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Urologiia (Moscow, Russia : 1999) Dec 2023Urinary tract disorders are one of the most common pathologies in children, regardless of age, and every year their prevalence is growing. Our study is dedicated to...
INTRODUCTION
Urinary tract disorders are one of the most common pathologies in children, regardless of age, and every year their prevalence is growing. Our study is dedicated to improvement of postoperative pain management after pediatric urologic procedures and to implementation of modern approaches for enhanced recovery.
AIM
To develop optimal methods of postoperative pain relief for moderate and severe intensity of pain syndrome in children undergoing urological procedures.
MATERIALS AND METHODS
The study involved 34 patients who were undergone to urological procedures. For an objective assessment of the quality of anesthesia, the following research methods were used: clinical study with the determination of the pain intensity on a visual analogue scale (VAS) and the determination of systolic and diastolic blood pressure, pulse oximetry and echocardiographic study.
RESULTS
The analysis of the postoperative period with monitoring of blood pressure, oxygen saturation, pulse oximetry, subjective assessment of the pain intensity on the VAS and the echocardiographic study showed that the relative stability of the condition was associated with an adequate pain relief. The use of a combination of infulgan, which caused an early analgesic effect, with tramadol realizing its action later, provides a prolongation of analgesia. A combination of tramadol with infulgan was several times more efficient than ketorolac.
CONCLUSIONS
The use of a combined analgesia after urological procedures, including ketorolac, provides a hemodynamically stability in the entire postoperative period.
Topics: Child; Humans; Tramadol; Ketorolac; Analgesics, Opioid; Pain, Postoperative; Postoperative Period; Double-Blind Method
PubMed: 38156692
DOI: No ID Found -
Journal of Neurosurgery Apr 2024The influence of persistent postoperative hyperglycemia after craniotomy has not yet been explored. This study aimed to investigate the hypothesis that persistent...
OBJECTIVE
The influence of persistent postoperative hyperglycemia after craniotomy has not yet been explored. This study aimed to investigate the hypothesis that persistent postoperative hyperglycemia is associated with mortality in patients undergoing an elective craniotomy.
METHODS
This study included adult patients (age ≥ 18 years) undergoing an elective craniotomy between January 2011 and March 2021 at the West China Hospital, Sichuan University. Peak daily blood glucose values measured within the first 7 days after craniotomy were collected. Persistent hyperglycemia was defined by two or more consecutive serum glucose levels of mild, moderate, or severe hyperglycemia. Normoglycemia, mild hyperglycemia, moderate hyperglycemia, and severe hyperglycemia were defined as glucose values of ≤ 6.1 mmol/L, > 6.1 and ≤ 7.8 mmol/L, > 7.8 and ≤ 10.0 mmol/L, and > 10.0 mmol/L, respectively.
RESULTS
This study included 14,907 patients undergoing an elective craniotomy. In the multivariable analysis, both moderate (adjusted OR 3.76, 95% CI 2.68-5.27) and severe (adjusted OR 3.82, 95% CI 2.54-5.76) persistent hyperglycemia in patients were associated with higher 30-day mortality compared with normoglycemia. However, this association was not observed in patients with mild hyperglycemia (adjusted OR 1.32, 95% CI 0.93-1.88). Interestingly, this association was observed regardless of whether patients had preoperative hyperglycemia. There was no interaction between moderate or severe hyperglycemia and preexisting diabetes (p for interaction = 0.65). When postoperative peak blood glucose values within the first 7 days after craniotomy were evaluated as a continuous variable, for each 1-mmol/L increase in blood glucose, the adjusted OR of 30-day mortality was 1.17 (95% CI 1.14-1.21). Postoperative blood glucose (area under the curve [AUC] = 0.78) was superior to preoperative blood glucose (AUC = 0.65; p < 0.001) for predicting mortality. Moderate and severe persistent hyperglycemia in patients were associated with an increased risk of deep venous thrombosis (adjusted OR 3.20, 95% CI 2.31-4.42), pneumonia (adjusted OR 2.77, 95% CI 2.40-3.21), myocardial infarction (adjusted OR 4.38, 95% CI 3.41-5.61), and prolonged hospital stays (adjusted OR 1.43, 95% CI 1.29-1.59).
