Current Issue : July - September Volume : 2018 Issue Number : 3 Articles : 5 Articles
Background. Preoperative risk stratification and optimising care of patients undergoing elective surgery are important to reduce\nthe risk of postoperative outcomes. Renal dysfunction is becoming increasingly prevalent, but its impact on patients undergoing\nelective gastrointestinal surgery is unknown although much evidence is available for cardiac surgery. This study aimed to investigate\nthe impact of preoperative estimated glomerular filtration rate (eGFR) and postoperative outcomes in patients undergoing\nelective gastrointestinal surgeries. Methods. This prospective study included consecutive adult patients undergoing\nelective gastrointestinal surgeries attending preassessment screening (PAS) clinics at the Queen Elizabeth Hospital Birmingham\n(QEHB) between July and August 2016. Primary outcome measure was 30-day overall complication rates and secondary outcomes\nwere grade of complications, 30-day readmission rates, and postoperative care setting. Results. This study included 370 patients, of\nwhich 11% (41/370) had eGFR of <60 ml/min/1.73m2. Patients with eGFR < 60 ml/min/1.73m2 were more likely to have ASA\ngrade 3/4 (p < 0.001) and >2 comorbidities (p < 0.001). Overall complication rates were 15% (54/370), with no significant\ndifference in overall (p 0.644) and major complication rates (p 0.831) between both groups. In adjusted models, only surgery\ngrade was predictive of overall complications. Preoperative eGFR did not impact on overall complications (HR: 0.89, 95% CI:\n0.45ââ?¬â??1.54 p 0.2). Conclusions. Preoperative eGFR does not appear to impact on postoperative complications in patients\nundergoing elective gastrointestinal surgeries, even when stratified by surgery grade. These findings will help preassessment clinics\nin risk stratification and optimisation of perioperative care of patients....
Perioperative pulmonary embolism can go undetected until the sudden onset of cardiopulmonary collapse. Point of care\nechocardiography in such setting can narrow the differential diagnosis of precipitous instability and facilitate tailored, rather\nthan empiric, therapy in the event of a massive pulmonary embolism. We describe the diagnosis and successful multidisciplinary\nmanagement of intraoperative massive pulmonary embolism aided by both transthoracic and transesophageal echocardiography.\nKey aspects regarding the classification and treatment of pulmonary embolism are subsequently reviewed....
Aim.The aim of the study was to assess the nitroglycerin patch as a new additive to Bierâ��s block and its impact on the effects and\ndose of lidocaine. Methods. Forty patients of each sex belonging to ASA I or II underwent elective tendon repair surgeries of the\nforearm and hand. The patients were divided into two equal groups as follows: Group C received only lidocaine (1.5 mg/kg, 0.25%)\nand Group N received lidocaine (1.5 mg/kg, 0.25%) + 5 mg transcutaneous nitroglycerin patch. Onset and recovery times for\nsensory and motor block, visual analogue scale (VAS) scores for bandage pain, postoperative VAS score, analgesic requirements,\npatientsâ�� satisfaction, and surgeonsâ�� opinion were recorded. Results. Sensory block onset time was shorter in Group N (3.80 �± 1.0)\nthan that in Group C (5.72 �± 1.46), and motor block onset time was shorter in Group N (10.72 �± 1.93) than that in Group C (13.56 �±\n1.26). Sensory block recovery time was prolonged in Group N (10.56 �± 1.12) than Group C (6.88 �± 1.45), recovery time of motor\nblock was prolonged in Group N (13.04 �± 1.57) than Group C (11.96 �± 1.72). Bandage pain had lower VAS scores in Group N.\nPostoperative VAS scores showed significant differences between both groups at the following points of measurement: 30 minutes,\n1 hour, and 4 hours after bandage deflation. Postoperative analgesic effect was the longest in Group N (187.20 �± 60.79 min) than\nGroup C (51.60 �± 25.28 min). Patientsâ�� satisfaction and surgeonsâ�� opinion were better in Group N than Group C. Conclusion.\nSupplementation of Bierâ��s block with transcutaneous nitroglycerin patch reduces the lidocaine dose, the sensory and motor block\nonset times, VAS scores, and analgesic consumption intra- and postoperatively. Length of the block recovery times for the sensory\nand motor effects, duration of postoperative analgesic effect, and the first time to analgesic requirement improved the quality of\nBierâ��s block with better patientsâ�� satisfaction and surgeonsâ�� opinion and had no adverse effects....
Background.The aim of this study was to investigate the effects of listening to Tibetan music on anxiety and endocrine, autonomic,\ncognitive responses in patients waiting for urologic surgery. Methods. Sixty patients waiting for surgery were enrolled to the study.\nThey were randomized in music (M) and control (C) groups. The M group listened to a low-frequency Tibetan music for 30 min\n(T0ââ?¬â??T30) through headphones, and the C group wore headphones with no sound. The State Trait Anxiety Inventory Questionnaire\n(STAI) Y-1 was administered at T0 and T30. Normalized low (LFnu) and high frequencies (HFnu) of heart rate variability, LF/HF\nratio, and galvanic skin response (GRS) data were analyzed at T0, T10, T20, T30, and T35.The salivary Ã?±-amylase (sAA) samples were\ncollected at T0, T35, and T45. Results. In the M group, the STAI Y-1 score decreased at T30 versus baseline (p < 0.001), sAA levels\ndecreased at T35 versus T0 (p 0.004), and GSR remained unchanged. In the C group, the STAI Y-1 score remained unchanged,\nsAA level increased at T35 versus T0 (p < 0.001), and GSR slightly increased at T35 versus baseline (p 0.359). LFnu was lower,\nand HFnu was significantly higher (T10ââ?¬â??T30) inMversus C group. Mean LF/HF ratio slightly reduced in theMgroup. Conclusions.\nOur results suggest that preoperative listening to relaxing Tibetan music might be a useful strategy to manage preoperative anxiety....
Health care-related apps provide valuable facts and have added a new dimension to knowledge sharing. The purpose of this\nstudy is to understand the pattern of utilization of mobile apps specifically created for anesthesia providers. Smartphone app\nstores were searched, and a survey was sent to 416 anesthesia providers at 136 anesthesiology residency programs querying\nspecific facets of application use. Among respondents, 11.4% never used, 12.4% used less than once per month, 6.0% used once\nper month, 12.1% used 2-3 times per month, 13.6% used once per week, 21% used 2-3 times per week, and 23.5% used daily.\nDosage/pharmaceutical apps were rated the highest as most useful. 24.6% of the participants would pay less than $2.00, 25.1%\nwould pay $5.00, 30.3% would pay $5ââ?¬â??$10.00, 9.6% would pay $10ââ?¬â??$25.00, 5.1% would pay $25ââ?¬â??$50.00, and 5.1% would pay\nmore than $50.00 if an app saves 5ââ?¬â??10 minutes per day or 30 minutes/week. The use of mobile phone apps is not limited to\nreiterating information from textbooks but provides opportunities to further the ever-changing field of anesthesiology. Our\nsurvey illustrates the convenience of apps for health care professionals. Providers must exercise caution when selecting apps to\nensure best evidence-based medicine....
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