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European Journal of Anaesthesiology Dec 2023In recent years, there has been increasing focus on the use of cardiac biomarkers in patients undergoing noncardiac surgery.
BACKGROUND
In recent years, there has been increasing focus on the use of cardiac biomarkers in patients undergoing noncardiac surgery.
AIMS
The aim of this focused guideline was to provide updated guidance regarding the pre-, post- and combined pre-and postoperative use of cardiac troponin and B-type natriuretic peptides in adult patients undergoing noncardiac surgery.
METHODS
The guidelines were prepared using Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology. This included the definition of critical outcomes, a systematic literature search, appraisal of certainty of evidence, evaluation of biomarker measurement in terms of the balance of desirable and undesirable effects including clinical outcomes, resource use, health inequality, stakeholder acceptance, and implementation. The panel differentiated between three different scopes of applications: cardiac biomarkers as prognostic factors, as tools for risk prediction, and for biomarker-enhanced management strategies.
RESULTS
In a modified Delphi process, the task force defined 12 critical outcomes. The systematic literature search resulted in over 25,000 hits, of which 115 full-text articles formed the body of evidence for recommendations. The evidence appraisal indicated heterogeneity in the certainty of evidence across critical outcomes. Further, there was relevant gradient in the certainty of evidence across the three scopes of application. Recommendations were issued and if this was not possible due to limited evidence, clinical practice statements were produced.
CONCLUSION
The ESAIC focused guidelines provide guidance on the perioperative use of cardiac troponin and B-type natriuretic peptides in patients undergoing noncardiac surgery, for three different scopes of application.
Topics: Adult; Humans; Biomarkers; Health Status Disparities; Natriuretic Peptide, Brain; Postoperative Period; Troponin
PubMed: 37265332
DOI: 10.1097/EJA.0000000000001865 -
Anesthesiology Clinics Mar 2024Anemia is the most common modifiable risk factor for postoperative morbidity and mortality. Early identification and optimal management are key to restore iron stores... (Review)
Review
Anemia is the most common modifiable risk factor for postoperative morbidity and mortality. Early identification and optimal management are key to restore iron stores and ensure its resolution before surgery. Several therapies have been proposed to treat anemia in the perioperative period, such as iron supplementation and erythropoiesis-stimulating agents, though it remains unclear which is the most optimal to improve clinical outcomes. This article summarizes the most updated evidence on perioperative management of anemia and denotes differences among the international guidelines to reflect the conflicting evidence in this field and the need for further research in specific areas.
Topics: Humans; Anemia; Iron; Hematinics; Risk Factors; Postoperative Period
PubMed: 38278593
DOI: 10.1016/j.anclin.2023.09.002 -
Current Opinion in Obstetrics &... Oct 2023The use of hormonally suppressive medication to reduce levels of reproductive hormones around the time of surgery is widely used in the management of endometriosis. This...
PURPOSE OF REVIEW
The use of hormonally suppressive medication to reduce levels of reproductive hormones around the time of surgery is widely used in the management of endometriosis. This review summarizes the current evidence concerning the perioperative use of hormonal treatment in the management of endometriosis.
RECENT FINDINGS
European Society of Human Reproduction and Embryology (ESHRE) guidanceSurgical Outcomes and Complications of Laparoscopic Hysterectomy for Endometriosis: A Multicentre Cohort StudyPre and postsurgical medical therapy for endometriosis surgery. Cochrane 2020Postoperative hormonal treatment for prevention of endometrioma recurrence after ovarian cystectomy: a systematic review and network meta-analysis. BJOG 2021.
SUMMARY
The literature highlights the importance of hormonal treatment for symptom relief, reduced surgical complications and postoperative benefits, including a reduction in pain, disease recurrence and improved pregnancy rates. The treatment of endometriosis can be broadly categorized into medical, commonly using hormonal suppression medications and surgical, in which endometriosis tissue is excised or ablated. This review aims to outline current management strategies and examines the relationship between the two treatment modalities.