CONCLUSIONS
In patients undergoing an elective craniotomy, moderate and severe persistent postoperative hyperglycemia were associated with an increased risk of mortality compared with normoglycemia, regardless of preoperative hyperglycemia.
Topics: Adult; Humans; Adolescent; Blood Glucose; Hyperglycemia; Diabetes Mellitus; Craniotomy; Postoperative Period; Retrospective Studies
PubMed: 38564805
DOI: 10.3171/2023.7.JNS23777 -
Minerva Anestesiologica Oct 2023The aim of this paper was to explore pupillary monitoring for determining remifentanil consumption during general anesthesia and evaluating postoperative recovery... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The aim of this paper was to explore pupillary monitoring for determining remifentanil consumption during general anesthesia and evaluating postoperative recovery quality.
METHODS
Eighty patients undergoing elective laparoscopic uterine surgery were randomly divided into pupillary monitoring group (Group P) and control group (Group C). In Group P, remifentanil dosage during general anesthesia was determined according to pupil dilation reflex; in Group C, it was adjusted according to hemodynamic changes. Intraoperative remifentanil consumption and endotracheal tube extraction time were recorded. The Numerical Rating Scale (NRS) Score, hemodynamic changes, and opioid-related adverse reactions in the post-anesthesia care unit were also recorded. The parameters of pupil light reflex from extubation to 30 min after extubation were analyzed in Group P, and the responsiveness of these parameters and hemodynamic changes to NRS was determined by ROC curve analyses.
RESULTS
Compared with Group C, in Group P, intraoperative remifentanil consumption, the NRS Score at 20 minutes after extubation, extubation time, and the incidence of nausea, vomiting, and respiratory amnesia were all significantly decreased (all, P<0.05). In Group P, ∆HR and ∆MAP had no value in judging the change of NRS. The ROC values and diagnostic cutoff values of ΔInit, ΔACV, and ΔMCV responding to NRS variation were 0.775 (95% CI: 0.582-0.968), 0.734(95% CI: 0.537-0.930), and 0.822 (95% CI: 0.648-0.997) and 0.21 (sensitivity, 92.3%; specificity, 23.1%), -1.3 (sensitivity, 92.3%; specificity, 18.3%), and -1.0 (sensitivity, 84.6%; specificity, 17.7%), respectively.
CONCLUSIONS
Intraoperative pupil dilation reflex monitoring can reduce remifentanil consumption and improve postoperative recovery quality. Furthermore, postoperative pupil light reflex monitoring can help evaluate pain degree with high sensitivity.
Topics: Humans; Remifentanil; Pupil; Piperidines; Analgesics, Opioid; Laparoscopy; Anesthesia Recovery Period; Pain, Postoperative
PubMed: 37307030
DOI: 10.23736/S0375-9393.23.17303-2 -
BMC Gastroenterology Nov 2023The present study aims to explore the clinical application of enhanced recovery after surgery (ERAS) in pediatric patients with congenital upper gastrointestinal...
BACKGROUND
The present study aims to explore the clinical application of enhanced recovery after surgery (ERAS) in pediatric patients with congenital upper gastrointestinal obstruction (CUGIO).
METHODS
A total of 82 pediatric patients with CUGIO admitted to the neonatal intensive care unit in Kunming Children's Hospital between June 2017 and June 2021 were enrolled in the present study and divided into two groups: the ERAS group (n = 46) and the control group (n = 36). The ERAS management mode was adopted in the ERAS group, and the conventional perioperative management mode was adopted in the control group.
RESULTS
In the ERAS group and the control group, the time to the first postoperative bowel movement was 49.2 ± 16.6 h and 58.4 ± 18.8 h, respectively, and the time to the first postoperative feeding was 79 ± 7.1 h and 125.2 ± 8.3 h, respectively. The differences in the above two indicators between the two groups were statistically significant (P < 0.05). In the ERAS group, the days of parenteral nutrition and the length of hospital stay were 14.5 ± 2.3 d and 18.8 ± 6.4 d, respectively. In the control group, 17.6 ± 2.2 d and 23.1 ± 8.1 d, respectively. The differences in these two indicators between the two groups were statistically significant (P < 0.05).
CONCLUSION
The ERAS management model had a positive effect on early postoperative recovery in pediatric patients with CUGIO.
