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Intensive care/postoperative care

Enrico Squiccimarro, Cataldo Labriola, Pietro Giorgio Malvindi, Vito Margari, Pietro Guida, Giuseppe Visicchio, Georgios Kounakis, Antonella Favale, Pierpaolo Dambruoso, Giuseppe Mastrototaro, Roberto Lorusso, Domenico Paparella
OBJECTIVES: Cardiac surgery induces a systemic inflammatory reaction that has been associated with postoperative mortality and morbidity. Many studies have characterized this reaction through laboratory biomarkers while clinical studies generally are lacking. This study aimed to assess the incidence of postoperative systemic inflammation after cardiac surgery, and the association of postoperative systemic inflammation with preoperative patients' characteristics and postoperative outcomes...
January 17, 2019: Journal of Cardiothoracic and Vascular Anesthesia
Asuka Tanaka, Takashi Onoe, Kohei Ishiyama, Kentaro Ide, Hirotaka Tashiro, Hideki Ohdan
INTRODUCTION: Transient Left Ventricular Apical Balloon Syndrome (LV-ABS) is an unknown acute dysfunction of the left ventricle, which develops under emotional or physical stress events like the major surgical postoperative period. PRESENTATION OF CASE: A 68-year-old woman diagnosed with hepatitis C cirrhosis was admitted for living donor liver transplantation (LDLT). No evidence for underlying cardiac or pulmonary disease was found. LDLT was performed, and her intra and post-operative course was uneventful...
February 10, 2019: International Journal of Surgery Case Reports
Benjamin Vojnar, Martin Zoremba
With focused transthoracic echocardiography (TTE) we rapidly and non-invasively receive up-to-date information on a patient's hemodynamic status. These can subsequently influence our therapy and thus our risk management. Postoperatively, TTE has proved its worth as an examination method in the recovery room and in the intensive care unit to promptly diagnose life-threatening causes of circulatory depression. Acute pathology such as a pericardial tamponade or fulminant pulmonary artery embolism can be detected quickly and thus possibly time-consuming transport to a CT can be avoided...
February 2019: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Prasad John Thottam, Taylor Gilliland, Nicholas Ettinger, Rahul Baijal, Deepak Mehta
OBJECTIVES: The aim of this study was to evaluate single-stage laryngotracheal reconstruction (ssLTR) outcomes before and after the implementation of a postoperative care protocol in pediatric patients. METHODS: A case-control study with chart review was conducted at 2 tertiary academic centers from 2010 to 2016. Pediatric patients who underwent ssLTR with a postoperative care protocol were compared with those who did not receive care under this protocol. Data regarding perioperative management were collected and compared using χ2 and Wilcoxon rank tests...
February 15, 2019: Annals of Otology, Rhinology, and Laryngology
Tarmo Niini, Aki Laakso, Päivi Tanskanen, Mika Niemelä, Teemu Luostarinen
OBJECTIVE: We reviewed retrospectively the perioperative treatment of microsurgically resected brain arteriovenous malformations (bAVMs) at the neurosurgical department of Helsinki University Hospital between the years 2006 and 2014. We examined the performance of the treatment protocol and the incidence of delayed postoperative hemorrhage (DPH). METHODS: The Helsinki protocol for postoperative treatment of bAVMs was used for the whole patient cohort of 121. The patients who had subsequent DPH were reviewed in more detail...
February 14, 2019: Neurocritical Care
Dana Y Fuhrman, Lan G Nguyen, Joan Sanchez-de-Toledo, Priyanka Priyanka, John A Kellum
BACKGROUND: There is an increasing number of young adults living with congenital heart disease (CHD). The goal of this study was to ascertain the frequency of acute kidney injury (AKI) as well as the risk factors and outcomes associated with AKI in young adults with CHD after a surgical procedure. METHODS: This was a single center retrospective cohort study including all patients 18-40 years of age with a diagnosis of CHD admitted to a quaternary care children's hospital cardiac intensive care unit postoperatively from 2004-2015...
February 11, 2019: Annals of Thoracic Surgery
Juying Jin, Su Min, Qibin Chen, Dong Zhang
To determine efficacy and safety of patient-controlled intravenous analgesia (PCIA) with tramadol and lornoxicam for postoperative analgesia, and its effects on surgical outcomes in patients following thoracotomy.The records of patients who underwent thoracotomy for lung resection between January 2014 and December 2014 at our institution were reviewed. The patients were divided into 2 groups according to postoperative pain treatment modalities. Patients of the patient-controlled epidural analgesia (PCEA) group (n = 63), received PCEA with 0...
