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International Journal of Environmental... Aug 2021Unintentional hypothermia (core temperature < 36 °C) is a common side effect in patients undergoing surgery. Several patient-centred and external factors, e.g., drugs,... (Review)
Review
Unintentional hypothermia (core temperature < 36 °C) is a common side effect in patients undergoing surgery. Several patient-centred and external factors, e.g., drugs, comorbidities, trauma, environmental temperature, type of anaesthesia, as well as extent and duration of surgery, influence core temperature. Perioperative hypothermia has negative effects on coagulation, blood loss and transfusion requirements, metabolization of drugs, surgical site infections, and discharge from the post-anaesthesia care unit. Therefore, active temperature management is required in the pre-, intra-, and postoperative period to diminish the risks of perioperative hypothermia. Temperature measurement should be done with accurate and continuous probes. Perioperative temperature management includes a bundle of warming tools adapted to individual needs and local circumstances. Warming blankets and mattresses as well as the administration of properly warmed infusions via dedicated devices are important for this purpose. Temperature management should follow checklists and be individualized to the patient's requirements and the local possibilities.
Topics: Blood Transfusion; Body Temperature; Humans; Hypothermia; Postoperative Period; Surgical Wound Infection
PubMed: 34444504
DOI: 10.3390/ijerph18168749 -
Anesthesiology Mar 2022The number of lung transplantations is progressively increasing worldwide, providing new challenges to interprofessional teams and the intensive care units. The outcome... (Review)
Review
The number of lung transplantations is progressively increasing worldwide, providing new challenges to interprofessional teams and the intensive care units. The outcome of lung transplantation recipients is critically affected by a complex interplay of particular pathophysiologic conditions and risk factors, knowledge of which is fundamental to appropriately manage these patients during the early postoperative course. As high-grade evidence-based guidelines are not available, the authors aimed to provide an updated review of the postoperative management of lung transplantation recipients in the intensive care unit, which addresses six main areas: (1) management of mechanical ventilation, (2) fluid and hemodynamic management, (3) immunosuppressive therapies, (4) prevention and management of neurologic complications, (5) antimicrobial therapy, and (6) management of nutritional support and abdominal complications. The integrated care provided by a dedicated multidisciplinary team is key to optimize the complex postoperative management of lung transplantation recipients in the intensive care unit.
Topics: Anti-Infective Agents; Critical Care; Fluid Therapy; Humans; Immunosuppressive Agents; Intensive Care Units; Lung Transplantation; Nutritional Support; Postoperative Care; Postoperative Complications; Postoperative Period; Respiration, Artificial; Transplant Recipients
PubMed: 34910811
DOI: 10.1097/ALN.0000000000004054 -
Neurology India 2021This paper highlights the hydrocephalus research efforts undertaken at AIIMS, New Delhi, supporting progress in the field. (Review)
Review
OBJECTIVE
This paper highlights the hydrocephalus research efforts undertaken at AIIMS, New Delhi, supporting progress in the field.
MATERIAL
Over a period of three decades, basic research, clinical investigations, and multicentric studies were undertaken. This report will review the work mainly to emphasize the need for future generations to pursue further research. Studies that impacted hydrocephalus care (mainly in India) are described, and some of these findings may be useful in other resource-challenged situations.
RESULTS
Investigative studies on the effect of shunting on brainstem auditory evoked responses (BAER), transcranial Doppler (TCD), and CT-SPECT were published offering management options for patients. Participation in the International Infant Hydrocephalus Study (IIHS) study offered opportunities to compare our approaches and develop modifications in patient care. This effort proved shunting was equal or better for young children with congenital aqueductal stenosis. Shunt infection protocols and changes made in a systematic manner helped develop local protocols to reduce postoperative shunt infections.
CONCLUSIONS
Hydrocephalus research over three decades at AIIMS, New Delhi was productive and educational, confirming that locally performed investigative work can help in decision making. Further studies and active participation in international efforts are necessary to advance the field.
Topics: Child; Child, Preschool; Humans; Hydrocephalus; Infant; Neurosurgical Procedures; Postoperative Complications; Postoperative Period; Ultrasonography, Doppler, Transcranial
PubMed: 35102975
DOI: 10.4103/0028-3886.332258 -
International Journal of Surgery... Oct 2020To evaluate the effects of different surgical dressings in reducing surgical site infection (SSI) and identify the optimal dressings. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the effects of different surgical dressings in reducing surgical site infection (SSI) and identify the optimal dressings.
METHODS
Randomized controlled trials investigating the application of surgical dressings were retrieved from electronic databases, including MEDLINE, EMBASE, and the Cochrane Library. The odds ratios (ORs) of the SSI rate were compared by direct meta-analysis, and the surface under the cumulative ranking (SUCRA) curve values were calculated based on the Bayesian theorem. A node-splitting model was applied to analyse the consistency of the comprehensive comparison results.
