. Tooth area in which maximum implants were placed in our study was 36 tooth region. Maximum implants were placed in Type II bone quality ( n = 38). Implants installed in the mandible were clamped more efficiently than implants placed in the maxilla ( P < 0.001). The difference of average STAI-State subscore before and after the surgery was statistically significant ( P < 0.05; significant). Mandibular dental implants show more clamping (torque) than maxillary dental implants.

  7. Characterization of Chronic Aortic and Mitral Regurgitation Undergoing Valve Surgery Using Cardiovascular Magnetic Resonance.

    Science.gov (United States)

    Polte, Christian L; Gao, Sinsia A; Johnsson, Åse A; Lagerstrand, Kerstin M; Bech-Hanssen, Odd

    2017-06-15

    Grading of chronic aortic regurgitation (AR) and mitral regurgitation (MR) by cardiovascular magnetic resonance (CMR) is currently based on thresholds, which are neither modality nor quantification method specific. Accordingly, this study sought to identify CMR-specific and quantification method-specific thresholds for regurgitant volumes (RVols), RVol indexes, and regurgitant fractions (RFs), which denote severe chronic AR or MR with an indication for surgery. The study comprised patients with moderate and severe chronic AR (n = 38) and MR (n = 40). Echocardiography and CMR was performed at baseline and in all operated AR/MR patients (n = 23/25) 10 ± 1 months after surgery. CMR quantification of AR: direct (aortic flow) and indirect method (left ventricular stroke volume [LVSV] - pulmonary stroke volume [PuSV]); MR: 2 indirect methods (LVSV - aortic forward flow [AoFF]; mitral inflow [MiIF] - AoFF). All operated patients had severe regurgitation and benefited from surgery, indicated by a significant postsurgical reduction in end-diastolic volume index and improvement or relief of symptoms. The discriminatory ability between moderate and severe AR was strong for RVol >40 ml, RVol index >20 ml/m 2 , and RF >30% (direct method) and RVol >62 ml, RVol index >31 ml/m 2 , and RF >36% (LVSV-PuSV) with a negative likelihood ratio ≤ 0.2. In MR, the discriminatory ability was very strong for RVol >64 ml, RVol index >32 ml/m 2 , and RF >41% (LVSV-AoFF) and RVol >40 ml, RVol index >20 ml/m 2 , and RF >30% (MiIF-AoFF) with a negative likelihood ratio surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Molecular biomarkers in extrahepatic bile duct cancer patients undergoing chemoradiotherapy for gross residual disease after surgery

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Hyeon Kang; Kim, Kyu Bo; Chie, Eui Kyu; Ha, Sung W. [Seoul National University College of Medicine, Seoul (Korea, Republic of); Park, Hae Jin [Dept. of Radiation Oncology, Soonchunhyang University Hospital, Seoul (Korea, Republic of)

    2012-12-15

    To analyze the outcomes of chemoradiotherapy for extrahepatic bile duct (EHBD) cancer patients who underwent R2 resection or bypass surgery and to identify prognostic factors affecting clinical outcomes, especially in terms of molecular biomarkers. Medical records of 21 patients with EHBD cancer who underwent R2 resection or bypass surgery followed by chemoradiotherapy from May 2001 to June 2010 were retrospectively reviewed. All surgical specimens were re-evaluated by immunohistochemical staining using phosphorylated protein kinase B (pAKT), CD24, matrix metalloproteinase 9 (MMP9), survivin, and {beta}-catenin antibodies. The relationship between clinical outcomes and immunohistochemical results was investigated. At a median follow-up of 20 months, the actuarial 2-year locoregional progression-free, distant metastasis-free and overall survival were 37%, 56%, and 54%, respectively. On univariate analysis using clinicopathologic factors, there was no significant prognostic factor. In the immunohistochemical staining, cytoplasmic staining, and nuclear staining of pAKT was positive in 10 and 6 patients, respectively. There were positive CD24 in 7 patients, MMP9 in 16 patients, survivin in 8 patients, and {beta}-catenin in 3 patients. On univariate analysis, there was no significant value of immunohistochemical results for clinical outcomes. There was no significant association between clinical outcomes of patients with EHBD cancer who received chemoradiotherapy after R2 resection or bypass surgery and pAKT, CD24, MMP9, survivin, and {beta}-catenin. Future research is needed on a larger data set or with other molecular biomarkers.

  9. Quality of life in children and adolescents undergoing spinal deformity surgery.

    Science.gov (United States)

    McKean, Greg M; Tsirikos, Athanasios I

    2017-01-01

    Quality of life measurements evaluate surgical results from patients' reported outcomes. To assess the impact of spinal deformity treatment using the Scoliosis Research Society-22 questionnaire. SRS-22 data was collected in 545 consecutive patients (425 females-120 males) pre-operatively, 6-, 12- and 24-months post-operatively. Variables included type and age of surgery (mean: 15.14 ± 2.07 years), gender, diagnosis and year of surgery. Age at surgery was divided in: 10-12, 13-15, and 15-19 years. Mean pre-operative SRS-22 scores for the whole group were: function 3.77 ± 0.75; pain 3.7 ± 0.97; self-image 3.14 ± 0.66; mental health 3.86 ± 0.77; total 3.62 ± 0.66. Mean 2-year post-operative scores were: function 4.39 ± 0.42; pain 4.59 ± 0.56; self-image 4.39 ± 0.51; mental health 4.43 ± 0.56; satisfaction 4.81 ± 0.40; total 4.52 ± 0.37 (padolescents.

  10. Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery in the Sugammadex Era: A Retrospective Study

    Directory of Open Access Journals (Sweden)

    Chung-Sik Oh

    2016-01-01

    Full Text Available Background. Residual neuromuscular block (NMB after general anesthesia has been associated with pulmonary dysfunction and hypoxia, which are both associated with postoperative delirium (POD. We evaluated the effects of sugammadex on POD in elderly patients who underwent hip fracture surgery. Methods. Medical records of 174 consecutive patients who underwent hip fracture surgery with general anesthesia were reviewed retrospectively to compare the perioperative incidence of POD, pulmonary complications, time to extubation, incidence of hypoxia, and laboratory findings between patients treated with sugammadex and those treated with a conventional cholinesterase inhibitor. Results. The incidence of POD was not significantly different between the two groups (33.3% versus 36.5%, resp.; P=0.750. Postoperative pulmonary complications and laboratory findings did not showed significant intergroup difference. However, time to extubation (6 ± 3 versus 8 ± 3 min; P<0.001 and the frequency of postoperative hypoxia were significantly lower (23% versus 43%; P=0.010 in the sugammadex group than in the conventional cholinesterase inhibitor group. Conclusion. Sugammadex did not reduce POD or pulmonary complications compared to conventional cholinesterase inhibitors, despite reducing time to extubation and postoperative hypoxia in elderly patients who underwent hip fracture surgery under general anesthesia.

  11. Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery in the Sugammadex Era: A Retrospective Study

    Science.gov (United States)

    Oh, Chung-Sik; Rhee, Ka Young; Yoon, Tae-Gyoon; Woo, Nam-Sik; Hong, Seung Wan; Kim, Seong-Hyop

    2016-01-01

    Background. Residual neuromuscular block (NMB) after general anesthesia has been associated with pulmonary dysfunction and hypoxia, which are both associated with postoperative delirium (POD). We evaluated the effects of sugammadex on POD in elderly patients who underwent hip fracture surgery. Methods. Medical records of 174 consecutive patients who underwent hip fracture surgery with general anesthesia were reviewed retrospectively to compare the perioperative incidence of POD, pulmonary complications, time to extubation, incidence of hypoxia, and laboratory findings between patients treated with sugammadex and those treated with a conventional cholinesterase inhibitor. Results. The incidence of POD was not significantly different between the two groups (33.3% versus 36.5%, resp.; P = 0.750). Postoperative pulmonary complications and laboratory findings did not showed significant intergroup difference. However, time to extubation (6 ± 3 versus 8 ± 3 min; P sugammadex group than in the conventional cholinesterase inhibitor group. Conclusion. Sugammadex did not reduce POD or pulmonary complications compared to conventional cholinesterase inhibitors, despite reducing time to extubation and postoperative hypoxia in elderly patients who underwent hip fracture surgery under general anesthesia. PMID:26998480

  12. Warming intravenous fluids reduces perioperative hypothermia in women undergoing ambulatory gynecological surgery.

    Science.gov (United States)

    Smith, C E; Gerdes, E; Sweda, S; Myles, C; Punjabi, A; Pinchak, A C; Hagen, J F

    1998-07-01

    We evaluated whether warming i.v. fluids resulted in less hypothermia (core temperature 30 min were randomized to two groups: fluid warming at 42 degrees C or control (room temperature fluids at approximately 21 degrees C). All patients received general anesthesia with isoflurane, tracheal intubation, standard operating room blankets and surgical drapes, and passive humidification of inspired gases. Tympanic membrane (core) temperatures were measured at baseline and at 15-min intervals after induction. The incidence of shivering and postoperative requirement for meperidine and/or radiant heat were evaluated. Core temperatures were lower in the control compared with the warm fluid group at the end of surgery (35.6 +/- 0.1 degrees C vs 36.2 +/- 0.1 degrees C; P unit or the incidence of shivering between the groups. We conclude that fluid warming, in conjunction with standard heat conservation measures, was effective in maintaining normothermia during outpatient gynecological surgery; however, there was no improvement in patient outcome. Women who received i.v. fluid at body temperature had significantly higher core temperatures during and after outpatient gynecological surgery compared with women who received i.v. fluids at the temperature of the operating room.

  13. Molecular biomarkers in extrahepatic bile duct cancer patients undergoing chemoradiotherapy for gross residual disease after surgery

    International Nuclear Information System (INIS)

    Koh, Hyeon Kang; Kim, Kyu Bo; Chie, Eui Kyu; Ha, Sung W.; Park, Hae Jin

    2012-01-01

    To analyze the outcomes of chemoradiotherapy for extrahepatic bile duct (EHBD) cancer patients who underwent R2 resection or bypass surgery and to identify prognostic factors affecting clinical outcomes, especially in terms of molecular biomarkers. Medical records of 21 patients with EHBD cancer who underwent R2 resection or bypass surgery followed by chemoradiotherapy from May 2001 to June 2010 were retrospectively reviewed. All surgical specimens were re-evaluated by immunohistochemical staining using phosphorylated protein kinase B (pAKT), CD24, matrix metalloproteinase 9 (MMP9), survivin, and β-catenin antibodies. The relationship between clinical outcomes and immunohistochemical results was investigated. At a median follow-up of 20 months, the actuarial 2-year locoregional progression-free, distant metastasis-free and overall survival were 37%, 56%, and 54%, respectively. On univariate analysis using clinicopathologic factors, there was no significant prognostic factor. In the immunohistochemical staining, cytoplasmic staining, and nuclear staining of pAKT was positive in 10 and 6 patients, respectively. There were positive CD24 in 7 patients, MMP9 in 16 patients, survivin in 8 patients, and β-catenin in 3 patients. On univariate analysis, there was no significant value of immunohistochemical results for clinical outcomes. There was no significant association between clinical outcomes of patients with EHBD cancer who received chemoradiotherapy after R2 resection or bypass surgery and pAKT, CD24, MMP9, survivin, and β-catenin. Future research is needed on a larger data set or with other molecular biomarkers.

