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Perioperative care

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18 papers 25 to 100 followers
By Axel Cayetano Urologist
N A Henriksen, E B Deerenberg, L Venclauskas, R H Fortelny, M Miserez, F E Muysoms
BACKGROUND: The aim of this systematic review and meta-analysis was to evaluate closure materials and suture techniques for emergency and elective laparotomies. The primary outcome was incisional hernia after 12 months, and the secondary outcomes were burst abdomen and surgical site infection. METHODS: A systematic literature search was conducted until September 2017. The quality of the RCTs was evaluated by at least 3 assessors using critical appraisal checklists...
June 2018: World Journal of Surgery
John C Alverdy, Neil Hyman, Jack Gilbert, James N Luo, Monika Krezalek
No abstract text is available yet for this article.
August 2017: Journal of the American College of Surgeons
Anders Winther Voldby, Birgitte Brandstrup
BACKGROUND: Perioperative hypovolemia and fluid overload have effects on both complications following surgery and on patient survival. Therefore, the administration of intravenous fluids before, during, and after surgery at the right time and in the right amounts is of great importance. This review aims to analyze the literature concerning perioperative fluid therapy in abdominal surgery and to provide evidence-based recommendations for clinical practice. RESULTS: Preoperative oral or intravenous administration of carbohydrate containing fluids has been shown to improve postoperative well-being and muscular strength and to reduce insulin resistance...
2016: Journal of Intensive Care
Anne P Ehlers, Vlad V Simianu, Amir L Bastawrous, Richard P Billingham, Giana H Davidson, Alessandro Fichera, Michael G Florence, Raman Menon, Richard C Thirlby, David R Flum, Farhood Farjah
BACKGROUND: Randomized trials have found that alvimopan hastens return of bowel function and reduces length of stay (LOS) by 1 day among patients undergoing colorectal surgery. However, its effectiveness in routine clinical practice and its impact on hospital costs remain uncertain. STUDY DESIGN: We performed a retrospective cohort study of patients undergoing elective colorectal surgery in Washington state (2009 to 2013) using data from a clinical registry (Surgical Care and Outcomes Assessment Program) linked to a statewide hospital discharge database (Comprehensive Hospital Abstract Reporting System)...
May 2016: Journal of the American College of Surgeons
Therese Rey-Conde, Arkadiusz P Wysocki, John B North, Jennifer Allen, Robert S Ware, David A Watters
BACKGROUND: All surgical deaths in Queensland, Australia are reviewed by external surgeon peers, and clinical events are recorded. The study objective was to classify clinical events in surgical patients who died. METHODS: Deaths notified to the Queensland Audit of Surgical Mortality between 2007 and 2013 were assessed by surgeons' peers who decided whether a clinical event occurred. The most serious clinical event per patient was analyzed. RESULTS: Peer surgeons reviewed 4,816 deaths...
October 2016: American Journal of Surgery
Pei-Yin Hsieh, Kuen-Yuan Chen, Hsuan-Yu Chen, Wang-Huei Sheng, Chin-Hao Chang, Chiou-Ling Wang, Pin-Yi Chiag, Hsiao-Ping Chen, Chin-Wen Shiao, Po-Chu Lee, Hao-Chih Tai, Hsiung-Fei Chien, Po-Jui Yu, Been-Ren Lin, Yeur-Hur Lai, Jin-Shing Chen, Hong-Shiee Lai
OBJECTIVE: To evaluate wound infection rates, pain scores, satisfaction with wound care, and wound care costs starting 48 hours after surgery. BACKGROUND: Showering after surgery is a controversial issue for wound care providers and patients. We investigated the benefits and detriments of showering for postoperative wound care. METHODS: Patients undergoing thyroid, lung, inguinal hernia, and face and extremity surgeries with clean or clean-contaminated wounds were included...
May 2016: Annals of Surgery
R Gupta, T J Gan
'Enhanced recovery after surgery' protocols implement a series of peri-operative interventions intended to improve recovery after major operations, one aspect of which is fluid management. The pre-operative goal is to prepare a hydrated, euvolaemic patient by avoiding routine mechanical bowel preparation and by encouraging patients to drink clear liquids up to two hours before induction of anaesthesia. The intra-operative goal is to achieve a 'zero' fluid balance at the end of uncomplicated surgery: goal-directed fluid therapy is recommended for poorly prepared or sick patients or those undergoing more complex surgery...