RESULTS
Twenty-two studies containing 5487 participants were pooled for the comprehensive comparison. Among all the studies included, 9 types of surgical dressings were identified for comparison. The results of the direct meta-analysis revealed that novel dressings significantly reduced the overall SSI rate with an OR of 1.026 (95% CI: 1.013-1.040, p < 0.001), which was determined to have low heterogeneity (I = 32.1%). Specifically, 3 types of dressings presented significant effects in reducing SSI, namely, mupirocin-containing (OR = 1.076, 95% CI: 1.014-1.142, p = 0.015), dialkylcarbamoyl-chloride-containing (OR = 1.047, 95% CI: 1.012-1.083, p = 0.008) and vitamin E (VE)-silicone-containing (OR = 1.129, 95% CI: 1.016-1.255, p = 0.025) dressings. Network meta-analysis demonstrated that the VE-silicone dressing (SUCRA = 0.37) was the optimal dressing, followed by the mupirocin dressing, with a SUCRA of 0.31.
CONCLUSION
The present network meta-analysis identified the superiority of VE-silicone and mupirocin dressings in preventing SSI. The evidence-based results provide suggestions and directions for future investigations on surgical dressings. More large-scale trials with rigorous designs are warranted to clarify the clinical value of novel dressings in surgical incision management.
Topics: Bandages; Bayes Theorem; Humans; Network Meta-Analysis; Odds Ratio; Postoperative Period; Surgical Wound; Surgical Wound Infection; Wound Healing
PubMed: 32853782
DOI: 10.1016/j.ijsu.2020.07.066 -
JAMA Sep 2020In patients who undergo mechanical ventilation during surgery, the ideal tidal volume is unclear. (Comparative Study)
Comparative Study Randomized Controlled Trial
Effect of Intraoperative Low Tidal Volume vs Conventional Tidal Volume on Postoperative Pulmonary Complications in Patients Undergoing Major Surgery: A Randomized Clinical Trial.
IMPORTANCE
In patients who undergo mechanical ventilation during surgery, the ideal tidal volume is unclear.
OBJECTIVE
To determine whether low-tidal-volume ventilation compared with conventional ventilation during major surgery decreases postoperative pulmonary complications.
DESIGN, SETTING, AND PARTICIPANTS
Single-center, assessor-blinded, randomized clinical trial of 1236 patients older than 40 years undergoing major noncardiothoracic, nonintracranial surgery under general anesthesia lasting more than 2 hours in a tertiary hospital in Melbourne, Australia, from February 2015 to February 2019. The last date of follow-up was February 17, 2019.
INTERVENTIONS
Patients were randomized to receive a tidal volume of 6 mL/kg predicted body weight (n = 614; low tidal volume group) or a tidal volume of 10 mL/kg predicted body weight (n = 592; conventional tidal volume group). All patients received positive end-expiratory pressure (PEEP) at 5 cm H2O.
MAIN OUTCOMES AND MEASURES
The primary outcome was a composite of postoperative pulmonary complications within the first 7 postoperative days, including pneumonia, bronchospasm, atelectasis, pulmonary congestion, respiratory failure, pleural effusion, pneumothorax, or unplanned requirement for postoperative invasive or noninvasive ventilation. Secondary outcomes were postoperative pulmonary complications including development of pulmonary embolism, acute respiratory distress syndrome, systemic inflammatory response syndrome, sepsis, acute kidney injury, wound infection (superficial and deep), rate of intraoperative need for vasopressor, incidence of unplanned intensive care unit admission, rate of need for rapid response team call, intensive care unit length of stay, hospital length of stay, and in-hospital mortality.
RESULTS
Among 1236 patients who were randomized, 1206 (98.9%) completed the trial (mean age, 63.5 years; 494 [40.9%] women; 681 [56.4%] undergoing abdominal surgery). The primary outcome occurred in 231 of 608 patients (38%) in the low tidal volume group compared with 232 of 590 patients (39%) in the conventional tidal volume group (difference, -1.3% [95% CI, -6.8% to 4.2%]; risk ratio, 0.97 [95% CI, 0.84-1.11]; P = .64). There were no significant differences in any of the secondary outcomes.
CONCLUSIONS AND RELEVANCE
Among adult patients undergoing major surgery, intraoperative ventilation with low tidal volume compared with conventional tidal volume, with PEEP applied equally between groups, did not significantly reduce pulmonary complications within the first 7 postoperative days.
TRIAL REGISTRATION
ANZCTR Identifier: ACTRN12614000790640.