February 2019: Medicine (Baltimore)
Eun-Ho Lee, Sung-Cheol Yun, Ye-Ji Lim, Jun-Young Jo, Dae-Kee Choi, In-Cheol Choi
We assessed whether perioperative fluid management with balanced solutions and a limited volume of hydroxyethyl starch (renal-protective fluid management [RPF] strategy) could improve renal outcomes after cardiovascular surgery.For this retrospective observational study, we evaluated 2613 patients who underwent cardiovascular surgery from January 1, 2010 to December 31, 2013. The control group were given intravenous fluids with saline-based solutions and unlimited volumes of hydroxyethyl starch solutions and the RPF group were given intravenous fluids with RPF...
February 2019: Medicine (Baltimore)
Shuo-Fang Ren, Hong Yu, Ying-Qiang Guo, Hai Yu
INTRODUCTION: Many studies have found that volatile anesthetics are associated with improved clinical outcomes for adults undergoing coronary artery bypass grafting. However, the effect of volatile anesthetics for adults after heart valve surgery has been unclear. So we conducted a meta-analysis of randomized controlled trials (RCTs) to explore whether the choice of an anesthetic regimen might influence patients' outcomes after valve surgery. EVIDENCE ACQUISITION: PubMed, Embase, and Cochrane Library were searched from inception to June 2018...
February 13, 2019: Minerva Anestesiologica
Qing Huang, Lan-Ying Lin, Xian-Zhong Lin
BACKGROUND The aim of this study was to evaluate the effectiveness and safety of remifentanil-based fast-track anesthesia for intraoperative device closure of atrial septal defects (ASDs). MATERIAL AND METHODS The clinical data of 152 pediatric patients who received intraoperative device closure of ASD in our hospital from January 2015 to December 2017 were retrospectively analyzed. Patients were divided into 2 groups: group F (remifentanil-based fast-track anesthesia group, n=72) and group C (fentanyl-based routine anesthesia group, n=80)...
February 13, 2019: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Michael Winterhalter, Steffen Rex, Christian Stoppe, Peter Kienbaum, Hans-Helge Müller, Ines Kaufmann, Hermann Kuppe, Aristidis Dongas, Bernhard Zwissler
PURPOSE: Perioperative right ventricular (RV) failure due to pressure overload from pulmonary hypertension (PH) worsens postoperative outcomes after cardiac surgery. Inhaled iloprost is a potent pulmonary vasodilator improving RV performance, ameliorating myocardial and pulmonary ischemia-reperfusion injury and attenuating inflammation. We hypothesized that the prophylactic inhalation of iloprost would reduce postoperative ventilation times after cardiac surgery. METHODS: In this phase III, multicentre, randomized, double-blind, placebo-controlled trial, we randomly assigned 253 cardiac surgical patients at high risk of perioperative RV failure to the prophylactic inhalation of 20 µg iloprost or placebo before and during weaning from extracorporeal circulation...
February 12, 2019: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Luís Guilherme Casimiro, Sara Pereira, Sofia Pires, Joana Mourão
INTRODUCTION: Informed consent is an active process of the doctor-patient relationship, based on ethical and legal principles. The anesthetic act has inherent risks, which should be subject of specific consent. The aim of this study was to evaluate the degree of implementation of written specific informed consent for anesthesia in the context of elective surgery. MATERIAL AND METHODS: An observational prospective study, at a tertiary university hospital, in 230 patients aged 60 years or older, undergoing elective surgery between May and July 2017...
February 1, 2019: Acta Médica Portuguesa
N Beghdadi, A Soprani, A Kraemer, P Bucur, C Barrat, L Genser
BACKGROUND: Severe post-operative malnutrition (SM) is a dreaded complication after gastric bypass often related to the short bowel syndrome consecutive limb length mismeasurement or intestinal resections. Patients with rapid weight loss or malnutrition can experience liver failure with cirrhosis and require liver transplantation (LT). Malnutrition can constitute a contraindication to LT since it negatively impacts on postoperative morbidity. RYGB reversal is an effective option to consider when nutritional support has failed...
February 11, 2019: Obesity Surgery
Sachin Talwar, Abhishek Anand, Bharat Siddarth, Sivasubramanian Ramakrishnan, Shiv Kumar Choudhary, Balram Airan
Objective: We compared the pre- and post-operative right ventricular (RV) function by tricuspid annular plane systolic excursion (TAPSE) between trans-right atrial (t-RA) versus t-RA/RV (RA/RV) approach for the repair of Tetralogy of Fallot (TOF). Patients and Methods: Fifty consecutive patients, 1-15 years of age, undergoing intracardiac repair of TOF between September 2015 and June 2016 were randomized into two groups based on the approach for repair as follows: t-RA or t-RA/RV approach...