January 2016: Anaesthesia
A H Petter-Puchner
No abstract text is available yet for this article.
November 2015: British Journal of Surgery
Eva B Deerenberg, Joris J Harlaar, Ewout W Steyerberg, Harold E Lont, Helena C van Doorn, Joos Heisterkamp, Bas Pl Wijnhoven, Willem R Schouten, Huib A Cense, Hein Bac Stockmann, Frits J Berends, F Paul Hlj Dijkhuizen, Roy S Dwarkasing, An P Jairam, Gabrielle H van Ramshorst, Gert-Jan Kleinrensink, Johannes Jeekel, Johan F Lange
BACKGROUND: Incisional hernia is a frequent complication of midline laparotomy and is associated with high morbidity, decreased quality of life, and high costs. We aimed to compare the large bites suture technique with the small bites technique for fascial closure of midline laparotomy incisions. METHODS: We did this prospective, multicentre, double-blind, randomised controlled trial at surgical and gynaecological departments in ten hospitals in the Netherlands...
September 26, 2015: Lancet
Craig J Wilson, Andrew J Mitchelson, Tony H Tzeng, Mouhanad M El-Othmani, Jasmine Saleh, Sonia Vasdev, Hillary J LaMontagne, Khaled J Saleh
BACKGROUND: Preoperative surgical anxiety is an unpleasant and common reaction exhibited by patients who are scheduled for surgical procedures. Beyond emotional effects on the patient, it can also have negative repercussions on the surgery including longer hospital stays and poorer outcomes. Given the widespread impacts of preoperative anxiety, it is critical for surgeons to gain a better understanding of how to identify and reduce surgical anxiety in their patients. DATA SOURCES: This study used the PubMed database to review the current literature to evaluate screening tools and interventions for surgically anxious patients...
July 2016: American Journal of Surgery
Paul R Daniels
The use of oral anticoagulants is becoming increasingly common. For many years warfarin was the main oral anticoagulant available, but therapeutic options have expanded with the introduction of oral direct thrombin (dabigatran) and factor Xa inhibitors (apixaban, rivaroxaban, and edoxaban). Management of patients taking any oral anticoagulant in the peri-procedural period poses a challenge to medical and surgical providers because of the competing risks of thrombosis and hemorrhage. Bridging therapy has been used to minimize time without anticoagulation when warfarin is interrupted for invasive procedures, but validated strategies based on high quality data are lacking...
July 14, 2015: BMJ: British Medical Journal
Dirk T Ubbink, Fleur E Brölmann, Peter M N Y H Go, Hester Vermeulen
Significance: Large variation and many controversies exist regarding the treatment of, and care for, acute wounds, especially regarding wound cleansing, pain relief, dressing choice, patient instructions, and organizational aspects. Recent Advances: A multidisciplinary team developed evidence-based guidelines for the Netherlands using the AGREE-II and GRADE instruments. A working group, consisting of 17 representatives from all professional societies involved in wound care, tackled five controversial issues in acute-wound care, as provided by any caregiver throughout the whole chain of care...
May 1, 2015: Advances in Wound Care
Sweyn S Garrioch, Michael A Gillies
PURPOSE OF REVIEW: This review appraises recent evidence and provides clinical guidance on optimal perioperative fluid therapy. RECENT FINDINGS: Choice of perioperative intravenous fluid continues to be the source of much debate. Not all crystalloids are equivalent, and there is growing evidence that balanced solutions are superior to 0.9% saline in many situations. Recent evidence from the critical care population has highlighted risks associated with synthetic colloids; this and the absence of demonstrable benefit in the surgical population make it difficult to recommend their use in the perioperative period...