Topics: Adult; Female; Humans; Incidence; Intraoperative Care; Lung Diseases; Male; Middle Aged; Positive-Pressure Respiration; Postoperative Complications; Postoperative Period; Single-Blind Method; Surgical Procedures, Operative; Tidal Volume
PubMed: 32870298
DOI: 10.1001/jama.2020.12866 -
Orthopaedics & Traumatology, Surgery &... Feb 2019The recent development of high-frequency ultrasonography transducers has provided better accuracy and improved the ability to image more superficial body structures.... (Review)
Review
The recent development of high-frequency ultrasonography transducers has provided better accuracy and improved the ability to image more superficial body structures. Ultrasonography is a widely available, inexpensive, comparative, and dynamic imaging technique that involves no radiation exposure and has no other adverse effects. Ultrasonography must always be combined with a medical history, physical examination, and radiographic assessment. What is ultrasound-assisted orthopaedic surgery? This approach consists in the use of ultrasonography by orthopaedic surgeons during patient visits and/or in the operating room. Similar to arthroscopy, ultrasonography is used as a complementary technique by physicians involved in the management of musculo-skeletal disease (e.g., radiologists, rheumatologists, and sports physicians). What knowledge of biophysics is needed to use ultrasonography? The surgeon must be familiar with the mechanisms by which the ultrasound waves are generated and received during B-mode and Doppler ultrasonography and with possible types of image artefacts. What is the procedure for examining a structure by ultrasonography? Each anatomic component must be assessed along two perpendicular planes in scanning mode. What does ultrasonography contribute during patient visits? Ultrasonography provides additional diagnostic information and helps to explain the pathological process to the patient. How does the contribution of ultrasonography vary across body sites and pathological processes? Ultrasonographic imaging is easier at some body sites than at others. Ultrasonography can provide useful information in patients with joint disease, sports injuries, osteo-articular infections, peripheral neuropathy, or tumours. What is interventional ultrasonography in orthopaedic surgery? Ultrasound-guided orthopaedic interventions include injections, aspirations, and minimally invasive surgical procedures. How can orthopaedic surgeons incorporate ultrasonography into their practice? The surgeon must purchase an ultrasound machine dedicated to the musculo-skeletal system and follow the necessary training courses.
Topics: Artifacts; Biopsy, Fine-Needle; Humans; Infections; Injections, Intra-Articular; Joints; Musculoskeletal Diseases; Neoplasms; Orthopedic Procedures; Orthopedics; Patient Education as Topic; Peripheral Nervous System Diseases; Physical Examination; Point-of-Care Systems; Postoperative Period; Preoperative Care; Ultrasonography
PubMed: 29990601
DOI: 10.1016/j.otsr.2018.04.027 -
Journal of Gastroenterology May 2018Hepatitis C virus (HCV) infection is one of the primary causes of liver cirrhosis and hepatocellular carcinoma. In hemodialysis patients, the rate of HCV infection is... (Review)
Review
Hepatitis C virus (HCV) infection is one of the primary causes of liver cirrhosis and hepatocellular carcinoma. In hemodialysis patients, the rate of HCV infection is high and is moreover associated with a poor prognosis. In liver transplantation patients with HCV infection, recurrent HCV infection is universal, and re-infected HCV causes rapid progression of liver fibrosis and graft loss. Additionally, in patients with HCV and human immunodeficiency virus (HIV) co-infection, liver fibrosis progresses rapidly. Thus, there is an acute need for prompt treatment of HCV infection in these special populations (i.e., hemodialysis, liver transplantation, HIV co-infection). However, until recently, the standard anti-HCV treatment involved the use of interferon-based therapy. In these special populations, interferon-based therapies could not achieve a high rate of sustained viral response and moreover were associated with a higher rate of adverse events. With the development of novel direct-acting antivirals (DAAs), the landscape of anti-HCV therapy for special populations has changed dramatically. Indeed, in special populations treated with interferon-free DAAs, the sustained viral response rate was above 90%, with a lower incidence and severity of adverse events.
Topics: Antiviral Agents; Coinfection; Drug Therapy, Combination; HIV Infections; Hepatitis C; Humans; Immunocompromised Host; Interferons; Liver Transplantation; Postoperative Period; Protease Inhibitors; Recurrence; Renal Dialysis; Renal Insufficiency, Chronic; Ribavirin
PubMed: 29299684
DOI: 10.1007/s00535-017-1427-x -
The Canadian Journal of Urology Dec 2020
Topics: Anti-Bacterial Agents; Humans; Male; Postoperative Period; Urethra; Urinary Incontinence; Urinary Sphincter, Artificial
PubMed: 33325345
DOI: No ID Found -
Cirugia Pediatrica : Organo Oficial de... Oct 2022The objective of this study was to assess the hyperlipasemia cases detected in the postoperative period of perforated appendicitis.