Topics: Female; Humans; Pregnancy; Endometriosis; Hysterectomy; Ovariectomy; Pain; Postoperative Period
PubMed: 37610988
DOI: 10.1097/GCO.0000000000000902 -
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 -
Skeletal Radiology Jul 2023Desmoid-type fibromatosis (DF) is a soft tissue tumor characterized by infiltrative growth and a tendency toward local recurrence, while it exhibits self-limiting... (Review)
Review
Desmoid-type fibromatosis (DF) is a soft tissue tumor characterized by infiltrative growth and a tendency toward local recurrence, while it exhibits self-limiting behavior and shows spontaneous regression. With its unpredictable behavior, a change in treatment strategies from initial surgery to nonsurgical management has been proposed, and active surveillance is currently widely chosen as the initial treatment strategy for DF. We reviewed the imaging features of DF regarding its clinical course, focusing on regression cases, postoperative cases, and imaging changes after systemic treatment.
Topics: Humans; Fibromatosis, Aggressive; Diagnostic Imaging; Combined Modality Therapy; Postoperative Period; Soft Tissue Neoplasms
PubMed: 36646850
DOI: 10.1007/s00256-023-04275-x -
Journal of Clinical Nursing Nov 2023Pain in the postoperative period of amputation surgeries, when not managed correctly, can have consequences for the patient. (Review)
Review
BACKGROUND
Pain in the postoperative period of amputation surgeries, when not managed correctly, can have consequences for the patient.
PURPOSES AND OBJECTIVES
The aim of this study was to map the scientific evidence on pain management in patients in the postoperative period of amputation surgeries.
DESIGN
Scoping review with elaboration based on the recommendations of the Joanna Briggs Institute, supported by The PAGER framework and guided by the PRISMA-ScR Checklist.
METHODS
The survey was conducted in August 2022 in 10 data sources. The 3300 publications found were analysed by two independent reviewers, after applying inclusion and exclusion criteria, 16 studies were selected.
RESULTS
Publications occurred between the years 1997 and 2022 and mainly dealt with the management of residual pain and phantom limb through pharmacological measures with pain assessment made by numerical scales.
CONCLUSIONS
The literature pointed out strategic uses of analgesics and highlighted technologies for neurostimulation through catheters. The need for new studies with non-pharmacological measures and with designs that can prove their effectiveness is reinforced.
RELEVANCE TO CLINICAL PRACTICE
The knowledge of these strategies by health professionals allows adequate pain management and patient follow-up for a less traumatic recovery.
PATIENT OR PUBLIC CONTRIBUTION
To patient or public involvement in this scoping review.
Topics: Humans; Amputation, Surgical; Analgesics; Pain Management; Pain, Postoperative; Phantom Limb; Postoperative Period
PubMed: 37605033
DOI: 10.1111/jocn.16846 -
The Annals of Thoracic Surgery Jul 2023Pectus excavatum is the most common congenital anterior chest wall deformity. Currently, a wide variety of diagnostic protocols and criteria for corrective surgery are... (Review)
Review
BACKGROUND
Pectus excavatum is the most common congenital anterior chest wall deformity. Currently, a wide variety of diagnostic protocols and criteria for corrective surgery are being used. Their use is predominantly based on local preferences and experience. To date, no guideline is available, introducing heterogeneity of care as observed in current daily practice. The aim of this study was to evaluate consensus and controversies regarding the diagnostic protocol, indications for surgical correction, and postoperative evaluation of pectus excavatum.
METHODS
The study consisted of 3 consecutive survey rounds evaluating agreement on different statements regarding pectus excavatum care. Consensus was achieved if at least 70% of participants provided a concurring opinion.