  14. Systematic review of psychological and social outcomes of adolescents undergoing bariatric surgery, and predictors of success.

    Science.gov (United States)

    White, B; Doyle, J; Colville, S; Nicholls, D; Viner, R M; Christie, D

    2015-12-01

    The psychological and social outcomes of bariatric surgery in adolescents, together with psychological and social predictors of success, were systematically reviewed. PubMed, EMBASE, ISI Web of Science and PsychInfo were searched on July 2014. Existing data were sparse; 15 were suitable for qualitative review and six for meta-analysis (four quality of life [QOL], two depression). One study was a randomized controlled trial. A total of 139 subjects underwent Roux-en-Y gastric bypass, 202 underwent adjustable gastric band and 64 underwent sleeve gastrectomy. Overall QOL improved after bariatric surgery, regardless of surgical type with peak improvement at 6-12 months. Meta-analysis of four studies showed changed in overall QOL at latest follow-up of 2.80 standard deviation (SD) (95% confidence interval [CI] 1.23-4.37). Depression improved across all studies, regardless of procedure (effect size -0.47 SD [95% CI -0.76, -0.18] at 4-6 months). Two cohorts reported changes in both overall QOL and depression following a quadratic trajectory, with overall improvement over 2 years and deterioration in the second post-operative year. There were limited data on other psychological and social outcomes. There were insufficient data on psychosocial predictors of outcome to form evidence-based recommendations for patient selection for bariatric surgery at this time. © 2015 World Obesity.

  15. Predictive Factors for Patients Undergoing ASD Device Occlusion Who "Crossover" to Surgery.

    Science.gov (United States)

    Mulukutla, Venkatachalam; Qureshi, Athar M; Pignatelli, Ricardo; Ing, Frank F

    2018-03-01

    The aim of this study was to define characteristics of those patients who are referred for device closure of an Atrial septal defect (ASD), but identified to "crossover" surgery. All patients who underwent surgical and device (Amplatzer or Helex occluder) closures of secundum ASDs from 2001 to 2010 were reviewed and organized into three groups: surgical closure, device closure, and "crossover" group. 369 patients underwent ASD closure (265 device, 104 surgical). 42 of the 265 patients referred for device closure "crossed over" to the surgical group at various stages of the catheterization procedure. The device group had defect size measuring 14.2 mm (mean) and an ASD index (Defect Size (mm)/BSA) of 14.0 compared to the corresponding values in the surgical group (20.1 mm, ASD index 25.9) (P ASD index) (P ASD index of 14.7 compared with the crossover group ASD index of 23.8 (P ASD index greater than 23.7 had a 90% specificity in "crossing over" to surgery. The crossover and surgical groups had statistically larger ASD defect size indexes compared with the device group. Deficient rim in the posterior/inferior rim is associated with a large ASD size index which is a predictive factor for crossing over to surgery. Catheterization did not negatively impact surgical results in the "crossover" group.

  16. Relaxation Training and Postoperative Music Therapy for Adolescents Undergoing Spinal Fusion Surgery.

    Science.gov (United States)

    Nelson, Kirsten; Adamek, Mary; Kleiber, Charmaine

    2017-02-01

    Spinal fusion for idiopathic scoliosis is one of the most painful surgeries experienced by adolescents. Music therapy, utilizing music-assisted relaxation with controlled breathing and imagery, is a promising intervention for reducing pain and anxiety for these patients. It can be challenging to teach new coping strategies to post-operative patients who are already in pain. This study evaluated the effects of introducing music-assisted relaxation training to adolescents before surgery. Outcome measures were self-reported pain and anxiety, recorded on 0-10 numeric rating scale, and observed behavioral indicators of pain and relaxation. The training intervention was a 12-minute video about music-assisted relaxation with opportunities to practice before surgery. Forty-four participants between the ages of 10 and 19 were enrolled. Participants were randomly assigned to the experimental group that watched the video at the preoperative visit or to the control group that did not watch the video. All subjects received a music therapy session with a board certified music therapist on post-operative day 2 while out of bed for the first time. Pain and anxiety were significantly reduced from immediately pre-therapy to post-therapy (paired t-test; p). Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  17. [Hereditary heterozygous factor VII deficiency in patients undergoing surgery : Clinical relevance].

    Science.gov (United States)

    Woehrle, D; Martinez, M; Bolliger, D

    2016-10-01

    A hereditary deficiency in coagulation factor VII (FVII) may affect the international normalized ratio (INR) value. However, FVII deficiency is occasionally associated with a tendency to bleed spontaneously. We hypothesized that perioperative substitution with coagulation factor concentrates might not be indicated in most patients. In this retrospective data analysis, we included all patients with hereditary heterozygous FVII deficiency who underwent surgical procedures at the University Hospital Basel between December 2010 and November 2015. In addition, by searching the literature, we identified publications reporting patients with FVII deficiency undergoing surgical procedures without perioperative substitution. We identified 22 patients undergoing 46 surgical procedures, resulting in a prevalence of 1:1500-2000. Coagulation factor concentrates were administered during the perioperative period in 15 procedures (33 %), whereas in the other 31 procedures (66 %), FVII deficiency was not substituted. No postoperative bleeding or thromboembolic events were reported. In addition, we found no differences in pre- and postoperative hemoglobin and coagulation parameters, with the exception of an improved postoperative INR value in the substituted group. In the literature review, we identified five publications, including 125 patients with FVII deficiency, undergoing 213 surgical procedures with no perioperative substitution. Preoperative substitution using coagulation factor concentrates does not seem to be mandatory in patients with an FVII level ≥15 %. For decision-making on preoperative substitution, patient history of an increased tendency to bleed may be more important than the FVII level or increased INR value.

  18. Ejnell surgery under nasal flexible fiber for a patient who is unable to undergo direct laryngoscopy

    International Nuclear Information System (INIS)

    Hara, Natsuki; Umezaki, Toshiro; Adachi, Kazuo; Toh, Satoshi; Kiyohara, Hideyuki; Komune, Shizuo

    2012-01-01

    The Ejnell method used to treat bilateral vocal cord paralysis without damaging the laryngeal framework. It is the first-line option for laterofixation of the vocal fold, because it is reversible and requires no tracheotomy. The Ejnell method normally requires direct laryngoscopy. It was applied without direct laryngoscopy in one patient, because a patient had difficulty extending the neck after radiation therapy. Nasal ENDO CLOSE TM was effective under flexible fiberscopy. Therefore, this could be an effective method a patient cannot undergo direct laryngoscopy. (author)

  19. [Psychopathologic risk assessment and self-esteem in patients undergoing hypospadias surgery].

    Science.gov (United States)

    Marte, A; Pintozzi, L; Prezioso, M; Borrelli, M; Pisano, S

    2014-01-01

    Although the long-term outcomes ofhypospadias surgery are considered important for psychosexual development, only a few attempts have been made to evaluate patient psico-pathology. 20 out 40 patients who received under sealed cover two envelopes--the first containing the assessment tools, the other empty and prepaid for the answer--joined the study. The results came from the analysis of anamnestic interview specially created in order to gather information on how to access to surgery and the degree of information that the parents had from the surgeon, from the analysis of the CBCL (Child Behavior CheckList 2001:4-16 years) and TMA (Multidimensional self-esteem Test: the Italian version of the MSCS Multidimensional Self-Concept Scale). Of the 20 patients recruited, 15, aged from 9 to 18 years (mean age 12.5), age at operation between 2 and 5 years (mean age 3.3 yrs), have returned the questionnaires correctly compiled. Patient data were compared with those of a control group not suffering from genital pathology. From the CBCL: the area of the identification of the problems showed no significant differences between the study group and the control. The area of competence, altered in both groups, did not show statistically significant differences. From the analysis of TMA: there were no statistically significant differences between the two groups in sub-domains: Social, Competence, Affect, Family and Physical. Within the subdomain school the two groups differed significantly for low self-esteem in the group of surgical patients. The MST test indicate that hypospadias surgery does not change the global self-esteem but, surprisingly, at least in this patient population, only a lower self-esteem in school performance in the age group considered. This study may indicate the importance of psychological support during the transition from adolescence to adulthood.

  20. Psychopathologic risk assessment and self-esteem in patients undergoing hypospadias surgery

    Directory of Open Access Journals (Sweden)

    A. Marte

    2014-04-01

    Full Text Available Aims: Although the long-term outcomes of hypospadias surgery are considered important for psychosexual development, only a few attempts have been made to evaluate patient psico-pathology. Material and Methods: 20 out 40 patients who received under sealed cover two envelopes - the first containing the assessment tools, the other empty and prepaid for the answer – joined the study. The results came from the analysis of anamnestic interview specially created in order to gather information on how to access to surgery and the degree of information that the parents had from the surgeon, from the analysis of the CBCL (Child Behavior CheckList 2001:4-16 years and TMA (Multidimensional self-esteem Test: the Italian version of the MSCS Multidimensional Self-Concept Scale. Of the 20 patients recruited, 15, aged from 9 to 18 years (mean age 12.5, age at operation between 2 and 5 years (mean age 3.3 yrs, have returned the questionnaires correctly compiled. Patient data were compared with those of a control group not suffering from genital pathology. Results: From the CBCL: the area of the identification of the problems showed no significant differences between the study group and the control. The area of competence, altered in both groups, did not show statistically significant differences. From the analysis of TMA: there were no statistically significant differences between the two groups in sub-domains: Social, Competence, Affect, Family and Physical. Within the subdomain school the two groups differed significantly for low self-esteem in the group of surgical patients. Conclusion: The MST test indicate that hypospadias surgery does not change the global self-esteem but, surprisingly, at least in this patient population, only a lower self-esteem in school performance in the age group considered . This study may indicate the importance of psychological support during the transition from adolescence to adulthood.

  1. Frailty and postoperative outcomes in patients undergoing surgery for degenerative spine disease.

    Science.gov (United States)

    Flexman, Alana M; Charest-Morin, Raphaële; Stobart, Liam; Street, John; Ryerson, Christopher J

    2016-11-01

    Frailty is defined as a state of decreased reserve and susceptibility to stressors. The relationship between frailty and postoperative outcomes after degenerative spine surgery has not been studied. This study aimed to (1) determine prevalence of frailty in the degenerative spine population; (2) describe patient characteristics associated with frailty; and (3) determine the association between frailty and postoperative complications, mortality, length of stay, and discharge disposition. This is a retrospective analysis on a prospectively collected cohort from the National Surgical Quality Improvement Program (NSQIP). A total of 53,080 patients who underwent degenerative spine surgery between 2006 and 2012 were included in the study. A modified frailty index (mFI) with 11 variables derived from the NSQIP dataset was used to determine prevalence of frailty and its correlation with a composite outcome of perioperative complications as well as hospital length of stay, mortality, and discharge disposition. After calculating the mFI for each patient, the prevalence and predictors of frailty were determined for our cohort. The association of frailty with postoperative outcomes was determined after adjusting for known and suspected confounders using multivariate logistic regression. Frailty was present in 2,041 patients within the total population (4%) and in 8% of patients older than 65 years. Frailty severity increased with increasing age, male sex, African American race, higher body mass index, recent weight loss, paraplegia or quadriplegia, American Society of Anesthesiologists (ASA) score, and preadmission residence in a care facility. Frailty severity was an independent predictor of major complication (OR 1.15 for every 0.10 increase in mFI, 95%CI 1.09-1.21, pdegenerative spine surgery. Preoperative recognition of frailty may be useful for perioperative optimization, risk stratification, and patient counseling. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Laparoscopy is safe among patients with congestive heart failure undergoing general surgery procedures.

