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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 -
Brazilian Journal of Cardiovascular... May 2022Early mobilization of patients in the postoperative period of cardiac surgery who are hospitalized in the intensive care unit (ICU) is a practice that has a positive... (Review)
Review
INTRODUCTION
Early mobilization of patients in the postoperative period of cardiac surgery who are hospitalized in the intensive care unit (ICU) is a practice that has a positive impact.
METHODS
This is a systematic review of studies published until September 2020 in the Medical Literature Analysis and Retrieval System Online (or MEDLINE®), Embase, Physiotherapy Evidence Database (or PEDro), Scientific Electronic Library Online (or SciELO), and Latin American and Caribbean Health Sciences Literature (or LILACS) databases. Randomized clinical trials describing mobilization protocols performed early in ICU patients after cardiac surgery were included.
RESULTS
According to the eligibility criteria, only 14 of the 1,128 articles found were included in the analysis. Early mobilization protocols were initiated in the immediate postoperative period or first postoperative day. The resources and technics used were progressive mobilization, cycle ergometer, early bed activities, walking protocols, resistance exercise, and virtual reality. Intensity of the mobilization activities was determined using the Borg scale and heart rate.
CONCLUSION
Early mobilization protocols are generalist (not individual), and low-intensity exercises are used, through progressive mobilization, with two daily physical therapy sessions, during 10 to 30 minutes.
Topics: Cardiac Surgical Procedures; Early Ambulation; Humans; Intensive Care Units; Postoperative Period; Prescriptions
PubMed: 35244377
DOI: 10.21470/1678-9741-2021-0140 -
Advances in Clinical and Experimental... Mar 2020Pain is one of the most common complaints expressed by hospital patients and is the main reason they seek medical help. Pain is always subjective, so its severity should... (Review)
Review
Pain assessment and management in children in the postoperative period: A review of the most commonly used postoperative pain assessment tools, new diagnostic methods and the latest guidelines for postoperative pain therapy in children.
Pain is one of the most common complaints expressed by hospital patients and is the main reason they seek medical help. Pain is always subjective, so its severity should be assessed individually for each patient. The main issue with pain management in children is the difficulty involved in evaluating it. Numerous studies have developed tools that would allow for an accurate assessment of the intensity of pain in children in the postoperative period. Adequate postoperative pain assessment in pediatric patients may significantly improve their comfort and quality of life. Postoperative pain prolongs recovery and hospitalization; therefore, the severity of the pain should be part of a routine assessment. Whichever tool is applied to measure pain, it should take into account the child's age, language, ethnicity, and cognitive ability. There is no one universal method for pain assessment which is appropriate for every pediatric patient. This article provides a review of the available subjective methods of postoperative pain assessment, including new objective diagnostic methods and the latest guidelines for postoperative pain therapy in a group of pediatric patients.
Topics: Child; Humans; Pain Management; Pain Measurement; Pain, Postoperative; Postoperative Period; Quality of Life
PubMed: 32129952
DOI: 10.17219/acem/112600 -
JAMA Jan 2022
Topics: Anesthesia, General; Humans; Postoperative Period
PubMed: 34928317
DOI: 10.1001/jama.2021.22465 -
Annals of Cardiac Anaesthesia 2021The life expectancy of patients with end-stage heart disease undergoing Orthotopic Heart Transplantation (OHT) has increased significantly in the recent decades since... (Review)
Review
The life expectancy of patients with end-stage heart disease undergoing Orthotopic Heart Transplantation (OHT) has increased significantly in the recent decades since its original introduction into the medical practice in 1967. Substantial advances in post-operative intensive care, surgical prophylaxis, and anti-rejection drugs have clearly impacted survivability after OHT, therefore the volume of patients presenting for non-cardiac surgical procedures is expected to continue to escalate in the upcoming years. There are a number of caveats associated with this upsurge of post-OHT patients requiring non-cardiac surgery, including presenting to healthcare facilities without the resources and technology necessary to manage potential perioperative complications or that may not be familiar with the care of these patients, facilities in which a cardiac anesthesiologist is not available, patients presenting for emergency procedures and so forth. The perioperative care of patients after OHT introduces several challenges to the anesthesiologist including preoperative risk assessments different to the general population and intraoperative management of a denervated organ with altered response to medications and drug-drug interactions. The present review aims to synopsize current data of patients presenting for non-cardiac surgery after OHT, surgical aspects of the transplant that may impact perioperative care, physiology of the transplanted heart as well as anesthetic considerations.
