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European Respiratory Review : An... Jan 2017Sleep disordered breathing, especially obstructive sleep apnoea (OSA), has a high and increasing prevalence. Depending on the apnoea and hypopnoea scoring criteria used,... (Review)
Review
Sleep disordered breathing, especially obstructive sleep apnoea (OSA), has a high and increasing prevalence. Depending on the apnoea and hypopnoea scoring criteria used, and depending on the sex and age of the subjects investigated, prevalence varies between 3% and 49% of the general population. These varying prevalences need to be reflected when considering screening for OSA. OSA is a cardiovascular risk factor and patients are at risk when undergoing medical interventions such as surgery. Screening for OSA before anaesthesia and surgical interventions is increasingly considered. Therefore, methods for screening and the rationale for screening for OSA are reviewed in this study.
Topics: Algorithms; Checklist; Continuous Positive Airway Pressure; Decision Support Techniques; Humans; Lung; Patient Selection; Polysomnography; Postoperative Complications; Predictive Value of Tests; Prevalence; Respiration; Risk Assessment; Risk Factors; Sleep Apnea, Obstructive; Surgical Procedures, Operative; Surveys and Questionnaires; Treatment Outcome; Waiting Lists
PubMed: 28049125
DOI: 10.1183/16000617.0012-2016 -
International Journal of Surgery... Sep 2020Globally, a staggering 310 million major surgeries are performed each year; around 40 to 50 million in USA and 20 million in Europe. It is estimated that 1-4% of these...
Globally, a staggering 310 million major surgeries are performed each year; around 40 to 50 million in USA and 20 million in Europe. It is estimated that 1-4% of these patients will die, up to 15% will have serious postoperative morbidity, and 5-15% will be readmitted within 30 days. An annual global mortality of around 8 million patients places major surgery comparable with the leading causes of death from cardiovascular disease and stroke, cancer and injury. If surgical complications were classified as a pandemic, like HIV/AIDS or coronavirus (COVID-19), developed countries would work together and devise an immediate action plan and allocate resources to address it. Seeking to reduce preventable deaths and post-surgical complications would save billions of dollars in healthcare costs. Part of the global problem resides in differences in institutional practice patterns in high- and low-income countries, and part from a lack of effective perioperative drug therapies to protect the patient from surgical stress. We briefly review the history of surgical stress and provide a path forward from a systems-based approach. Key to progress is recognizing that the anesthetized brain is still physiologically 'awake' and responsive to the sterile stressors of surgery. New intravenous drug therapies are urgently required after anesthesia and before the first incision to prevent the brain from switching to sympathetic overdrive and activating secondary injury progression such as hyperinflammation, coagulopathy, immune activation and metabolic dysfunction. A systems-based approach targeting central nervous system-mitochondrial coupling may help drive research to improve outcomes following major surgery in civilian and military medicine.
Topics: Global Health; Glycocalyx; Humans; Hypothalamo-Hypophyseal System; Mitochondria; Pituitary-Adrenal System; Postoperative Complications; Stress, Physiological; Surgical Procedures, Operative
PubMed: 32738546
DOI: 10.1016/j.ijsu.2020.07.017 -
Cirugia Espanola 2020In view of the current pandemic by SARS-CoV-2 it deems essential to understand the key concepts about the infection: its epidemiological origin, presentation, clinical... (Review)
Review
In view of the current pandemic by SARS-CoV-2 it deems essential to understand the key concepts about the infection: its epidemiological origin, presentation, clinical course, diagnosis and treatment (still experimental in many cases). The knowledge about the virus is still limited, but as the pandemic progresses and the physiopathology of the disease is understood, new evidence is being massively published. Surgical specialists are facing an unprecedented situation: they must collaborate in the ER or medical wards attending these patients, while still needing to make decisions about surgical patients with probable COVID-19. The present narrative review aims to summarize the most relevant aspects and synthetize concepts on COVID-19 for surgeons.