    Science.gov (United States)

    Speicher, Paul J; Ganapathi, Asvin M; Englum, Brian R; Vaslef, Steven N

    2014-08-01

    Over the past 2 decades, laparoscopy has been established as a superior technique in many general surgery procedures. Few studies, however, have examined the impact of the use of a laparoscopic approach in patients with symptomatic congestive heart failure (CHF). Because pneumoperitoneum has known effects on cardiopulmonary physiology, patients with CHF may be at increased risk. This study examines current trends in approaches to patients with CHF and effects on perioperative outcomes. The 2005-2011 National Surgical Quality Improvement Program Participant User File was used to identify patients who underwent the following general surgery procedures: Appendectomy, segmental colectomy, small bowel resection, ventral hernia repair, and splenectomy. Included for analysis were those with newly diagnosed CHF or chronic CHF with new signs or symptoms. Trends of use of laparoscopy were assessed across procedure types. The primary endpoint was 30-day mortality. The independent effect of laparoscopy in CHF was estimated with a multiple logistic regression model. A total of 265,198 patients were included for analysis, of whom 2,219 were identified as having new or recently worsened CHF. Of these patients, there were 1,300 (58.6%) colectomies, 486 (21.9%) small bowel resections, 216 (9.7%) ventral hernia repairs, 141 (6.4%) appendectomies, and 76 (3.4%) splenectomies. Laparoscopy was used less frequently in patients with CHF compared with their non-CHF counterparts, particularly for nonelective procedures. Baseline characteristics were similar for laparoscopy versus open procedures with the notable exception of urgent/emergent case status (36.4% vs 71.3%; P surgery procedures, particularly in urgent/emergent cases. Despite these patterns and apparent preferences, laparoscopy seems to offer a safe alternative in appropriately selected patients. Because morbidity and mortality were considerable regardless of approach, further understanding of appropriate management in this

  3. Perioperative management of vitamin K antagonists in patients with low thromboembolic risk undergoing elective surgery: A prospective experience.

    Science.gov (United States)

    Becerra, Ana Florencia; Cornavaca, María Teresita; Revigliono, José Ignacio; Contreras, Alejandro; Albertini, Ricardo; Tabares, Aldo Hugo

    2017-10-11

    To quantify thromboembolic and bleeding events in patients with low thromboembolic risk, who were chronically receiving vitamin K antagonists and undergoing elective surgery. A descriptive, prospective, single-center study was conducted between December 2010 and July 2014. Patients aged over 18 years old, chronically anticoagulated with vitamin K antagonists and admitted for elective surgery were included in the study. We excluded patients with a creatinine clearance120kg, heparin-induced thrombocytopenia, pregnant women, carriers of an epidural catheter for analgesia, patients who underwent unscheduled surgery and high thromboembolic risk-patients. Vitamin K antagonists were discontinued 5 days prior to the procedure without administering anticoagulant enoxaparin. The NIR was measured 24h before the procedure. A single dose of 3mg of vitamin K was administered in cases of a NIR>1.5. Vitamin K antagonists was resumed according to the surgical bleeding risk. Events were registered between 5 days prior to the procedure until 30 days after it. A total of 75 procedures were included in the study. Fifty-six patients (74.7%) received vitamin K antagonists for atrial fibrillation, 15 suffered from venous thromboembolism (20%) and 4 had mechanical heart valves (5.3%). Twenty-six patients (34.5%) underwent high-bleeding risk surgeries and 49 (65.5%) underwent low risk procedures. No thromboembolic event was recorded. Four bleeding events (5.3%) were reported, 3 of which were considered major bleeding events (2 fatal). Suspending vitamin K antagonists with no bridging therapy performed in patients with a low thromboembolic risk does not expose such patients to a significant risk of embolic events. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  4. Psychometric validation of the Spanish version of the USS-PROM questionnaire for patients who undergo anterior urethral surgery.

    Science.gov (United States)

    Puche-Sanz, I; Martín-Way, D; Flores-Martín, J; Expósito-Ruiz, M; Vicente-Prados, J; Nogueras-Ocaña, M; Tinaut-Ranera, J; Cózar-Olmo, J M

    2016-06-01

    To translate into Spanish and validate the Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROM) questionnaire, assessing its psychometric properties and determining its suitability for clinical use in our community. We also assessed the potential changes in ejaculatory function using the Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD). A systematic translation of the British version was performed. Patients scheduled for anterior urethral stricture surgery between September 2014 and September 2015 were prospectively included in the study. All patients completed the questionnaire before and after the surgery. We conducted an in-depth psychometric study of the questionnaire. We assessed the responses of a total of 40 patients. The questionnaire showed its validity, presenting an excellent negative correlation between the voiding symptom scores and the maximum flow (r=-0.6, P<.001), and also showed significant improvement in the EQ5D-VAS (visual analogue scale) and the time trade-off. For internal consistency, the Cronbach's alpha was 0.701. For the test-retest reliability, the overall intraclass correlation coefficient (ICC) was 0.974, and the ICC for each item separately ranged from 0.799 to 0.980. We observed significant improvement in all items regarding urinary symptoms and health-related quality of life (P<.001), thereby demonstrating the response capacity to changing the questionnaire. There were no significant changes in the MSHQ-EjD. The Spanish version of the USS-PROM questionnaire is a valid instrument for quantifying changes in voiding symptoms and the health-related quality of life of patients undergoing anterior urethral surgery. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Cognitive-Behavioral-Based Physical Therapy for Patients With Chronic Pain Undergoing Lumbar Spine Surgery: A Randomized Controlled Trial.

    Science.gov (United States)

    Archer, Kristin R; Devin, Clinton J; Vanston, Susan W; Koyama, Tatsuki; Phillips, Sharon E; George, Steven Z; McGirt, Matthew J; Spengler, Dan M; Aaronson, Oran S; Cheng, Joseph S; Wegener, Stephen T

    2016-01-01

    The purpose of this study was to determine the efficacy of a cognitive-behavioral-based physical therapy (CBPT) program for improving outcomes in patients after lumbar spine surgery. A randomized controlled trial was conducted on 86 adults undergoing a laminectomy with or without arthrodesis for a lumbar degenerative condition. Patients were screened preoperatively for high fear of movement using the Tampa Scale for Kinesiophobia. Randomization to either CBPT or an education program occurred at 6 weeks after surgery. Assessments were completed pretreatment, posttreatment and at 3-month follow-up. The primary outcomes were pain and disability measured by the Brief Pain Inventory and Oswestry Disability Index. Secondary outcomes included general health (SF-12) and performance-based tests (5-Chair Stand, Timed Up and Go, 10-Meter Walk). Multivariable linear regression analyses found that CBPT participants had significantly greater decreases in pain and disability and increases in general health and physical performance compared with the education group at the 3-month follow-up. Results suggest a targeted CBPT program may result in significant and clinically meaningful improvement in postoperative outcomes. CBPT has the potential to be an evidence-based program that clinicians can recommend for patients at risk for poor recovery after spine surgery. This study investigated a targeted cognitive-behavioral-based physical therapy program for patients after lumbar spine surgery. Findings lend support to the hypothesis that incorporating cognitive-behavioral strategies into postoperative physical therapy may address psychosocial risk factors and improve pain, disability, general health, and physical performance outcomes. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

  6. Systemic assessment of patients undergoing dental implant surgeries: A trans- and post-operative analysis

    Directory of Open Access Journals (Sweden)

    Sanjay Byakodi

    2017-01-01

    Full Text Available Background: Procedure-related and patient-related factors influence the prognosis of dental implants to a major extent. Hence, we aimed to evaluate and analyze various systemic factors in patients receiving dental implants. Materials and Methods: Fifty-one patients were included in the study, in which a total of 110 dental implants were placed. Complete examination of the subjects was done before and after placement of dental implants. Implant surgery was planned, and osseointegrated dental implants were placed in the subjects. Postoperative evaluation of the dental implant patients was done after 3 weeks. Anxiety levels were determined using State-Trait Anxiety Inventory (STAI questionnaire on the surgery day and after 1 week of surgery. The participant describes how they feel at the moment by responding to twenty items as follows: (1 absolutely not, (2 slightly, (3 somewhat, or (4 very much. All the results were recorded and statistical analyzed by SPSS software. Results: Out of 51, 29 patients were males while 22 were females, with ratio of 1.32:1. Female patients' mean age was 50.18 years while male patients' mean age was 52.71 years, with statistically nonsignificant difference between them. Functional rehabilitation was the main purpose of choosing dental implants in more than 90% of the subjects. Diameter of 3.75 mm was the shortest implants to be placed in the present study, whereas in terms of length, 8.5 mm was the shortest length of dental implant used in the present study. Tooth area in which maximum implants were placed in our study was 36 tooth region. Maximum implants were placed in Type II bone quality (n = 38. Implants installed in the mandible were clamped more efficiently than implants placed in the maxilla (P < 0.001. The difference of average STAI-State subscore before and after the surgery was statistically significant (P < 0.05; significant. Conclusion: Mandibular dental implants show more clamping (torque than maxillary

  7. Vitreoretinal Complications and Outcomes in 92 Eyes Undergoing Surgery for Modified Osteo-Odonto-Keratoprosthesis: A 10-Year Review.