Topics: Heart; Heart Transplantation; Humans; Perioperative Care; Postoperative Period; Risk Assessment
PubMed: 33884968
DOI: 10.4103/aca.ACA_130_19 -
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 -
Journal of Vascular Surgery Sep 2019
Topics: Aortic Aneurysm, Abdominal; Humans; Kidney Diseases; Postoperative Period
PubMed: 31445646
DOI: 10.1016/j.jvs.2019.05.024 -
British Journal of Anaesthesia Dec 2016Falls are a known public health problem, and there is increasing recognition of the importance of perioperative falls for risk prediction and quality assessment. Our... (Review)
Review
UNLABELLED
Falls are a known public health problem, and there is increasing recognition of the importance of perioperative falls for risk prediction and quality assessment. Our objective was to review existing literature regarding the occurrence, injuries, and risk factors of preoperative and postoperative falls. A systematized search of PubMed entries between 1947 and November 2015 produced 24 articles that met inclusion criteria. Most studied orthopaedic surgery patients older than 65 yr. Four were rated 'good' quality. Interrater reliability for the quality assessment was moderate (κ = 0.77). In the 3-12 months before surgery, the proportion of preoperative patients who fell ranged from 24 to 48%. Injuries were common (70%). The rate of postoperative falls ranged from 0.8 to 16.3 per 1000 person-days, with a gradual decline in the months after surgery. Injuries from postoperative falls occurred in 10-70% of fallers, and 5-20% experienced a severe injury. Risk factors were not well studied. Prospective studies reported a higher percentage of falls and fall-related injuries than retrospective studies, suggesting that there may be underdetection of falls and injuries with retrospective studies. Perioperative falls were more common than falls reported in the general community, even up to 12 months after surgery. Surgery-related falls may therefore occur beyond the hospitalization period. Future studies should use a prospective design, validated definitions, and broader populations to study perioperative falls. In particular, investigations of risk factors and follow-up after hospitalization are needed.
REGISTRY NUMBER
PROSPERO registration number CRD42015029971.
Topics: Accidental Falls; Aged; Aged, 80 and over; Hospitalization; Humans; Postoperative Period; Risk Factors
PubMed: 27956670
DOI: 10.1093/bja/aew377 -
Obstetrics and Gynecology Mar 2024Gynecologic surgeons have traditionally restricted the physical activity of postoperative patients. Minimally invasive surgery and enhanced recovery after surgery... (Review)
Review
Gynecologic surgeons have traditionally restricted the physical activity of postoperative patients. Minimally invasive surgery and enhanced recovery after surgery programs have contributed to decreased hospital stays and more expeditious recovery. In this narrative review, we review the current state of postoperative activity restrictions in gynecology and other specialties, the purported risks and potential benefits of postoperative activity, the available evidence to refute or support activity in the postoperative activity, and, finally, the potential benefit of added activity in the postoperative period.
Topics: Female; Humans; Gynecologic Surgical Procedures; Length of Stay; Postoperative Period; Minimally Invasive Surgical Procedures
PubMed: 38207325
DOI: 10.1097/AOG.0000000000005501 -
The Journal of Thoracic and... Dec 2017
Topics: Ductus Arteriosus, Patent; Echocardiography; Humans; Infant; Infant, Newborn; Infant, Premature; Ligation; Postoperative Period
PubMed: 28967417
DOI: 10.1016/j.jtcvs.2017.08.048