January 2019: Annals of Pediatric Cardiology
Tessa Heinonen, Suzie Ferrie, Clare Ferguson
BACKGROUND: Management of gut function in the intensive care unit (ICU) is often protocol-driven. Protocols for enteral feeding or bowel management are based on assumptions about what is 'normal' gastrointestinal motility during critical illness or in the early postoperative period, although 'normal' has not been well described in this group. OBJECTIVES: This study aimed to describe aspects of gut function based on an audit of current ICU patients. METHODS: A retrospective medical audit of 100 recent consecutive ICU patients was conducted to obtain data on gut function parameters in the critically ill or postoperative population...
February 7, 2019: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Giulio Porcedda, Alice Brambilla, Silvia Favilli, Bruno Murzi, Lorenzo Mirabile, Roberto Baggi, Luigi Arcieri
BACKGROUND:  Left pulmonary artery (LPA) sling (PAS) is a vascular ring, which is frequently associated with long-segment tracheal stenosis (TS). Mortality rate in operated children is still high, especially in cases of severe tracheal hypoplasia and/or associated congenital heart defects (CHDs). We report our experience of treatment and follow-up in a pediatric cohort of patients affected by PAS with severe tracheobronchial involvement. METHODS:  From 2005 to 2017, we enrolled 11 children diagnosed with PAS and congenital TS requiring surgical intervention...
February 11, 2019: Thoracic and Cardiovascular Surgeon
Alice M Kai, Nalini Vadivelu, Feng Dai, Susan Dabu-Bondoc, Hosni Mikhael, Peter A Blume
BACKGROUND: Studies on obtaining donor skin graft using intravenous sedation for patients undergoing major foot surgeries in the same operating room visit have not previously been reported. The objective of this retrospective study is to demonstrate that intravenous sedation in this setting is both adequate and safe in patients undergoing skin graft reconstruction of the lower extremities in which donor skin graft is harvested from the same patient in one operating room visit. METHODS: Medical records of 79 patients who underwent skin graft reconstruction of the lower extremities by one surgeon at the Yale New Haven Health System between November 1, 2008, and July 31, 2014, were reviewed...
November 2018: Journal of the American Podiatric Medical Association
Seracettin Eğin, Berk Gökçek, Metin Yeşiltaş, Semih Hot, Dursun Özgür Karakaş
A 55-year-old male patient developed a duodenal re-leak, which caused severe peritonitis, on the second postoperative day after surgery to treat an acutely perforated duodenal ulcer. Relaparotomy was performed 2 days after surgery for the re-leak after omentoplasty. The necrotic omentum was dissociated from the bulbus duodeni. Viable omentum for reinsertion of the omental patch was not found. The turned-outward duodenal mucosa was excised and the duodenal perforation was sutured. Two-way vacuum-assisted closure (VAC) was carried out by taking a liquid culture of the abdomen and washing the abdomen...
January 2019: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
Müge Çakırca, İsa Sözen, Gülsüm Tozlu Bindal, Mustafa Baydar, Ahmet Çınar Yastı
BACKGROUND: Due to a massive increase in capillary permeability during the state of shock caused by burns, albumin and intravascular fluid rapidly move to the extravascular areas. Therefore, hypoalbuminemia is seen as an early and prolonged finding in major burns. Hypoalbuminemia leads to various problems. The aim of this study was to investigate the effect of the preoperative albumin level on perioperative morbidity and mortality in patients with major burns. METHODS: Demographic data, preoperative albumin levels, surgical records, and clinical follow-up records of a total of 61 patients who underwent surgery for major burns in our hospital for the last 2 years were examined...
January 2019: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
Kathrine D Lycke, Christian F Christiansen, Jennifer L Lund, Lene H Iversen, Mette Nørgaard
AIM: Few studies have evaluated how preadmission antidepressant use affects outcomes in colorectal cancer (CRC) patients undergoing surgery. Therefore, our aim is to examine if preadmission use of antidepressants increased the risk of complications and death in patients undergoing CRC surgery. METHODS: We identified patients undergoing CRC surgery in Denmark from 2005 to 2012 through the Danish Colorectal Cancer Group Database. We identified prescriptions for antidepressants redeemed within one year prior to surgery and categorized users as current (≤90 days), former (91-365 days), and non-users...
February 11, 2019: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
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