    Science.gov (United States)

    Rishi, Pukhraj; Rishi, Ekta; Agarwal, Vishvesh; Nair, Sridevi; Iyer, Geetha; Srinivasan, Bhaskar; Agarwal, Shweta

    2018-06-01

    To analyze vitreoretinal (VR) complications and treatment outcomes in eyes undergoing modified osteo-odonto-keratoprosthesis (OOKP) surgery. Retrospective case series. All patients who underwent modified OOKP (mOOKP) surgery at a tertiary eye-care center from March 2003 to February 2013 were included. Medical records were reviewed for relevant medical history, best-corrected visual acuity (BCVA), slit-lamp examination, ultrasound scan, oral examination findings, and VR complications. The BCVA at the last visit. Optimal anatomic outcome was attached retina with a normal intraocular pressure at the last visit. A total of 92 eyes of 90 patients were included. Indications for OOKP included Stevens-Johnson syndrome (n = 53), chemical injury (n = 36), and ocular cicatricial pemphigoid (n = 3). A total of 41 eyes of 39 patients developed VR complications, including vitritis (n = 21), retinal detachment (RD) (n = 12; primary RD = 5), retroprosthetic membrane (RPM) (n = 10; primary RPM = 2), endophthalmitis (n = 8), vitreous hemorrhage (VH) (n = 5; primary VH = 1), serous choroidal detachment (n = 5), hemorrhagic choroidal detachment (n = 2), and leak-related hypotony (n = 1). Mean interval from mOOKP surgery to occurrence of VR complication(s) was 43.8 months (median, 41.9 months; range, 0.2-95.5 months). After treatment of VR complication, visual improvement was seen in 17 eyes (42%) (mean improvement = 1.2 logarithm of the minimum angle of resolution [logMAR]; median, 0.8 logMAR; range, 0.1-2.5 logMAR), visual decline in 7 eyes (14%) (mean decline in BCVA = 0.6 logMAR; median, 0.4 logMAR; range, 0.3-1.8 logMAR), and no change in BCVA in 17 eyes (42%). However, BCVA ≥6/60 was retained in 19 eyes and ≥6/18 was retained in 9 eyes after final VR treatment. Vitreoretinal complications constitute a significant cause of visual morbidity in eyes undergoing mOOKP surgery and pose a challenging situation to manage. However, appropriate and timely intervention

  8. Body dysmorphic disorder in patients undergoing septorhinoplasty surgery: should we be performing routine screening?

    Science.gov (United States)

    Joseph, J; Randhawa, P; Hannan, S A; Long, J; Goh, S; O'Shea, N; Saleh, H; Hansen, E; Veale, D; Andrews, P

    2017-06-01

    Body dysmorphic disorder (BDD) is defined as having a preoccupation with a perceived flaw in one's appearance, which appears slight to others and significantly interferes with a person's functioning. When undetected in septorhinoplasty patients, it will often lead to poor outcomes. We performed a prospective cohort study to determine the prevalence of BDD in our patients and whether surgical correction could be considered. We recruited 34 patients being considered for septorhinoplasty in a tertiary referral rhinology clinic and a control group of 50 from the otology clinic giving a total of 84. Participants completed the Body Dysmorphic Disorder Questionnaire (BDDQ), the sino-nasal outcome test-23 (SNOT-23) and underwent nasal inspiratory peak flow (NIPF). Those found to be at high risk for BDD were referred to a clinical psychologist. Of the septorhinoplasty patients, 11 (32%) were high risk for BDD. Following psychological assessment, 7 (63%) patients were felt to be unsuitable for surgery and were offered psychological therapy. SNOT-23 scores were significantly higher in the BDD group indicating a negative impact on quality of life. NIPF readings were not significantly different in the BDD group compared to the control group. The BDDQ is a valid tool for identifying patients at risk of BDD. A close working relationship with clinical psychology has been advantageous to help the selection process of candidates for surgery when there is a high risk of BDD. © 2016 John Wiley & Sons Ltd.

  9. Clinical outcome of patients with familial hypercholesterolemia and coronary artery disease undergoing partial ileal bypass surgery

    Directory of Open Access Journals (Sweden)

    Jaqueline Scholz Issa

    2000-07-01

    Full Text Available Familial hypercholesterolemia is characterized by high serum levels of total cholesterol and LDL-cholesterol. It may be homozygous or heterozygous. In homozygous patients, LDL-cholesterol levels range from 500 to 1000mg/dL and coronary artery disease is precocious, usually manifesting itself between the 2nd and 3rd decades of life. The diagnosis is often made by the presence of xanthoma tuberosum and tendinous xanthomas that appear between the 1st and 2nd decades of life. The use of high doses of statins or even unusual procedures (apheresis, partial ileal bypass surgery, liver transplantation, gene therapy, or both, is necessary for increasing survival and improving quality of life, because a reduction in cholesterol levels is essential for stabilizing the coronary artery disease and reducing xanthomas. We report our experience with 3 patients with xanthomatous familial hypercholesterolemia and coronary artery disease, who underwent partial ileal bypass surgery. Their follow-up over the years (approximately 8 years showed a mean 30% reduction in total cholesterol, with a significant reduction in the xanthomas and stabilization of the coronary artery disease.

  10. The Role of Levosimendan in Patients with Decreased Left Ventricular Function Undergoing Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Marija Bozhinovska

    2016-06-01

    Full Text Available The postoperative low cardiac output is one of the most important complications following cardiac surgery and is associated with increased morbidity and mortality. The condition requires inotropic support to achieve adequate hemodynamic status and tissue perfusion. While catecholamines are utilised as a standard therapy in cardiac surgery, their use is limited due to increased oxygen consumption. Levosimendan is calcium sensitising inodilatator expressing positive inotropic effect by binding with cardiac troponin C without increasing oxygen demand. Furthermore, the drug opens potassium ATP (KATP channels in cardiac mitochondria and in the vascular muscle cells, showing cardioprotective and vasodilator properties, respectively. In the past decade, levosimendan demonstrated promising results in treating patients with reduced left ventricular function when administered in peri- or post- operative settings. In addition, pre-operative use of levosimendan in patients with severely reduced left ventricular ejection fraction may reduce the requirements for postoperative inotropic support, mechanical support, duration of intensive care unit stay as well as hospital stay and a decrease in post-operative mortality. However, larger studies are needed to clarify clinical advantages of levosimendan versus conventional inotropes.

  11. Normothermic versus hypothermic cardiopulmonary bypass in children undergoing open heart surgery (thermic-2): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Baos, Sarah; Sheehan, Karen; Culliford, Lucy; Pike, Katie; Ellis, Lucy; Parry, Andrew J; Stoica, Serban; Ghorbel, Mohamed T; Caputo, Massimo; Rogers, Chris A

    2015-05-25

    During open heart surgery, patients are connected to a heart-lung bypass machine that pumps blood around the body ("perfusion") while the heart is stopped. Typically the blood is cooled during this procedure ("hypothermia") and warmed to normal body temperature once the operation has been completed. The main rationale for "whole body cooling" is to protect organs such as the brain, kidneys, lungs, and heart from injury during bypass by reducing the body's metabolic rate and decreasing oxygen consumption. However, hypothermic perfusion also has disadvantages that can contribute toward an extended postoperative hospital stay. Research in adults and small randomized controlled trials in children suggest some benefits to keeping the blood at normal body temperature throughout surgery ("normothermia"). However, the two techniques have not been extensively compared in children. The Thermic-2 study will test the hypothesis that the whole body inflammatory response to the nonphysiological bypass and its detrimental effects on different organ functions may be attenuated by maintaining the body at 35°C-37°C (normothermic) rather than 28°C (hypothermic) during pediatric complex open heart surgery. This is a single-center, randomized controlled trial comparing the effectiveness and acceptability of normothermic versus hypothermic bypass in 141 children with congenital heart disease undergoing open heart surgery. Children having scheduled surgery to repair a heart defect not requiring deep hypothermic circulatory arrest represent the target study population. The co-primary clinical outcomes are duration of inotropic support, intubation time, and postoperative hospital stay. Secondary outcomes are in-hospital mortality and morbidity, blood loss and transfusion requirements, pre- and post-operative echocardiographic findings, routine blood gas and blood test results, renal function, cerebral function, regional oxygen saturation of blood in the cerebral cortex, assessment of

  12. Should WOC nurses measure health-related quality of life in patients undergoing intestinal ostomy surgery?

    Science.gov (United States)

    Pittman, Joyce; Kozell, Kathryn; Gray, Mikel

    2009-01-01

    Ostomy surgery requires significant reconstruction of the gastrointestinal tract, resulting in uncontrolled passage of fecal effluent from a stoma in the abdominal wall. Concerns about creation of an ostomy often supersede all other concerns. Ostomy-related concerns include impaired body image; fear of incontinence; fear of odor; limitations affecting social, travel-related, and leisure activities; and impaired sexual function. Because the creation of an ostomy affects multiple domains within the construct of health-related quality of life (HRQOL), it is not surprising that quality of life is a frequent outcome measure in ostomy-related research. We reviewed existing research in order to identify the influence of intestinal ostomy surgery on HRQOL. We sought to identify clinical evidence documenting the influence of nursing interventions on HRQOL in patients with an intestinal ostomy. In addition, we systematically reviewed the literature to evaluate the validity and reliability of condition-specific instruments for measuring HRQOL in this patient population. We completed an integrative review using the key terms "quality of life" and "ostomy" in order to identify sufficient evidence to determine the influence of intestinal ostomy surgery on HRQOL. A systematic review using the key terms "ostomy" and "nursing" was completed to identify the effect of specific nursing interventions on HRQOL in patients with intestinal ostomies. Only randomized clinical trials were included in this review. A systematic review using the key terms "quality of life" and "ostomy" was used to review and identify condition-specific HRQOL instruments and evidence of their validity and reliability. MEDLINE and CINAHL databases were used to address all 3 aims of this Evidence-Based Report Card. Searches were limited to studies published between 1980 and January 2009. Hand searches of the ancestry of studies and review articles were completed to identify additional studies. An integrative

  13. The effect of education given before surgery on self-esteem and body image in women undergoing hysterectomy.

    Science.gov (United States)

    Yaman, Şengül; Ayaz, Sultan

    2015-12-01

    To evaluate the effect of information provided before surgery on the self-esteem and body image of women undergoing hysterectomy. The study had a semi-experimental design with pre-post tests. A total of 60 women were included in the study and divided into two groups, the intervention group (n=30) and control group (n=30). A questionnaire, the Rosenberg self-esteem scale, and the body image scale were used to collect data. The pre- and post-test body image scores were similar in the intervention group patients, but the post-test scores were significantly higher in the control group (pself-esteem scores were again similar in the intervention group, but the post-test scores were significantly lower in the control group (pbody image and consequently self-esteem.

  14. Effects of foot reflexology on anxiety and physiological parameters in patients undergoing coronary artery bypass graft surgery: A clinical trial.

    Science.gov (United States)

    Abbaszadeh, Yaser; Allahbakhshian, Atefeh; Seyyedrasooli, Alehe; Sarbakhsh, Parvin; Goljarian, Sakineh; Safaei, Naser

    2018-05-01

    This study aimed to investigate the effect of foot reflexology on anxiety and physiological parameters in patients after CABG surgery. This was a single-blind, three-arm, parallel-group, randomized controlled trial with three groups of 40 male patients undergoing CABG. Participants were placed in three groups, named intervention, placebo, and control. Physiological parameters were measured including systolic and diastolic blood pressure, mean arterial pressure, heart rate, respiratory rate, percutaneous oxygen saturation, and anxiety of participants. Results showed a statistically significant difference between intervention and control groups in terms of the level of anxiety (p foot reflexology may be used by nurses as an adjunct to standard ICU care to reduce anxiety and stabilize physiological parameters such as systolic, diastolic, mean arterial pressure, and heart rate. Copyright © 2018 Elsevier Ltd. All rights reserved.

  15. The effect of cardiac rehabilitation on anxiety and depression in patients undergoing cardiac bypass graft surgery in Iran

    Directory of Open Access Journals (Sweden)

    Sharif Farkhondeh

    2012-06-01

    Full Text Available Abstract Background Many patients experience anxiety and depression after cardiac bypass surgery. The aim of this study was to examine the effect of cardiac rehabilitation on anxiety and depression in patients undergoing coronary artery bypass grafting in hospitals affiliated to Shiraz University of Medical Sciences in southern Iran. Methods For this randomized controlled trial, 80 patients who met the inclusion criteria were recruited and randomly assigned to case and control groups. Anxiety was measured with the Spielberger Anxiety Scale and depression was measured using Beck’s Depression Inventory at three points in time: on discharge from the hospital, immediately after the intervention, and 2 months after cardiac rehabilitation. After measuring anxiety and depression in both groups upon discharge, the experimental group participated in 8 cardiac rehabilitation sessions over a 4-week period. The control group received only the routine follow-up care. Results There was a statistically significant difference in depression scores between groups at all three time-points (Mean score from 19.6 to 10 in the intervention group and from 19.5 to 14 in the control group, P = 0.0014. However, no significant difference was seen in anxiety scores between the groups (Mean score from 37 to 28 in the intervention group and from 38 to 32 in the control group, P = 0.079. Conclusions Cardiac rehabilitation was effective in reducing depression 2 months after surgery in patients undergoing coronary artery bypass grafting. Trial registration IRCTN201203262812N8

  16. Impact of Blood Transfusions on Survival of Locally Advanced Cervical Cancer Patients Undergoing Neoadjuvant Chemotherapy Plus Radical Surgery.