Topics: Infant, Newborn; Humans; Child; Enhanced Recovery After Surgery; Duodenal Obstruction; Intestines; Postoperative Period; Length of Stay; Postoperative Complications; Retrospective Studies
PubMed: 38036993
DOI: 10.1186/s12876-023-03057-y -
Zhonghua Nan Ke Xue = National Journal... Aug 2023To explore the safety and effectiveness of the "scarless" circumcision technique (a modified sleeve-style circumcision method) that preserves the original appearance,...
OBJECTIVE
To explore the safety and effectiveness of the "scarless" circumcision technique (a modified sleeve-style circumcision method) that preserves the original appearance, providing a more suitable surgical option for patients with redundant prepuce.
METHODS
Clinical data of patients who underwent "scarless" circumcision at the Eastern Theater Command General Hospital from April 2022 to March 2023 were collected, with patients who underwent conventional circumcision (single-use stapler method) during the same period serving as the control group. The two groups were compared in terms of operation time, postoperative recovery time, incidence of postoperative complications, and patient satisfaction rates after surgery.
RESULTS
The operation time for the study group was significantly longer than that of the control group; there was no significant difference in pain scores on the day of surgery between the two groups, but the pain scores on postoperative days 1, 3, and 7 were lower in the study group than in the control group; the postoperative recovery time was significantly shorter in the study group than in the control group; regarding postoperative complications: the control group had higher rates of edema, incision infection, and wound dehiscence than the study group. A satisfaction survey conducted 30 days postoperatively showed higher satisfaction in the study group than in the control group.
CONCLUSION
The "scarless" circumcision technique that preserves the original appearance is safe and effective for patients with simple redundant prepuce and is a new surgical method with value for widespread adoption.
Topics: Male; Humans; Circumcision, Male; Operative Time; Patient Satisfaction; Postoperative Period; Pain
PubMed: 38619517
DOI: No ID Found -
Acta Medica Okayama Oct 2023Elderly patients are at higher risk of postoperative hypoxemia due to their decreased respiratory function. The aim of this study was to investigate the relationship of...
Elderly patients are at higher risk of postoperative hypoxemia due to their decreased respiratory function. The aim of this study was to investigate the relationship of intraoperative oxygen saturation (SpO2) and end-expiratory carbon dioxide (ETCO2) values with postoperative hypoxemia in elderly patients. The inclusion criteria were: 1) patients aged≥75 years; 2) underwent general anesthesia in non-cardiac surgery; 3) operative time longer than two hours; and 4) admission to the intensive care unit (ICU) following surgery performed between January and December 2019. Intraoperative SpO2 and ETCO2 values were collected every minute for the first two hours during surgery. The 253 patients were divided into two groups: SpO2≥92% and SpO2<92%. The time-weighted averages of intraoperative SpO2 and ETCO2 were used to compare differences between the two groups. The incidence of postoperative hypoxemia was 22.5%. For similar ventilator settings, patients with postoperative hypoxemia had lower intraoperative SpO2 and higher ETCO2 values. Sex, ASA classification, and intraoperative SpO2 were independent risk factors for postoperative hypoxemia. In conclusion, postoperative SpO2<92% was a frequent occurrence (> 20%) in elderly patients who underwent major non-cardiac surgery. Postoperative hypoxemia was associated with low intraoperative SpO2 and relatively higher ETCO2.
Topics: Aged; Humans; Oxygen Saturation; Hypoxia; Carbon Dioxide; Respiration; Postoperative Period
PubMed: 37899265
DOI: 10.18926/AMO/65976 -
The Surgical Clinics of North America Oct 2023It is estimated that approximately one in four men and one in 20 women will develop an inguinal hernia over the course of their lifetime. A non-mesh inguinal hernia... (Review)
Review
It is estimated that approximately one in four men and one in 20 women will develop an inguinal hernia over the course of their lifetime. A non-mesh inguinal hernia repair via the Shouldice technique is a unique approach that necessitates dissection of the entire groin region as well as careful assessment for any secondary hernias. Subsequently, a pure tissue laminated closure allows the repair to be performed without tension. Herein, the authors describe a brief overview of inguinal hernias and discuss the relevant patient evaluation, operative steps of the Shouldice procedure, and postoperative considerations.