August 2015: Current Opinion in Critical Care
J C Gómez-Izquierdo, L S Feldman, F Carli, G Baldini
BACKGROUND: Intraoperative goal-directed therapy (GDT) was introduced to titrate intravenous fluids, with or without inotropic drugs, based on objective measures of hypovolaemia and cardiac output measurements to improve organ perfusion. This meta-analysis aimed to determine the effect of GDT on the recovery of bowel function after abdominal surgery. METHODS: MEDLINE, Embase, the Cochrane Library and PubMed databases were searched for randomized clinical trials and cohort studies, from January 1989 to June 2013, that compared patients who did, or did not, receive intraoperative GDT, and reported outcomes on the recovery of bowel function...
May 2015: British Journal of Surgery
F E Muysoms, S A Antoniou, K Bury, G Campanelli, J Conze, D Cuccurullo, A C de Beaux, E B Deerenberg, B East, R H Fortelny, J-F Gillion, N A Henriksen, L Israelsson, A Jairam, A Jänes, J Jeekel, M López-Cano, M Miserez, S Morales-Conde, D L Sanders, M P Simons, M Śmietański, L Venclauskas, F Berrevoet
BACKGROUND: The material and the surgical technique used to close an abdominal wall incision are important determinants of the risk of developing an incisional hernia. Optimising closure of abdominal wall incisions holds a potential to prevent patients suffering from incisional hernias and for important costs savings in health care. METHODS: The European Hernia Society formed a Guidelines Development Group to provide guidelines for all surgical specialists who perform abdominal incisions in adult patients on the materials and methods used to close the abdominal wall...
February 2015: Hernia: the Journal of Hernias and Abdominal Wall Surgery
Lars B Holst, Nicolai Haase, Jørn Wetterslev, Jan Wernerman, Anne B Guttormsen, Sari Karlsson, Pär I Johansson, Anders Aneman, Marianne L Vang, Robert Winding, Lars Nebrich, Helle L Nibro, Bodil S Rasmussen, Johnny R M Lauridsen, Jane S Nielsen, Anders Oldner, Ville Pettilä, Maria B Cronhjort, Lasse H Andersen, Ulf G Pedersen, Nanna Reiter, Jørgen Wiis, Jonathan O White, Lene Russell, Klaus J Thornberg, Peter B Hjortrup, Rasmus G Müller, Morten H Møller, Morten Steensen, Inga Tjäder, Kristina Kilsand, Suzanne Odeberg-Wernerman, Brit Sjøbø, Helle Bundgaard, Maria A Thyø, David Lodahl, Rikke Mærkedahl, Carsten Albeck, Dorte Illum, Mary Kruse, Per Winkel, Anders Perner
BACKGROUND: Blood transfusions are frequently given to patients with septic shock. However, the benefits and harms of different hemoglobin thresholds for transfusion have not been established. METHODS: In this multicenter, parallel-group trial, we randomly assigned patients in the intensive care unit (ICU) who had septic shock and a hemoglobin concentration of 9 g per deciliter or less to receive 1 unit of leukoreduced red cells when the hemoglobin level was 7 g per deciliter or less (lower threshold) or when the level was 9 g per deciliter or less (higher threshold) during the ICU stay...
October 9, 2014: New England Journal of Medicine
A Lai, N Davidson, S W Galloway, J Thachil
BACKGROUND: New oral anticoagulants (NOACs) offer an alternative to warfarin for preventing stroke in patients with atrial fibrillation. NOACs are expected to replace warfarin and other vitamin K antagonists for most of their indications in the future. Knowledge of the use of NOACs in the perioperative period is important for optimal care. METHODS: Studies that reported on the use of NOACs were identified, focusing on evidence-based guidance relating to the perioperative period...
June 2014: British Journal of Surgery
Sam Schulman, Mark A Crowther
Two novel oral anticoagulants, dabigatran and rivaroxaban, have recently been approved. They differ in many ways from warfarin, including rapid onset of action, shorter half-life, fewer drug-drug interactions, lack of need for monitoring, and no need for titration or dose adjustments. These novel agents represent a landmark shift in anticoagulant care; however, many aspects of their use will be unfamiliar to practicing clinicians, despite the imminent widespread use of these agents in the community. The management of these anticoagulants when transitioning from or back to warfarin, around surgery or in case of major hemorrhage, requires knowledge of their pharmacokinetics and mechanism of action...
March 29, 2012: Blood
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