    Science.gov (United States)

    Bogani, Giorgio; Ditto, Antonino; Martinelli, Fabio; Signorelli, Mauro; Chiappa, Valentina; Lopez, Carlos; Indini, Alice; Leone Roberti Maggiore, Umberto; Sabatucci, Ilaria; Lorusso, Domenica; Raspagliesi, Francesco

    2017-03-01

    Transfusions represent one of the main progresses of modern medicine. However, accumulating evidence supports that transfusions correlate with worse survival outcomes in patients affected by solid cancers. In the present study, we aimed to investigate the effects of perioperative blood transfusion in locally advanced cervical cancer. Data of consecutive patients affected by locally advanced cervical cancer scheduled to undergo neoadjuvant chemotherapy plus radical surgery were retrospectively searched to test the impact of perioperative transfusions on survival outcomes. Five-year survival outcomes were evaluated using Kaplan-Meier and Cox models. The study included 275 patients. Overall, 170 (62%) patients had blood transfusion. Via univariate analysis, we observed that transfusion correlated with an increased risk of developing recurrence (hazard ratio [HR], 2.2; 95% confidence interval [CI], 1.09-4.40; P = 0.02). Other factors associated with 5-year disease-free survival were noncomplete clinical response after neoadjuvant chemotherapy (HR, 2.99; 95% CI, 0.92-9.63; P = 0.06) and pathological (P = 0.03) response at neoadjuvant chemotherapy as well as parametrial (P = 0.004), vaginal (P < 0.001), and lymph node (P = 0.002) involvements. However, via multivariate analysis, only vaginal (HR, 3.07; 95% CI, 1.20-7.85; P = 0.01) and lymph node involvements (HR, 2.4; 95% CI, 1.00-6.06; P = 0.05) correlate with worse disease-free survival. No association with worse outcomes was observed for patients undergoing blood transfusion (HR, 2.71; 95% CI, 0.91-8.03; P = 0.07). Looking at factors influencing overall survival, we observed that lymph node status (P = 0.01) and vaginal involvement (P = 0.06) were independently associated with survival. The role of blood transfusions in increasing the risk of developing recurrence in LAAC patients treated by neoadjuvant chemotherapy plus radical surgery remains unclear; further prospective studies are warranted.

  17. Comparison of harmonic blade versus traditional approach in canine patients undergoing spinal decompressive surgery for naturally occurring thoracolumbar disk extrusion.

    Directory of Open Access Journals (Sweden)

    Bianca F Hettlich

    Full Text Available To assess feasibility of the harmonic Osteovue blade (HOB for use in the soft tissue approach for dogs undergoing hemilaminectomy and to compare outcomes between dogs undergoing HOB or traditional approach (TRAD.A prospective randomized clinical trial was performed using 20 client-owned dogs with thoracolumbar intervertebral disk extrusion requiring hemilaminectomy. Dogs were randomly assigned to HOB or TRAD. Neurologic function and pain scores were assessed pre-operatively. Intraoperative blood loss and surgical approach time as well as postoperative pain and wound healing scores were recorded. Additionally, neurologic recovery and owner perceived quality of life were recorded at day 10 and 30 postoperative.There was no significant difference in sex distribution, weight, age, preoperative neurological grade and pain score, and perioperative outcome measures between groups. Intraoperative total blood loss was minimal for HOB and TRAD (median: 0 ml (range 0-9 and 2.2 ml (range 0-6.8, respectively; p = 0.165 and approach times were similar (median: 7 min (range 5-12 and 8 min (range 5-13, respectively; p = 0.315. While changes in wound healing scores were similar, changes in postoperative pain scores and neurological function were significantly improved in the HOB compared to the TRAD group. Postoperative complications in the HOB group consisted of automutilation of part of the incision and development of a small soft, non-painful subcutaneous swelling in 1 dog each.The HOB is a safe and effective tool for the soft tissue approach for routine spinal surgery in dogs and is associated with decreased pain and increased neurological function post-surgery.

  18. Effect of perioperative mupirocin and antiseptic body wash on infection rate and causative pathogens in patients undergoing cardiac surgery.

    Science.gov (United States)

    Kohler, Philipp; Sommerstein, Rami; Schönrath, Felix; Ajdler-Schäffler, Evelyne; Anagnostopoulos, Alexia; Tschirky, Sandra; Falk, Volkmar; Kuster, Stefan P; Sax, Hugo

    2015-07-01

    Preoperative nasal mupirocin has been shown to reduce surgical site infections (SSIs) in patients undergoing cardiac surgery. We analyzed the effect of mupirocin plus antiseptic body wash on SSI rate and etiology. Prospective SSI surveillance was done for patients undergoing cardiac surgery before and after implementation of mupirocin nasal ointment and chlorhexidine/octenidine body wash. Overall SSI rate was 8.6% (81 out of 945) for the control and 6.9% (58 out of 842) for the intervention cohort (P = .19). In multivariable analysis, the study protocol was associated with an odds ratio of 0.61 (95% confidence interval, 0.41-0.91; P = .015) with regard to any SSI. This effect was exclusively due to a reduction in superficial SSIs and was observed both in patients with preoperative and postoperative treatment initiation. Coagulase-negative staphylococci (CoNS), the most commonly isolated pathogen, were found in 37% and 48% (P = .19) of patients in the control and the intervention cohort, respectively. CoNS were methicillin resistant in 69% of cases. Mupirocin and antiseptic body wash reduced the rate of superficial but not deep or organ/space SSIs. Postoperative patient treatment may be critical in reducing the risk for superficial SSI, presumably due to a reduction of bacterial skin load. A high proportion of SSI was due to methicillin-resistant CoNS and thus not covered by routine perioperative antimicrobial prophylaxis. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  19. [Periodontal microbiota and microorganisms isolated from heart valves in patients undergoing valve replacement surgery in a clinic in Cali, Colombia].

    Science.gov (United States)

    Moreno, Sandra; Parra, Beatriz; Botero, Javier E; Moreno, Freddy; Vásquez, Daniel; Fernández, Hugo; Alba, Sandra; Gallego, Sara; Castillo, Gilberto; Contreras, Adolfo

    2017-12-01

    Periodontitis is an infectious disease that affects the support tissue of the teeth and it is associated with different systemic diseases, including cardiovascular disease. Microbiological studies facilitate the detection of microorganisms from subgingival and cardiovascular samples. To describe the cultivable periodontal microbiota and the presence of microorganisms in heart valves from patients undergoing valve replacement surgery in a clinic in Cali. We analyzed 30 subgingival and valvular tissue samples by means of two-phase culture medium, supplemented blood agar and trypticase soy agar with antibiotics. Conventional PCR was performed on samples of valve tissue. The periodontal pathogens isolated from periodontal pockets were: Fusobacterium nucleatum (50%), Prevotella intermedia/ nigrescens (40%), Campylobacter rectus (40%), Eikenella corrodens (36.7%), Gram negative enteric bacilli (36.7%), Porphyromonas gingivalis (33.3%), and Eubacterium spp. (33.3%). The pathogens isolated from the aortic valve were Propionibacterium acnes (12%), Gram negative enteric bacilli (8%), Bacteroides merdae (4%), and Clostridium bifermentans (4%), and from the mitral valve we isolated P. acnes and Clostridium beijerinckii. Conventional PCR did not return positive results for oral pathogens and bacterial DNA was detected only in two samples. Periodontal microbiota of patients undergoing surgery for heart valve replacement consisted of species of Gram-negative bacteria that have been associated with infections in extraoral tissues. However, there is no evidence of the presence of periodontal pathogens in valve tissue, because even though there were valve and subgingival samples positive for Gram-negative enteric bacilli, it is not possible to maintain they corresponded to the same phylogenetic origin.

  20. Anesthetic considerations in the patients of chronic obstructive pulmonary disease undergoing laparoscopic surgeries.

    Science.gov (United States)

    Khetarpal, Ranjana; Bali, Kusum; Chatrath, Veena; Bansal, Divya

    2016-01-01

    The aim of this study was to review the various anesthetic options which can be considered for laparoscopic surgeries in the patients with the chronic obstructive pulmonary disease. The literature search was performed in the Google, PubMed, and Medscape using key words "analgesia, anesthesia, general, laparoscopy, lung diseases, obstructive." More than thirty-five free full articles and books published from the year 1994 to 2014 were retrieved and studied. Retrospective data observed from various studies and case reports showed regional anesthesia (RA) to be valid and safer option in the patients who are not good candidates of general anesthesia like patients having obstructive pulmonary diseases. It showed better postoperative patient outcome with respect to safety, efficacy, postoperative pulmonary complications, and analgesia. So depending upon disease severity RA in various forms such as spinal anesthesia, paravertebral block, continuous epidural anesthesia, combined spinal epidural anesthesia (CSEA), and CSEA with bi-level positive airway pressure should be considered.

  1. Anesthetic management of a pediatric patient with hypohidrotic ectodermal dysplasia undergoing emergency surgery.

    Science.gov (United States)

    Ahiskalioglu, Elif Oral; Ahiskalioglu, Ali; Firinci, Binali; Dostbil, Aysenur; Aksoy, Mehmet

    2015-01-01

    Ectodermal dysplasias are rare conditions with a triad of hypotrichosis, anodontia and anhidrosis. In literature review there have been only a few reports of anesthetic management of patients with ectodermal dysplasias. Hyperthermia is a very serious risk which may occur due to the defect of sweat glands. The present case involves a 10-year-old child with ectodermal dysplasia who presented with an acute abdomen and was considered for an emergency surgery. Our aim was to demonstrate the successful management of this case using a combination of general and epidural anesthesia. It is important for anesthesiologist to have information about this syndrome in case of emergency operations, since it can prevent serious complications and even save lives. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  2. The role of physiotherapy in patients undergoing pulmonary surgery for lung cancer. A literature review

    Directory of Open Access Journals (Sweden)

    F. Kendall

    2017-11-01

    In conclusion, physiotherapy programs should be individually designed, and the goals established according to surgery timings, and according to each subject's needs. It can also be concluded that in the preoperative phase, the main goals are to avoid postoperative pulmonary complications and reduce the length of hospital stay, and the therapeutic targets are respiratory muscle training, bronchial hygiene and exercise training. For the perioperative period, breathing exercises for pulmonary expansion and bronchial hygiene, as well as early mobilization and deambulation, postural correction and shoulder range of motion activities, should be added. Finally, it can be concluded that in the postoperative phase exercise training should be maintained, and adoption of healthy life-style behaviours must be encouraged.

