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Perioperative Medicine

Vincenzo Pota, Pasquale Sansone, Alfonso Fiorelli, Maria Beatrice Passavanti, Mauro D'Amora, Paola Vosa, Elena Bignami, Maria Caterina Pace, Caterina Aurilio
Tracheobronchial ruptures are very severe and life-threatening injuries. The origin of such airway damage is trauma or an iatrogenic event. Last year, we operated on three different cases of tracheal ruptures using endobronchial suture with three different airway management. We exposed the description of three different techniques to manage the airway during an endoscopic suture of tracheobronchial rupture with fibrin glue (laryngeal mask, orotracheal tube positioned distally the lesion, one lung ventilation with a small size single tube)...
2018: Perioperative Medicine
Chiedozie I Udeh, Jing You, Matthew R Wanek, Jarrod Dalton, Belinda L Udeh, Sevag Demirjian, Nadeem Rahman, J Steven Hata
Background: The use of hyperoncotic albumin (HA) for shock resuscitation is controversial given concerns about its cost, effectiveness, and potential for nephrotoxicity. We evaluated the association between early exposure to hyperoncotic albumin (within the first 48 h of onset of shock) and acute organ dysfunction in post-surgical patients with shock. Methods: This retrospective, cohort study included 11,512 perioperative patients with shock from 2009 to 2012...
2018: Perioperative Medicine
Akshay Shah, Antony J R Palmer, Sheila A Fisher, Shah M Rahman, Susan Brunskill, Carolyn Doree, Jack Reid, Anita Sugavanam, Simon J Stanworth
Background: Guidelines to treat anaemia with intravenous (IV) iron have focused on elective surgical patients with little attention paid to those undergoing non-elective/emergency surgery. Whilst these patients may experience poor outcomes because of their presenting illness, observational data suggests that untreated anaemia may also be a contributing factor to poor outcomes. We conducted a systematic review to investigate the safety and efficacy of IV iron in patients undergoing non-elective surgery...
2018: Perioperative Medicine
Peter M Odor, Sohail Bampoe, Ahilanandan Dushianthan, Elliott Bennett-Guerrero, Suzie Cro, Tong J Gan, Michael P W Grocott, Michael F M James, Michael G Mythen, Catherine M N O'Malley, Anthony M Roche, Kathy Rowan, Edward Burdett
Background: Buffered intravenous fluid preparations contain substrates to maintain acid-base status. The objective of this systematic review was to compare the effects of buffered and non-buffered fluids administered during the perioperative period on clinical and biochemical outcomes. Methods: We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library until May 2017 and included all randomised controlled trials that evaluated buffered versus non-buffered fluids, whether crystalloid or colloid, administered to surgical patients...
2018: Perioperative Medicine
Pei-Hsin Tsai, Jen-Hung Wang, Shian-Che Huang, Yen-Kuang Lin, Chen-Fuh Lam
Background: Post-extubation negative pressure pulmonary edema (NPPE) is an uncommon but important anesthesia-related emergency presenting with acute respiratory distress and hypoxemia after removal of airway devices. This study investigated the incidence and associated risk factors for post-extubation NPPE during emergence. Methods: This retrospective, matched case-control study was conducted by reviewing the post-anesthesia records in Tzu Chi General Hospital, Taiwan...
2018: Perioperative Medicine
Daniel I Rhon, Suzanne J Snodgrass, Joshua A Cleland, Charles D Sissel, Chad E Cook
Background: Prescription opioid use at high doses or over extended periods of time is associated with adverse outcomes, including dependency and abuse. The aim of this study was to identify mediating variables that predict chronic opioid use, defined as three or more prescriptions after orthopedic surgery. Methods: Individuals were ages between 18 and 50 years and undergoing arthroscopic hip surgery between 2004 and 2013. Two categories of chronic opioid use were calculated based on individuals (1) having three or more unique opioid prescriptions within 2 years and (2) still receiving opioid prescriptions > 1 year after surgery...