Topics: COVID-19; Coronavirus Infections; Humans; Infection Control; Pandemics; Pneumonia, Viral; Spain; Surgeons; Surgical Procedures, Operative
PubMed: 32345443
DOI: 10.1016/j.ciresp.2020.04.009 -
The British Journal of Surgery Jul 2020
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Disease Transmission, Infectious; Education, Medical; General Surgery; Humans; Pandemics; Pneumonia, Viral; SARS-CoV-2; Safety; Surgical Procedures, Operative
PubMed: 32492170
DOI: 10.1002/bjs.11740 -
Medicine Sep 2022In this study, the application effect of fast-track surgery (FTS) nursing intervention in laparotomy and laparoscopic surgery for colorectal cancer (CRC) is... (Randomized Controlled Trial)
Randomized Controlled Trial
In this study, the application effect of fast-track surgery (FTS) nursing intervention in laparotomy and laparoscopic surgery for colorectal cancer (CRC) is investigated, and the optimal perioperative management strategy for CRC surgery is explored. One hundred thirty CRC patients are included in this study, in which 67 patients undergo laparotomy (Group A) and 63 patients undergo laparoscopic surgery (Group B). These patients were also randomly divided into traditional nursing subgroup (Group A1 [n = 33] and Group B1 [n = 31]) and FTS nursing subgroup (Group A2 [n = 34] and Group B2 [n = 32]). The general data of patients, pre-operative preparation, intra-operative data, postoperative recovery data, and postoperative complications are recorded. Both FTS and laparoscopic surgery can advance the anal exhaust time, and shorten postoperative fasting and water deprivation time, and the hospitalization time without increasing the incidence of complications. FTS has advantages in reducing the indwelling time of gastric tube and throat pain. Simultaneous implementation of FTS and laparoscopic surgery has the best effect on the postoperative recovery of CRC patients.
Topics: Digestive System Surgical Procedures; Humans; Laparoscopy; Laparotomy; Length of Stay; Postoperative Complications
PubMed: 36123937
DOI: 10.1097/MD.0000000000030603 -
Updates in Surgery Jun 2021Current evidence shows that robotic pancreatoduodenectomy (RPD) is feasible with a safety profile equivalent to either open pancreatoduodenectomy (OPD) or laparoscopic... (Review)
Review
Current evidence shows that robotic pancreatoduodenectomy (RPD) is feasible with a safety profile equivalent to either open pancreatoduodenectomy (OPD) or laparoscopic pancreatoduodenectomy (LPD). However, major intraoperative bleeding can occur and emergency conversion to OPD may be required. RPD reduces the risk of emergency conversion when compared to LPD. The learning curve of RPD ranges from 20 to 40 procedures, but proficiency is reached only after 250 operations. Once proficiency is achieved, the results of RPD may be superior to those of OPD. As for now, RPD is at least equivalent to OPD and LPD with respect to incidence and severity of POPF, incidence and severity of post-operative complications, and post-operative mortality. A minimal annual number of 20 procedures per center is recommended. In pancreatic cancer (versus OPD), RPD is associated with similar rates of R0 resections, but higher number of examined lymph nodes, lower blood loss, and lower need of blood transfusions. Multivariable analysis shows that RPD could improve patient survival. Data from selected centers show that vein resection and reconstruction is feasible during RPD, but at the price of high conversion rates and frequent use of small tangential resections. The true Achilles heel of RPD is higher operative costs that limit wider implementation of the procedure and accumulation of a large experience at most single centers. In conclusion, when proficiency is achieved, RPD may be superior to OPD with respect to CR-POPF and oncologic outcomes. Achievement of proficiency requires commitment, dedication, and truly high volumes.
Topics: Humans; Learning Curve; Pancreatic Neoplasms; Pancreaticoduodenectomy; Postoperative Complications; Retrospective Studies; Robotic Surgical Procedures
PubMed: 34014497
DOI: 10.1007/s13304-021-01058-8 -
Journal of Visceral Surgery Dec 2016The prevention of post-operative risk of venous thrombo-embolism (VTE) is of fundamental importance, but preventive methods have progressed with the introduction of... (Review)
Review
The prevention of post-operative risk of venous thrombo-embolism (VTE) is of fundamental importance, but preventive methods have progressed with the introduction of direct oral anticoagulants (DOAC), the development of ambulatory surgery and enhanced recovery programs (ERP) after surgery. Surgery is, inherently a trigger for venous thrombo-embolic disease, as is prolonged immobilization. However, the risk of VTE is very low following ambulatory surgery, especially in this selected population. ERP, consists of a set of measures to optimize the patient's peri-operative management while reducing length of stay, costs and morbidity and mortality; one measure is the encouragement of early ambulation. This will undoubtedly have an impact on the incidence of VTE and lessen the need for prolonged thrombo-prophylaxis.