  3. HPV genotype distribution in older Danish women undergoing surgery due to cervical cancer

    DEFF Research Database (Denmark)

    Hammer, Anne; Mejlgaard, Else; Gravitt, Patti

    2015-01-01

    INTRODUCTION: The prevalence of human papillomavirus (HPV)16/18 in cervical cancer may decrease with age. This study aimed to describe the HPV genotype distribution in Danish women aged 55 years or older with cervical cancer. MATERIAL AND METHODS: In this cross-sectional study we identified 153...... cases of cervical cancer diagnosed at Aarhus University Hospital, Denmark (1990-2012) and Copenhagen University Hospital Herlev, Denmark (2007-2012). All women had surgery to treat the disease. HPV genotyping was performed on cervical cancer tissue using the INNO LiPA HPV genotyping extra (Fujirebio......, Belgium) at the Department of Pathology, Aarhus University Hospital, Denmark. The main outcome was to estimate the age-specific prevalence of high-risk HPV genotypes included in the bivalent, the quadrivalent, and the nonavalent vaccine. RESULTS: Of 121 cases of cervical cancer included in this study, 113...

  4. Metformin Increases Overall Survival in Patients with Diabetes Undergoing Surgery for Colorectal Cancer

    DEFF Research Database (Denmark)

    Fransgaard, Tina; Thygesen, Lau Caspar; Gögenur, Ismail

    2015-01-01

    -Meier estimator and the Cox regression model adjusted for important clinical risk factors were used. RESULTS: A total of 30,493 patients were included in the study, of which 3391 were diagnosed with diabetes and 1962 were treated with metformin. The adjusted HR of all-cause mortality for the diabetes group was 1......BACKGROUND: Emerging evidence suggests that metformin decreases the risk of developing colorectal cancer in patients with diabetes, but only few studies have examined potential survival benefits after surgery for colorectal cancer (CRC). The purpose of the study was to examine the association......'s National Clinical Database (DCCG). The Danish National Patient Register (NPR) records all hospital contacts in Denmark, and the diagnosis of diabetes was identified by combining NPR data with use of antidiabetic drugs identified through the Danish National Prescription Registry and DCCG. The Kaplan...

  5. Anesthetic management of a pediatric patient with hypohidrotic ectodermal dysplasia undergoing emergency surgery

    Directory of Open Access Journals (Sweden)

    Elif Oral Ahiskalioglu

    2015-11-01

    Full Text Available Ectodermal dysplasias are rare conditions with a triad of hypotrichosis, anodontia and anhidrosis. In literature review there have been only a few reports of anesthetic management of patients with ectodermal dysplasias. Hyperthermia is a very serious risk which may occur due to the defect of sweat glands. The present case involves a 10-year-old child with ectodermal dysplasia who presented with an acute abdomen and was considered for an emergency surgery. Our aim was to demonstrate the successful management of this case using a combination of general and epidural anesthesia. It is important for anesthesiologist to have information about this syndrome in case of emergency operations, since it can prevent serious complications and even save lives.

  6. Anesthetic management of a pediatric patient with hypohidrotic ectodermal dysplasia undergoing emergency surgery

    Directory of Open Access Journals (Sweden)

    Elif Oral Ahiskalioglu

    2015-12-01

    Full Text Available ABSTRACT Ectodermal dysplasias are rare conditions with a triad of hypotrichosis, anodontia and anhidrosis. In literature review there have been only a few reports of anesthetic management of patients with ectodermal dysplasias. Hyperthermia is a very serious risk which may occur due to the defect of sweat glands. The present case involves a 10-year-old child with ectodermal dysplasia who presented with an acute abdomen and was considered for an emergency surgery. Our aim was to demonstrate the successful management of this case using a combination of general and epidural anesthesia. It is important for anesthesiologist to have information about this syndrome in case of emergency operations, since it can prevent serious complications and even save lives.

  7. Pre- and post-operative values of serum CRP in patients undergoing surgery for brain tumour

    International Nuclear Information System (INIS)

    Syeda, T.; Rizvi, H.A.; Hashim, A.S.

    2014-01-01

    Objective: To determine the concentration of C-reactive protein in pre- and post-operative serum samples of brain tumour patients in order to detect the potential risks of post-operative infections. Methods: Serum C-reactive protein was measured on pre- and post-operative Day 1, Day 2 and Day 7 in 18 patients who underwent surgery for brain tumours. The study was performed at the Neurosurgical Ward, Jinnah Postgraduate Medical Centre, Karachi, from May 2007 to April 2008. Mean pre-operative patients and control values were compared using Mann-Whitney or Wilcoxon tests for comparing between pre- and post-operative values. P-value was considered significant at 5.0mg/L but no statistically significant difference was found when compared with healthy controls, with mean 4.4+-6.6 and 0.9+-0.7, respectively. Significantly raised serum concentrations were observed in all post-operative samples when compared with pre-operative samples. Serum CRP concentrations significantly increased post-operatively on Day 1, with mean value of 102.9+-82.0mg/L (p<0.0005), and further increased on Day 2 with mean value of 166.9+-128.1mg/L (p<0.0005), but declined on Day 7, with mean value of 42.7+-63.6mg/L (p<0.005). Conclusion: Pre-operative serum C-reactive protein concentrations of 28% of the patients were elevated, suggesting an association with brain tumours. Post-operative serum concentrations were significantly higher than those noted before the surgery. Absence of a fall of concentration from peak value on post-operative Day 2 or a secondary rise from post-operative Day 7 could be alarming for inter-current infection. (author)

  8. Effect of Dex medetomidine on Neuromuscular Blockade in Patients Undergoing Complex Major Abdominal or Pelvic Surgery

    International Nuclear Information System (INIS)

    El-Awady, G.A.; Abdelhalim, J.M.K.; Azer, M.S.

    2003-01-01

    Dex medetomidine is a highly selective α2 agonist with anesthetic, analgesic and sympatholytic properties. Its neuromuscular effects in humans are unknown. This study evaluates the effect of dex medetomidine on neuromuscular block and hemodynamics during thiopental/ isoflurane anesthesia for patients with complex abdominal or pelvic surgery. Patients and methods: During thiopental/isoflurane anesthesia, the rocuronium infusion rate was adjusted in 20 complex surgery patients to maintain a stable first response (T1) in the train of four sequence of 50% ± 3 of the pre-rocuronium value. Dex medetomidine was then administered by infusion pump, targeting a plasma dex medetomidine concentration of 0.6 ng/dL for 45 min. The evoked mechanical responses of the adductor pollicis responses (T1 response and T4/T1 ratio), systolic blood pressure, diastolic blood pressure and heart rate (HR) were measured during the dex medetomidine infusion using repeated measures analysis of variance. Plasma levels ranged from 0.73 to 1.38 ng/mL. Results: T1 values decreased during the infusion from 55(ρ2 to 38±9 ((ρ< 0.05). T4/Tl values did not change during the infusion. Dex medetomidine increased SBP (ρ< 0.001) and decreased HR ((ρ< 0.05) (10 min median values) during the infusion compared with values before the infusion. This study demonstrated that dex medetomidine decreased T1, increased SBP and decreased HR during thiopental/isoflurane anesthesia. Conclusion: We conclude that dex medetomidine induced direct vasoconstriction may alter pharmacokinetics of rocuronium, therefore increasing plasma rocuronium concentration. Although these effects were statistically significant, further studies should be held for understanding and characterizing the peripheral vasoconstrictive effects of a2 agonists that allow better management and determination of drug dosing regimens

  9. OSA screening with the pediatric sleep questionnaire for adolescents undergoing bariatric surgery in teen-LABS.

    Science.gov (United States)

    Ishman, Stacey; Heubi, Christine; Jenkins, Todd; Michalsky, Marc; Simakajornboon, Narong; Inge, Thomas

    2016-11-01

    Obstructive sleep apnea (OSA) is reported in 70% of adolescents who present for bariatric surgery. The Pediatric Sleep Questionnaire (PSQ) was developed to identify children at risk for OSA but is not validated in adolescents with obesity. The aims of this study were: (1) to assess validity of the PSQ to detect OSA and (2) to determine the correlation between anthropometric and polysomnography measurements. A cross-sectional assessment of Teen-Longitudinal Assessment of Bariatric Surgery participants at high risk for OSA was performed. Participants completed an overnight polysomnography, and caregivers completed the PSQ. Forty-five participants (84% female, 78% Caucasian, mean age = 16.7 ± 1.5 years) were evaluated. Mean BMI was 51.3 ± 7.7 kg/m 2 and mean obstructive apnea-hypopnea index (oAHI) was 6.1 ± 5.9 events/h. For diagnosis of OSA (oAHI ≥5), the total PSQ score sensitivity, specificity, and positive predictive value (PPV) were 86%, 38%, and 55%, respectively. For snoring >50% of the time, PPV was 84%, sensitivity was 64%, and specificity was 43%. Sagittal abdominal diameter correlated with oAHI and oxygen saturation nadir (ρ = 0.34, P = 0.027), whereas BMI, neck, and waist circumference correlated with neither. The PSQ demonstrated low specificity, and PPV and the question regarding snoring >50% of the time did not effectively identify OSA. Sagittal abdominal diameter correlated with oAHI and oxygen saturation nadir. © 2016 The Obesity Society.

  10. Hispanic parents' experiences of the process of caring for a child undergoing routine surgery: a focus on pain and pain management.

    Science.gov (United States)

    Olshansky, Ellen; Zender, Robynn; Kain, Zeev N; Rosales, Alvina; Guadarrama, Josue; Fortier, Michelle A

    2015-07-01

    The purpose was to understand the processes Hispanic parents undergo in managing postoperative care of children after routine surgical procedures. Sixty parents of children undergoing outpatient surgery were interviewed. Data were analyzed using grounded theory methodology. Parents experienced five subprocesses that comprised the overall process of caring for a child after routine surgery: (a) becoming informed; (b) preparing; (c) seeking reassurance; (d) communicating with one's child; and (e) making pain management decisions. Addressing cultural factors related to pain management in underserved families may instill greater confidence in managing pain. © 2015, Wiley Periodicals, Inc.

  11. Noncardiac chest pain: diagnosis and management.

    Science.gov (United States)

    Yamasaki, Takahisa; Fass, Ronnie

    2017-07-01

    Noncardiac chest pain (NCCP) has been defined as recurrent chest pain that is indistinguishable from ischemic heart pain after excluding a cardiac cause. NCCP is a common and highly challenging clinical problem in Gastrointestinal practice that requires targeted diagnostic assessment to identify the underlying cause of the symptoms. Treatment is tailored according to the cause of NCCP: gastroesophageal reflux disease (GERD), esophageal dysmotility or functional chest pain. The purpose of this review is to discuss the current diagnosis and treatment of NCCP. Utilization of new diagnostic techniques such as pH-impedance and high-resolution esophageal manometry, and the introduction of a new definition for functional chest pain have helped to better diagnose the underlying mechanisms of NCCP. A better therapeutic approach toward GERD-related NCCP, the introduction of new interventions for symptoms due to esophageal spastic motor disorders and the expansion of the neuromodulator armamentarium for functional chest pain have changed the treatment landscape of NCCP. GERD is the most common esophageal cause of NCCP, followed by functional chest pain and esophageal dysmotility. The proton pump inhibitor test, upper endoscopy, wireless pH capsule and pH-impedance are used to identify GERD-induced NCCP. High-resolution esophageal manometry is the main tool to identify esophageal motor disorder in non-GERD-related NCCP. Negative diagnostic assessment suggests functional chest pain. Potent antireflux treatment is offered to patients with GERD-related NCCP; medical, endoscopic or surgical interventions are considered in esophageal dysmotility; and neuromodulators are prescribed for functional chest pain. Assessment and treatment of psychological comorbidity should be considered in all NCCP patients.