RESULTS
All 3 rounds were completed by 57 participants (18% response rate). Consensus was achieved on 18 of 62 statements (29%). Regarding the diagnostic protocol, participants agreed to routinely include conventional photography. In the presence of cardiac impairment, electrocardiography and echocardiography were indicated. Upon suspicion of pulmonary impairment, spirometry was recommended. In addition, consensus was reached on the indications for corrective surgery, including symptomatic pectus excavatum and progression. Participants moreover agreed that a plain chest radiograph must be acquired directly after surgery, whereas conventional photography and physical examination should both be part of routine postoperative follow-up.
CONCLUSIONS
Through a multiround survey, international consensus was formed on multiple topics to aid standardization of pectus excavatum care.
Topics: Humans; Funnel Chest; Consensus; Lung; Spirometry; Postoperative Period
PubMed: 36997016
DOI: 10.1016/j.athoracsur.2023.02.059 -
Digestive Diseases and Sciences Sep 2023
Topics: Humans; Crohn Disease; Gastrointestinal Agents; Postoperative Complications; Postoperative Period; Recurrence
PubMed: 37548895
DOI: 10.1007/s10620-023-08051-8 -
Current Opinion in Anaesthesiology Feb 2024To provide an approach to perioperative fluid management for lung resection patients that incorporates the entire patient pathway in the context of international... (Review)
Review
PURPOSE OF REVIEW
To provide an approach to perioperative fluid management for lung resection patients that incorporates the entire patient pathway in the context of international guidelines on enhanced recovery after surgery (ERAS).
RECENT FINDINGS
The concern with intraoperative fluid management is that giving too little or too much fluid is associated with worse outcomes after lung resection. However, it has not emerged as a key care element in thoracic ERAS programs probably due to the influence of other ERAS elements. Carbohydrate loading 2 h before surgery and the allowance of water until just prior to induction ensures the patient is both well hydrated and metabolically normal when they enter the operating room. Consequently, maintaining a euvolemic state during anesthesia can be achieved without goal-directed fluid therapy despite the recommendations of some guidelines. Intravenous fluids can be safely stopped in the immediate postoperative period.
SUMMARY
The goal of perioperative euvolemia can be achieved with the ongoing evolution and application of ERAS principles. A focus on the pre and postoperative phases of fluid management and a pragmatic approach to intraoperative fluid management negates the need for goal-directed fluid therapy in most cases.
Topics: Humans; Thoracic Surgery; Perioperative Care; Enhanced Recovery After Surgery; Fluid Therapy; Postoperative Period; Postoperative Complications; Length of Stay
PubMed: 38085874
DOI: 10.1097/ACO.0000000000001333 -
Radiographics : a Review Publication of... Apr 2024Endometriosis is a highly prevalent disease that affects 10%-15% of women of reproductive age worldwide and is mainly associated with chronic pelvic pain and...
Endometriosis is a highly prevalent disease that affects 10%-15% of women of reproductive age worldwide and is mainly associated with chronic pelvic pain and infertility. With the widespread use of imaging for the diagnosis and monitoring of endometriosis, combined with the ability of surgery to eradicate the disease and address infertility, there has been a significant increase in recent years in imaging examinations for postoperative evaluation of endometriosis. US and MRI are used not only to help diagnose and map endometriosis but also to evaluate refractory symptoms, residual lesions, and complications at posttreatment assessment. Knowledge of surgical techniques and recognition of expected postoperative imaging findings are crucial to differentiate postoperative changes from residual disease and/or recurrence. The authors discuss imaging aspects of postoperative endometriosis, with an emphasis on the imaging approach, comprehension of surgical techniques, recognition of the expected findings, possible complications, and analysis of residual disease or recurrence. RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by VanBuren in this issue. The slide presentation from the RSNA Annual Meeting is available for this article.
Topics: Female; Humans; Endometriosis; Pelvic Pain; Magnetic Resonance Imaging; Infertility; Postoperative Period
PubMed: 38512726
DOI: 10.1148/rg.230159