Topics: Adult; Ambulatory Surgical Procedures; Anticoagulants; Early Ambulation; Female; Humans; Length of Stay; Male; Middle Aged; Operative Time; Patient Safety; Postoperative Care; Postoperative Complications; Pulmonary Embolism; Risk Assessment; Treatment Outcome; Venous Thromboembolism
PubMed: 27789264
DOI: 10.1016/j.jviscsurg.2016.09.002 -
Current Opinion in Anaesthesiology Oct 2020Few outcomes in surgery are as important to patients as that of their neurologic status. The purpose of this review is to discuss and categorize the most common... (Review)
Review
PURPOSE OF REVIEW
Few outcomes in surgery are as important to patients as that of their neurologic status. The purpose of this review is to discuss and categorize the most common perioperative neurologic complications. We will also discuss strategies to help prevent and mitigate these complications for our patients.
RECENT FINDINGS
There are several strategies the anesthesiologist can undertake to prevent or treat conditions, such as perioperative neurocognitive disorders, spinal cord ischemia, perioperative stroke, and postoperative visual loss.
SUMMARY
A thorough understanding of threats to patients' neurologic well-being is essential to excellent clinical practice.
Topics: Humans; Nervous System Diseases; Perioperative Period; Postoperative Complications; Spinal Cord Ischemia; Stroke; Surgical Procedures, Operative
PubMed: 32769748
DOI: 10.1097/ACO.0000000000000905 -
Anaesthesia Jan 2016Cardiovascular complications are an important cause of morbidity and mortality after non-cardiac surgery. Pre-operative identification of high-risk individuals and... (Review)
Review
Cardiovascular complications are an important cause of morbidity and mortality after non-cardiac surgery. Pre-operative identification of high-risk individuals and appropriate peri-operative management can reduce cardiovascular risk. It is important to continue chronic beta-blocker and statin therapy. Statins are relatively safe and peri-operative initiation may be beneficial in high-risk patients and those scheduled for vascular surgery. The pre-operative introduction of beta-blockers reduces myocardial injury but increases rates of stroke and mortality, possibly due to hypotension. They should only be considered in high-risk patients and the dose should be titrated to heart rate. Alpha-2 agonists may also contribute to hypotension. Aspirin continuation can increase the risk of major bleeding and offset the benefit of reduced myocardial risk. Contrary to the initial ENIGMA study, nitrous oxide does not seem to increase the risk of myocardial injury. Volatile anaesthetic agents and opioids have been shown to be cardioprotective in animal laboratory studies but these effects have, so far, not been conclusively reproduced clinically.
Topics: Cardiotonic Agents; Cardiovascular Diseases; Humans; Perioperative Care; Postoperative Complications; Risk Factors; Surgical Procedures, Operative
PubMed: 26620144
DOI: 10.1111/anae.13305 -
Scandinavian Journal of Gastroenterology Oct 2016Pancreas surgery has developed into a fairly safe procedure in terms of mortality, but is still hampered by considerable morbidity. Among the most frequent and dreaded... (Review)
Review
BACKGROUND
Pancreas surgery has developed into a fairly safe procedure in terms of mortality, but is still hampered by considerable morbidity. Among the most frequent and dreaded complications are the development of a post-operative pancreatic fistula (POPF). The prediction and prevention of POPF remains an area of debate with several questions yet to be firmly addressed with solid answers.
METHODS
A systematic review of systematic reviews/meta-analyses and randomized trials in the English literature (PubMed/MEDLINE, Cochrane library, EMBASE) covering January 2005 to December 2015 on risk factors and preventive strategies for POPF.
RESULTS
A total of 49 systematic reviews and meta-analyses over the past decade discussed patient, surgeon, pancreatic disease and intraoperative related factors of POPF. Non-modifiable factors (age, BMI, comorbidity) and pathology (histotype, gland texture, duct size) that indicates surgery are associated with POPF risk. Consideration of anastomotic technique and use of somatostatin-analogs may slightly modify the risk of fistula. Sealant products appear to have no effect. Perioperative bleeding and transfusion enhance risk, but is modifiable by focus on technique and training. Drains may not prevent fistulae, but may help in early detection. Early drain-amylase may aid in detection. Predictive scores lack uniform validation, but may have a role in patient information if reliable pre-operative risk factors can be obtained.
CONCLUSIONS
Development of POPF occurs through several demonstrated risk factors. Anastomotic technique and use of somatostatin-analogs may slightly decrease risk. Drains may aid in early detection of leaks, but do not prevent POPF.
Topics: Digestive System Surgical Procedures; Drainage; Humans; Morbidity; Pancreas; Pancreatic Fistula; Postoperative Complications; Predictive Value of Tests; Randomized Controlled Trials as Topic; Risk Factors
PubMed: 27216233
DOI: 10.3109/00365521.2016.1169317