OBJECTIVE
The objective of this study was to assess the hyperlipasemia cases detected in the postoperative period of perforated appendicitis.
MATERIALS AND METHODS
A retrospective analysis of the perforated appendicitis cases occurred in our institution over a 7-year period (2013-2019) was carried out. Only cases where preoperative and postoperative serum lipase levels were available were included. The variables collected were statistically assessed by means of a descriptive, univariate analysis.
RESULTS
A total of 88 patients were studied. They were divided into 3 groups according to postoperative lipase levels - 57 were allocated to Group 1 (lipase: 70-194.0 U/L, normal range), 20 were allocated to Group 2 (lipase: 195-582 U/L), and 11 were allocated to Group 3 (lipase: > 582 U/L, which triples normal levels). Statistically significant differences were found in the following variables: sex, postoperative abscess, postoperative subocclusion/intestinal occlusion, preoperative lipase levels, days of parenteral nutrition, days of ICU stay, and days of hospital stay. Postoperative lipase had a moderate correlation with preoperative lipase, and none of the cases met acute pancreatitis diagnostic criteria.
CONCLUSIONS
Hyperlipasemia in the postoperative period of perforated appendicitis is not associated with developing clinical pancreatitis, but it is associated with worse progression in terms of increased complications, such as subocclusion/intestinal occlusion and intra-abdominal abscess, and longer ICU stay, hospital stay, and parenteral nutrition. There is a moderate correlation between preoperative and postoperative lipase, which means they could both prove useful as prognostic markers.
Topics: Acute Disease; Appendectomy; Appendicitis; Child; Humans; Intestinal Obstruction; Lipase; Pancreatitis; Postoperative Complications; Postoperative Period; Retrospective Studies
PubMed: 36217785
DOI: 10.54847/cp.2022.04.15 -
BMC Endocrine Disorders Jun 2018The benefit results of postoperative tight glycemic control (TGC) were controversial and there was a lack of well-powered studies that support current guideline... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The benefit results of postoperative tight glycemic control (TGC) were controversial and there was a lack of well-powered studies that support current guideline recommendations.
METHODS
The EMBASE, MEDLINE, and the Cochrane Library databases were searched utilizing the key words "Blood Glucose", "insulin" and "Postoperative Period" to retrieve all randomized controlled trials evaluating the benefits of postoperative TGC as compared to conventional glycemic control (CGC) in patients undergoing surgery.
RESULTS
Fifteen studies involving 5053 patients were identified. As compared to CGC group, there were lower risks of total postoperative infection (9.4% vs. 15.8%; RR 0.586, 95% CI 0.504 to 0.680, p < 0.001) and wound infection (4.6% vs. 7.2%; RR 0.620, 95% CI 0.422 to 0.910, p = 0.015) in TGC group. TGC also showed a lower risk of postoperative short-term mortality (3.8% vs. 5.4%; RR 0.692, 95% CI 0.527 to 0.909, p = 0.008), but sensitivity analyses showed that the result was mainly influenced by one study. The patients in the TGC group experienced a significant higher rate of postoperative hypoglycemia (22.3% vs. 11.0%; RR 3.145, 95% CI 1.928 to 5.131, p < 0.001) and severe hypoglycemia (2.8% vs. 0.7%; RR 3.821, 95% CI 1.796 to 8.127, p < 0.001) as compared to CGC group. TGC showed less length of ICU stay (SMD, - 0.428 days; 95% CI, - 0.833 to - 0.022 days; p = 0.039). However, TGC showed a neutral effect on neurological dysfunction (1.1% vs. 2.4%; RR 0.499, 95% CI 0.219 to 1.137, p = 0.098), acute renal failure (3.3% vs. 5.4%, RR 0.610, 95% CI 0.359 to 1.038, p = 0.068), duration of mechanical ventilation (p = 0.201) and length of hospitalization (p = 0.082).
CONCLUSIONS
TGC immediately after surgery significantly reduces total postoperative infection rates and short-term mortality. However, it might limit conclusion regarding the efficacy of TGC for short-term mortality in sensitivity analyses. The patients in the TGC group experienced a significant higher rate of postoperative hypoglycemia. This study may suggest that TGC should be administrated under close glucose monitoring in patients undergoing surgery, especially in those with high postoperative infection risk.
Topics: Aged; Blood Glucose; Child, Preschool; Glycemic Load; Humans; Infant; Infant, Newborn; Middle Aged; Postoperative Complications; Postoperative Period; Randomized Controlled Trials as Topic
PubMed: 29929558
DOI: 10.1186/s12902-018-0268-9