  12. The influence of body mass index on outcomes in patients undergoing cardiac surgery: does the obesity paradox really exist?

    Directory of Open Access Journals (Sweden)

    Juan Carlos Lopez-Delgado

    Full Text Available Obesity influences risk stratification in cardiac surgery in everyday practice. However, some studies have reported better outcomes in patients with a high body mass index (BMI: this is known as the obesity paradox. The aim of this study was to quantify the effect of diverse degrees of high BMI on clinical outcomes after cardiac surgery, and to assess the existence of an obesity paradox in our patients.A total of 2,499 consecutive patients requiring all types of cardiac surgery with cardiopulmonary bypass between January 2004 and February 2009 were prospectively studied at our institution. Patients were divided into four groups based on BMI: normal weight (18.5-24.9 kg∙m-2; n = 523; 21.4%, overweight (25-29.9 kg∙m-2; n = 1150; 47%, obese (≥ 30-≤ 34.9 kg∙m-2; n = 624; 25.5% and morbidly obese (≥ 35kg∙m-2; n = 152; 6.2%. Follow-up was performed in 2,379 patients during the first year.After adjusting for confounding factors, patients with higher BMI presented worse oxygenation and better nutritional status, reflected by lower PaO2/FiO2 at 24h and higher albumin levels 48 h after admission respectively. Obese patients showed a higher risk for Perioperative Myocardial Infarction (OR: 1.768; 95% CI: 1.035-3.022; p = 0.037 and septicaemia (OR: 1.489; 95% CI: 1.282-1.997; p = 0.005. In-hospital mortality was 4.8% (n = 118 and 1-year mortality was 10.1% (n = 252. No differences were found regarding in-hospital mortality between BMI groups. The overweight group showed better 1-year survival than normal weight patients (91.2% vs. 87.6%; Log Rank: p = 0.029. HR: 1.496; 95% CI: 1.062-2.108; p = 0.021.In our population, obesity increases Perioperative Myocardial Infarction and septicaemia after cardiac surgery, but does not influence in-hospital mortality. Although we found better 1-year survival in overweight patients, our results do not support any protective effect of obesity in patients undergoing cardiac surgery.

  13. Effect of laparoscopic surgery on health care utilization and costs in patients who undergo colectomy.

    Science.gov (United States)

    Crawshaw, Benjamin P; Chien, Hung-Lun; Augestad, Knut M; Delaney, Conor P

    2015-05-01

    Laparoscopic colectomy is safe and effective in the treatment of many colorectal diseases. However, the effect of increasing use of laparoscopy on overall health care utilization and costs, especially in the long term, has not been thoroughly investigated. To evaluate the effect of laparoscopic vs open colectomy on short- and long-term health care utilization and costs. Retrospective multivariate regression analysis of national health insurance claims data was used to evaluate health care utilization and costs up to 1 year following elective colectomy. Data were obtained from the Truven Health Analytics MarketScan Commercial Claims and Encounters database. Patients aged 18 to 64 years who underwent elective laparoscopic or open colectomy from January 1, 2010, through December 31, 2010, were included. Patients with complex diagnoses that require increased non-surgery-related health care utilization, including malignant neoplasm, inflammatory bowel disease, human immunodeficiency virus, transplantation, and pregnancy, were excluded. Of 25 481 patients who underwent colectomy, 4160 were included in the study. Healthcare utilization, including office, hospital outpatient, and emergency department visits and inpatient services 90 and 365 days after the index procedure; total health care costs; and estimated days off from work owing to health care utilization. Of 25 481 patients who underwent colectomy, 4160 were included in the study (laparoscopic, 45.6%; open, 54.4%). The mean (SD) net and total payments were lower for laparoscopy ($23 064 [$14 558] and $24 196 [$14 507] vs $29 753 [$21 421] and $31 606 [$23 586]). In the first 90 days after surgery, an open approach was significantly associated with a 1.26-fold increase in health care costs (estimated, $1715; 95% CI, $338-$2853), increased use of heath care services, and more estimated days off from work (2.78 days; 95% CI, 1.93-3.59). Similar trends were found in the full postoperative year, with

  14. Role of oral gabapentin as preemptive adjuvant with spinal anesthesia for postoperative pain in patients undergoing surgeries under spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Roshan Lal Gogna

    2017-01-01

    Full Text Available Background and Aims: The study was undertaken to evaluate postoperative benefit in patients administered tablet gabapentin as premedication with the primary outcome determining the effect on duration of analgesia with total analgesic requirement and measurement of postoperative sedation scores as our secondary outcomes. Methods: The study was a prospective randomized observational study in sixty patients undergoing surgeries in spinal anesthesia (SA. Patients were randomly assigned into two groups. Group A (n = 30 patients received tablet gabapentin (600 mg while Group B (n = 30 received a placebo (Vitamin B complex orally 2 h before surgery. Postoperative pain was managed with intravenous tramadol 2 mg/kg. Postoperative monitoring and assessment included pain assessment every 2 h with Numeric Rating Scale (0–10 for 12 h and then at 24 h. Results: On comparison of intergroup data, the duration of analgesia was prolonged in Group A (288.79 ± 38.81 min as compared to Group B (218.67 ± 37.62 min with P (0.0001. Total opioid requirement was higher in placebo group as compared to the Group A (P = 0.025. Statistical difference in mean (standard deviation pain score at 24 h was statistically significant (P = 0.0002. Sedation scores were significantly higher in Group A at 2 and 4 h post-SA. Conclusion: Single dose of gabapentin administered 2 h before surgery provides better pain control as compared to placebo. It prolongs the duration of analgesia, reduces the total analgesic requirement during the postoperative period.

  15. Effect of a Preoperative Preparation Program on Anxiety in School-age Children Undergoing Surgery Using a Factorial Design

    Directory of Open Access Journals (Sweden)

    Maliheh Shoja

    2018-01-01

    Full Text Available Background: Surgery is a stressful experience in children. Therefore, the familiarization of this population with treatment processes by means of appropriate training tools and techniques can be an effective way to control their anxiety. Aim: The aim of this study was to determine the effect of a preoperative preparation program on anxiety in school-age children undergoing surgery using a factorial design. Method: This clinical trial was conducted on 81 children aged 6-12 years as candidates for elective surgery at Doctor Sheikh Hospital in Mashhad, Iran, in 2016. A preparation program was implemented with two methods (i.e., displaying video tutorials with and without nurses’ explanations and on two different days (i.e., prior to and on the day of operation using a factorial design. The estimation of children’s anxiety was accomplished by using the Revised Children’s Manifest Anxiety Scale administered before training and prior to operating room admission. The data were analyzed by statistical tests in SPSS software, version 16. Results: The study groups were comparable in terms of demographic characteristics (P>0.05. There was no significant differences among the four groups regarding manifest anxiety based on the place of referral (i.e., department or clinic (P=0.22, presentation or non-presentation of explanations by nurses (P=0.12, and their interaction effects (P=0.22. Implications for Practice: No significant difference was observed among the four groups in terms of manifest anxiety. Therefore, all four training methods were effective in reducing anxiety in children. Consequently, each of these methods can be used depending on human resources and infrastructure of each department.

  16. Optimised anaesthesia to reduce post operative cognitive decline (POCD in older patients undergoing elective surgery, a randomised controlled trial.

    Directory of Open Access Journals (Sweden)

    Clive Ballard

    Full Text Available BACKGROUND: The study determined the one year incidence of post operative cognitive decline (POCD and evaluated the effectiveness of an intra-operative anaesthetic intervention in reducing post-operative cognitive impairment in older adults (over 60 years of age undergoing elective orthopaedic or abdominal surgery. METHODS AND TRIAL DESIGN: The design was a prospective cohort study with a nested randomised, controlled intervention trial, using intra-operative BiSpectral index and cerebral oxygen saturation monitoring to enable optimisation of anaesthesia depth and cerebral oxygen saturation in older adults undergoing surgery. RESULTS: In the 52 week prospective cohort study (192 surgical patients and 138 controls, mild (χ(2 = 17.9 p<0.0001, moderate (χ(2 = 7.8 p = 0.005 and severe (χ(2 = 5.1 p = 0.02 POCD were all significantly higher after 52 weeks in the surgical patients than among the age matched controls. In the nested RCT, 81 patients were randomized, 73 contributing to the data analysis (34 intervention, 39 control. In the intervention group mild POCD was significantly reduced at 1, 12 and 52 weeks (Fisher's Exact Test p = 0.018, χ(2 = 5.1 p = 0.02 and χ(2 = 5.9 p = 0.015, and moderate POCD was reduced at 1 and 52 weeks (χ(2 = 4.4 p = 0·037 and χ(2 = 5.4 p = 0.02. In addition there was significant improvement in reaction time at all time-points (Vigilance Reaction Time MWU Z = -2.1 p = 0.03, MWU Z = -2.7 p = 0.004, MWU Z = -3.0 p = 0.005, in MMSE at one and 52 weeks (MWU Z = -2.9 p = 0.003, MWU Z = -3.3 p = 0.001, and in executive function at 12 and 52 weeks (Trail Making MWU Z = -2.4 p = .0.018, MWU Z = -2.4 p = 0.019. CONCLUSION: POCD is common and persistent in older adults following surgery. The results of the nested RCT indicate the potential benefits of intra-operative monitoring of anaesthetic depth and cerebral oxygenation as a pragmatic intervention to reduce post-operative cognitive impairment. TRIAL REGISTRATION

  17. Demographic characteristics and visual status of patients undergoing cataract surgery at a tertiary hospital in Kano, Nigeria.