Topics: Male; Female; Humans; Hernia, Inguinal; Patient Selection; Dissection; Postoperative Period
PubMed: 37709392
DOI: 10.1016/j.suc.2023.04.001 -
The Cleft Palate-craniofacial Journal :... Mar 2024The purpose of this study is to analyze cranial width and length growth curves in the early postoperative period of patients by undergoing endoscopic sagittal strip...
OBJECTIVE
The purpose of this study is to analyze cranial width and length growth curves in the early postoperative period of patients by undergoing endoscopic sagittal strip craniectomy (ESC) to determine the timing of the maximal growth curve change. By analyzing the complex interplay of cephalic length and width measurements, we hope to better understand the cephalic index (CI) growth curve during this early period. This is the first of a multistep process to elucidate the ideal cranial remolding orthosis (CRO) treatment duration.
DESIGN
Retrospective review.
SETTING
Tertiary academic institution.
PATIENTS
Children with isolated sagittal craniosynostosis.
INTERVENTIONS
ESC and postoperative CRO treatment (2015-2019).
MAIN OUTCOME MEASURES
One cranial orthotist obtained preoperative and postoperative measurements. The maximal rate of change of width, length, and CI were compared against the postoperative week these occurred.
RESULTS
Thirteen children (mean age: 3.3 months, average preoperative CI: 73.4) underwent this intervention. CI reached its highest growth rate by 4.9 average weeks postoperatively, which correlated with the maximal width growth rate (5.2 weeks). Length curves reached their maximal growth rate by 15.5 weeks. CI peaked (81.3) by 22.7 weeks postoperatively, a significant increase from baseline.
CONCLUSIONS
Following ESC, in the early postoperative period, the CI growth curve has 4 phases: initial rapid expansion, early and late slowed expansion, and plateau, followed by possible regression phases. This highlights the importance of early postoperative CRO initiation, CRO compliance, and properly fitting CROs, especially in the first 2 phases. This data sets the stage for investigating the ideal treatment length.
Topics: Child; Humans; Infant; Treatment Outcome; Skull; Craniosynostoses; Craniotomy; Postoperative Period; Retrospective Studies
PubMed: 36217735
DOI: 10.1177/10556656221131119 -
Obesity Surgery Apr 2024Increasing evidence suggests that bariatric surgery (BS) patients are at risk for substance abuse disorders (SUD). The purpose of this systematic review and... (Meta-Analysis)
Meta-Analysis Review
Increasing evidence suggests that bariatric surgery (BS) patients are at risk for substance abuse disorders (SUD). The purpose of this systematic review and meta-analysis was to determine the relationship between BS and the development of new-onset substance abuse disorder (SUDNO) in bariatric patients. On October 31, 2023, we reviewed the scientific literature following PRISMA guidelines. A total of 3242 studies were analyzed, 7 met the inclusion criteria. The pooled incidence of SUDNO was 4.28%. Patients' characteristics associated with SUDNO included preoperative mental disorders, high pre-BS BMI, and public health insurance. Surgical factors associated with new SUDNOs included severe complications in the peri- or postoperative period. The occurrence of SUDNOs is a non-negligeable complication after BS. Predisposing factors may be identified and preventive actions undertaken.
Topics: Humans; Obesity, Morbid; Bariatric Surgery; Substance-Related Disorders; Postoperative Period; Preoperative Period
PubMed: 38430321
DOI: 10.1007/s11695-024-07130-7 -
Revista Brasileira de Enfermagem 2024to map the factors associated with increased lactate levels in the postoperative period of cardiac surgery using extracorporeal circulation. (Review)
Review
OBJECTIVES
to map the factors associated with increased lactate levels in the postoperative period of cardiac surgery using extracorporeal circulation.
METHODS
this is a scoping review carried out in December 2022, across ten data sources. It was prepared in accordance with the recommendations of the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta Analyses Extension for Scoping Reviews checklist.
RESULTS
the most recurrent findings in studies regarding the factors responsible for the increase in lactate were: tissue hypoperfusion, cardiopulmonary bypass time and use of vasoactive drugs. In 95% of studies, increased lactate was related to increased patient mortality.
CONCLUSIONS
discussing the causes of possible complications in cardiac surgery patients is important for preparing the team and preventing complications, in addition to ensuring quality recovery.
Topics: Humans; Cardiac Surgical Procedures; Checklist; Lactic Acid; Postoperative Period; Research Design
PubMed: 38511788
DOI: 10.1590/0034-7167-2023-0117