2018: Perioperative Medicine
Yussr M Ibrahim, Nicole R Marques, Carlos R Garcia, Michael Salter, Christopher McQuitty, Michael Kinsky, Mindy Juan, Achiau Ludomirsky
Background: Intravascular air embolism (AE) is a preventable but potentially catastrophic complication caused by intravenous tubing, trauma, and diagnostic and surgical procedures. The potentially fatal risks of arterial AE are well-known, and emerging evidence demonstrates impact of venous AEs on inflammatory response and coagulation factors. A novel FDA-approved in-line air detection and purging system was used to detect and remove air caused by administering a rapid fluid bolus during surgery...
2018: Perioperative Medicine
Clare M Morkane, Helen McKenna, Andrew F Cumpstey, Alex H Oldman, Michael P W Grocott, Daniel S Martin
[This corrects the article DOI: 10.1186/s13741-018-0098-3.].
2018: Perioperative Medicine
Andrew D Shaw, Michael G Mythen, Douglas Shook, David K Hayashida, Xuan Zhang, Jeffrey R Skaar, Sloka S Iyengar, Sibyl H Munson
Background: The utility of pulmonary artery catheters (PACs) and their measurements depend on a variety of factors including data interpretation and personnel training. This US multi-center, retrospective electronic health record (EHR) database analysis was performed to identify associations between PAC use in adult cardiac surgeries and effects on subsequent clinical outcomes. Methods: This cohort analysis utilized the Cerner Health Facts database to examine patients undergoing isolated coronary artery bypass graft (CABG), isolated valve surgery, aortic surgery, other complex non-valvular and multi-cardiac procedures, and/or heart transplant from January 1, 2011, to June 30, 2015...
2018: Perioperative Medicine
Juying Jin, Su Min, Dan Liu, Ling Liu, Bixiao Lv
Background: Several randomized controlled trials suggest that goal-directed fluid therapy (GDFT) may result in improved postoperative outcomes. The aim of this study was to assess the clinical and financial impact of the real-life implementation of intraoperative GDFT in patients undergoing elective gastrointestinal surgery in a Chinese tertiary medical center. Methods: This Quality Improvement Program (QIP) study comprised three phases of 5, 1, and 5 months, respectively...
2018: Perioperative Medicine
Andrew Smith, Sarka Moravcova, Thomas A Treibel, Patricia Colque-Navarro, Roland Mollby, James C Moon, Colin Hamilton-Davies
Background: Morbidity and mortality following cardiac valve surgery is high. Immunity is an important contributor to outcome. This study examines the relationship of staphylococcal and endotoxin antibody levels to outcome following cardiac surgery. Methods: Using enzyme-linked immunosorbent assays (ELISA), we measured pre-operative levels of antibodies to endotoxin core (EndoCAb); 3 common staphylococcal epitopes and varicella on saved serum of 60 adult patients scheduled to undergo elective primary surgical aortic valve replacement (AVR)...
2018: Perioperative Medicine
Johann Sigurjonsson, David Hedman, Peter Bansch, Ulf Schött
Background: Hydroxyethyl starches have been withdrawn from the European market. In Sweden, dextran was the main colloid until 2000, when starches overtook the market. After the recent 6S-trial, it was suggested that dextran could be reinstituted, but concerns for greater coagulopathy, bleeding and anaphylaxis still remain. An experimental study from our department indicated that isovolemic substitution of dextran-70 did not derange the von Willebrand function more than albumin 5%, considering the fact that dextran is hyperoncotic in comparison to albumin 5% and, therefore, induces a greater plasma volume expansion and thereby a greater dilutional coagulopathy...
2018: Perioperative Medicine
Thomas Deiss, Lee-Lynn Chen, Ankit Sarin, Ramana K Naidu
Background: Enhanced recovery after surgery (ERAS) programs have been established as perioperative strategies associated with improved outcomes. However, intermediate and long-term patient-reported outcome data for patients undergoing ERAS interventions remain limited. We utilized an automated telephone survey 6 months post-colorectal surgery from patients who participated in an ERAS program to determine 6-month patient-reported outcomes and associated predictive factors. Methods: We conducted a prospective observational study, using an automated telephone survey and researcher-administered telephone questionnaire 6 months after patients underwent abdominal colorectal surgery...