    Science.gov (United States)

    Kurawa, Musbahu Sani; Abdu, Lawan

    2017-01-01

    Objective/Purpose: To describe the demographic and baseline ocular characteristics, prevalence of blindness and visual impairment among patients undergoing extracapsular cataract extraction for age related cataract at the study hospital over a one year period. Materials/Patients: All consecutive patients aged 40 years and above identified with age related cataract in one or both eyes who voluntarily agree to participate were included. The study adhered to the tenets of the Helsinki declaration. Written informed consent was obtained from all eligible patients. All patients underwent basic eye examination by the ophthalmologist. Visual impairment was determined for each eye according to the standard WHO categorizations. Information obtained also included age, sex and history of previous cataract surgery. Data were recorded in manual tally sheets and on modified computer Cataract Surgery Record forms. Analyses were done using SPSS (version 16, SPSS Inc., Chicago, USA). The participation rate was 91.2%. There were 495 eyes of 487 consecutive patients. This include 212 males and 275 females (M:F, 1:1.3). The age range was 40 to 99 years with a mean age of 62.76 ± 10.49 years (61.35 ± 9.75 years in men and 63.85±10.9 years in females). Most of the patients (n = 451; 92.6%, 95% CI: 89.9-94.6%) were aged 50 years and above. Sixty patients (12.3%, 95% CI: 9.6-15.5%) had cataract in both eyes, 427 (87.7%, 95% CI: 84.5-90.3%) were in one eye. Among these, preoperatively 16 (3.3%, 95% CI: 2.0-5.3%) had aphakia, 21 (4.3%, 95% CI: 2.8-6.5%) had uniocular pseudophakia. About 63.2% (95% CI: 58.9-67.4%) of patients had normal vision in the better eye (presenting VA ≥6/18). Overall 9.5% (95% CI: 7.3-12.7%) were bilaterally blind. About 96.8% of eyes (95% CI: 94.5-98.0%) undergoing cataract surgery were blind (presenting VAConclusion: The study highlights preponderance of females and high incidence of blinding cataract. Education and early disease awareness may play an important

  18. Evaluation of patients undergoing lung volume reduction surgery: Ancillary information available from computed tomography

    International Nuclear Information System (INIS)

    Cleverley, Joanne R.; Desai, Sujal R.; Wells, Athol U.; Koyama, Hiroshi; Eastick, Sian; Schmidt, Maria A.; Charrier, Clare L.; Gatehouse, Peter D.; Goldstraw, Peter; Pepper, John R.; Geddes, Duncan M.; Hansell, David M.

    2000-01-01

    AIM: A number of imaging techniques have been used for the pre-operative assessment of patients for lung volume reduction surgery (LVRS). We evaluated whether data currently acquired from perfusion scintigrams and cine MR of the diaphragm are obtainable from high resolution CT (HRCT) of the thorax. MATERIALS AND METHODS: Thirty patients taking part in a randomized controlled trial of LVRS against maximal medical therapy were evaluated. HRCT examinations (n= 30) were scored for (i) the extent and distribution of emphysema; (ii) the extent of normal pulmonary vasculature; and (iii) diaphragmatic contour, apparent defects and herniation. On scintigraphy, (n28), perfusion of the lower thirds of both lungs, as a proportion of total lung perfusion (LZ/T PERF ), was expressed as a percentage of predicted values (derived from 10 normal control subjects). On cine MR (n= 25) hemidiaphragmatic excursion and coordination were recorded. RESULTS: Extensive emphysema was present on HRCT (60% ± 13.2%). There was strong correlation between the extent of normal pulmonary vasculature on HRCT and on perfusion scanning (r s = 0.85, P< 0.00005). Hemidiaphragmatic incoordination on MR was weakly associated with hemidiaphragmatic eventration on HRCT (P0.04). CONCLUSION: The strong correlation between lung perfusion assessed by HRCT and lung perfusion on scintigraphy suggests that perfusion scintigraphy is superfluous in the pre-operative evaluation of patients with emphysema for LVRS. Cleverley, J.R. (2000)

  19. Lean Six Sigma: a new approach to the management of patients undergoing prosthetic hip replacement surgery.

    Science.gov (United States)

    Improta, Giovanni; Balato, Giovanni; Romano, Maria; Carpentieri, Francesco; Bifulco, Paolo; Alessandro Russo, Mario; Rosa, Donato; Triassi, Maria; Cesarelli, Mario

    2015-08-01

    In 2012, health care spending in Italy reached €114.5 billion, accounting for 7.2% of the Gross Domestic Product (GDP) and 14.2% of total public spending. Therefore, reducing waste in health facilities could generate substantial cost savings. The objective of this study is to show that Lean Six Sigma represents an appropriate methodology for the development of a clinical pathway which allows to improve quality and to reduce costs in prosthetic hip replacement surgery. The methodology used for the development of a new clinical pathway was Lean Six Sigma. Problem solving in Lean Six Sigma is the DMAIC (Define, Measure, Analyse, Improve, Control) roadmap, characterized by five operational phases which make possible to reach fixed goals through a rigorous process of defining, measuring, analysing, improving and controlling business problems. The following project indicated several variables influencing the inappropriate prolongation of the length of stay for inpatient treatment and corrective actions were performed to improve the effectiveness and efficiency of the process of care. The average length of stay was reduced from 18.9 to 10.6 days (-44%). This article shows there is no trade-off between quality and costs: Lean Six Sigma improves quality and, at the same time, reduces costs. © 2015 John Wiley & Sons, Ltd.

  20. Perioperative Management of Patients with Inflammatory Rheumatic Diseases Undergoing Major Orthopaedic Surgery: A Practical Overview.

    Science.gov (United States)

    Gualtierotti, Roberta; Parisi, Marco; Ingegnoli, Francesca

    2018-04-01

    Patients with inflammatory rheumatic diseases often need orthopaedic surgery due to joint involvement. Total hip replacement and total knee replacement are frequent surgical procedures in these patients. Due to the complexity of the inflammatory rheumatic diseases, the perioperative management of these patients must envisage a multidisciplinary approach. The frequent association with extraarticular comorbidities must be considered when evaluating perioperative risk of the patient and should guide the clinician in the decision-making process. However, guidelines of different medical societies may vary and are sometimes contradictory. Orthopaedics should collaborate with rheumatologists, anaesthesiologists and, when needed, cardiologists and haematologists with the common aim of minimising perioperative risk in patients with inflammatory rheumatic diseases. The aim of this review is to provide the reader with simple practical recommendations regarding perioperative management of drugs such as disease-modifying anti-rheumatic drugs, corticosteroids, non-steroidal anti-inflammatory drugs and tools for a risk stratification for cardiovascular and thromboembolic risk based on current evidence for patients with inflammatory rheumatic diseases.

  1. Urinary cotinine testing as pre-operative assessment of patients undergoing free flap surgery.

    Science.gov (United States)

    Reinbold, C; Rausky, J; Binder, J-P; Revol, M

    2015-02-01

    The identified risks of smoking with regard to operated tissues are so elevated that it is clearly dangerous to operate a smoker when the proposed intervention is neither vital nor urgent. The aim of this prospective study was to evaluate a simple method of screening patients who smoke, with the evaluation carried out before agreeing to carry out free tissue transfer. The purpose of the testing was to hold the patient responsible for his actions and minimize smoking-related complications by cancelling or postponing the planned operation if the patient continued to smoke. Screening included use of a standardized questionnaire at the first consultation and detection of cotinine using a urine test strip 7 days before the scheduled surgery. Patients were informed that in the event of positive results, the operation would not take place. A six-week preoperative smoking cessation period was mandatory. Seventy-six patients were included in this study. Among them, 25 (32.9%) reported being former smokers and 11 (14.5%) admitted in the initial questionnaire to being active smokers. Six patients (7.9%), including one self-reported non-smoker, tested positive for cotinine, and their operations were cancelled. Screening using a questionnaire and cotinine detection appeared to constitute a simple, inexpensive, rapid and reliable test. It allowed us to refuse to operate 6 non-compliant patients and was thereby likely to diminish morbidity in the free tissue transfers carried out in our ward. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  2. Intrathecal morphine is superior to intravenous PCA in patients undergoing minimally invasive cardiac surgery

    Directory of Open Access Journals (Sweden)

    Chirojit Mukherjee

    2012-01-01

    Full Text Available Aim of our study was to evaluate the beneficial effect of low dose intrathecal morphine on postoperative analgesia, over the use of intravenous patient controlled anesthesia (PCA, in patients undergoing fast track anesthesia during minimally invasive cardiac surgical procedures. A randomized controlled trial was undertaken after approval from local ethical committee. Written informed consent was obtained from 61 patients receiving mitral or tricuspid or both surgical valve repair in minimal invasive technique. Patients were assigned randomly to 2 groups. Group 1 received general anesthesia and intravenous patient controlled analgesia (PCA pump with Piritramide (GA group. Group 2 received a single shot of intrathecal morphine (1.5 μg/kg body weight prior to the administration of general anesthesia (ITM group. Site of puncture was confined to lumbar (L1-2 or L2-3 intrathecal space. The amount of intravenous piritramide used in post anesthesia care unit (PACU and the first postoperative day was defined as primary end point. Secondary end points included: time for tracheal extubation, pain and sedation scores in PACU upto third postoperative day. For statistical analysis Mann-Whitney-U Test and Fishers exact test (SPSS were used. We found that the demand for intravenous opioids in PACU was significantly reduced in ITM group (P <0.001. Pain scores were significantly decreased in ITM group until second postoperative day (P <0.01. There was no time delay for tracheal extubation in ITM group, and sedation scores did not differ in either group. We conclude that low dose single shot intrathecal morphine provides adequate postoperative analgesia, reduces the intravenous opioid consumption during the early postoperative period and does not defer early extubation.

  3. The effect of ketamine on the separation anxiety and emergence agitation in children undergoing brief ophthalmic surgery under desflurane general anesthesia

    OpenAIRE

    Jeong, Won Ju; Kim, Woon Young; Moon, Man Gook; Min, Doo Jae; Lee, Yoon Sook; Kim, Jae Hwan; Park, Young Cheol

    2012-01-01

    Background Emergence agitation (EA) frequently occurs after desflurane anesthesia in children. Ketamine, because of its sedative and analgesic properties, might be useful for the management of separation anxiety and EA. We investigated the preventive effect of ketamine on separation anxiety and EA after desflurane anesthesia in children for brief ophthalmic surgery. Methods Sixty children, ranging in age from 2-8 years old, undergoing brief ophthalmic surgery were randomly allocated to one of...

  4. Full-thickness knee articular cartilage defects in national football league combine athletes undergoing magnetic resonance imaging: prevalence, location, and association with previous surgery.

    Science.gov (United States)

    Nepple, Jeffrey J; Wright, Rick W; Matava, Matthew J; Brophy, Robert H

    2012-06-01

    To better define the prevalence and location of full-thickness articular cartilage lesions in elite football players undergoing knee magnetic resonance imaging (MRI) at the National Football League (NFL) Invitational Combine and assess the association of these lesions with previous knee surgery. We performed a retrospective review of all participants in the NFL Combine undergoing a knee MRI scan from 2005 to 2009. Each MRI scan was reviewed for evidence of articular cartilage disease. History of previous knee surgery including anterior cruciate ligament reconstruction, meniscal procedures, and articular cartilage surgery was recorded for each athlete. Knees with a history of previous articular cartilage restoration surgery were excluded from the analysis. A total of 704 knee MRI scans were included in the analysis. Full-thickness articular cartilage lesions were associated with a history of any previous knee surgery (P football players at the NFL Combine undergoing MRI. The lateral compartment appears to be at greater risk for full-thickness cartilage loss. Previous knee surgery, particularly meniscectomy, is associated with these lesions. Level IV, therapeutic case series. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  5. Clinically suspected anaphylaxis induced by sugammadex in a patient with Weaver syndrome undergoing restrictive mammoplasty surgery

    Science.gov (United States)

    Bedirli, Nurdan; Işık, Berrin; Bashiri, Mehrnoosh; Pampal, Kutluk; Kurtipek, Ömer

    2018-01-01

    Abstract Rationale: Sugammadex is a cylodextrin derivate that encapsulates steroidal neuromuscular blocker agents and is reported as a safe and well-tolerated drug. In this case report, we present a patient who developed grade 3 anaphylaxis just after sugammadex administration. Patient concerns: A 22-year-old woman with diagnosis of Weaver syndrome was sch