2018: Perioperative Medicine
Zühre Uz, Can Ince, Philippe Guerci, Yasin Ince, Renata P Araujo, Bulent Ergin, Matthias P Hilty, Thomas M van Gulik, Bas A de Mol
Background: Management of tissue perfusion following cardiac surgery is a challenging task where common clinical parameters do not reflect microcirculatory dysfunction. Heterogeneity in blood flow perfusion and abnormalities in capillary density characterize microcirculatory dysfunction. The restoration of a normal microcirculation may become a novel target for therapy in the future in addition to macrocirculatory parameters. The aim of this study is to determine how the sublingual microcirculatory parameters vary at the bedside in post-cardiac surgery patients which underwent diuretic therapy to correct fluid overload...
2018: Perioperative Medicine
Clare M Morkane, Helen McKenna, Andrew F Cumpstey, Alex H Oldman, Michael P W Grocott, Daniel S Martin
Background: Considerable controversy remains about how much oxygen patients should receive during surgery. The 2016 World Health Organization (WHO) guidelines recommend that intubated patients receive a fractional inspired oxygen concentration (FIO2 ) of 0.8 throughout abdominal surgery to reduce the risk of surgical site infection. However, this recommendation has been widely criticised by anaesthetists and evidence from other clinical contexts has suggested that giving a high concentration of oxygen might worsen patient outcomes...
2018: Perioperative Medicine
Elena J Koepke, Erin L Manning, Timothy E Miller, Arun Ganesh, David G A Williams, Michael W Manning
Opioid use has risen dramatically in the past three decades. In the USA, opioid overdose has become a leading cause of unintentional death, surpassing motor vehicle accidents. A patient's first exposure to opioids may be during the perioperative period, a time where anesthesiologists have a significant role in pain management. Almost all patients in the USA receive opioids during a surgical encounter. Opioids have many undesirable side effects, including potential for misuse, or opioid use disorder. Anesthesiologists and surgeons employ several methods to decrease unnecessary opioid use, opioid-related adverse events, and side effects in the perioperative period...
2018: Perioperative Medicine
Joanne Lee, Viren Asher, Arun Nair, Victoria White, Catherine Brocklehurst, Martyn Traves, Anish Bali
Background: Enhanced recovery has been shown to improve patients' experience after surgery. There are no previous studies comparing patients' experience between those undergoing laparoscopic and open gynaecological surgery. Therefore, the aim of this prospective study is to compare patients' functional recovery based on milestones set by the enhanced recovery programme and patients' satisfaction between the two groups. Methods: All eligible patients undergoing gynaecological surgery within an enhanced recovery after surgery (ERAS) programme from March to August 2014 were involved in this study...
2018: Perioperative Medicine
Stephen T McSorley, Campbell S D Roxburgh, Paul G Horgan, Donald C McMillan
Background: Both preoperative cardiopulmonary exercise test (CPET)-derived measures of fitness and postoperative C-reactive protein (CRP) concentrations are associated with complications following surgery for colorectal cancer. The aim of the present pilot study was to examine the relationship between CPET and postoperative CRP concentrations in this patient group. Methods: Patients who had undergone CPET prior to elective surgery for histologically confirmed colorectal cancer in a single centre between September 2008 and April 2017 were included...
2018: Perioperative Medicine
C Groleau, S N Morin, L Vautour, A Amar-Zifkin, A Bessissow
Background: Perioperative administration of corticosteroid is common and variable. Guidelines for perioperative corticosteroid administration before non-cardiac non-transplant surgery in patients with current or previous corticosteroid use to reduce the risk of adrenal insufficiency are lacking. Perioperative use of corticosteroid may be associated with serious adverse events, namely hyperglycemia, infection, and poor wound healing. Objective: To determine whether perioperative administration of corticosteroids, compared to placebo or no intervention, reduces the incidence of adrenal insufficiency in adult patients undergoing non-cardiac surgery who were or are exposed to corticosteroids...
2018: Perioperative Medicine
Gary Stier, Davinder Ramsingh, Ronak Raval, Gary Shih, Bryan Halverson, Briahnna Austin, Joseph Soo, Herbert Ruckle, Robert Martin
Background: Perioperative care has been identified as an area of wide variability in quality, with conflicting models, and involving multiple specialties. In 2014, the Loma Linda University Departments of Anesthesiology and Urology implemented a perioperative hospitalist service (PHS), consisting of anesthesiology-trained physicians, to co-manage patients for the entirety of their perioperative period. We hypothesized that implementation of this PHS model would result in an improvement in patient recovery...
2018: Perioperative Medicine
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