-
Ugeskrift For Laeger Dec 2023
Topics: Humans; Anesthesia; Anesthesiology
PubMed: 38084619
DOI: No ID Found -
British Journal of Hospital Medicine... Jan 2024Adverse effects of perioperative opioids have led to the pursuit of 'opioid-free anaesthesia'. While early studies have shown that effective analgesia can be achieved...
Adverse effects of perioperative opioids have led to the pursuit of 'opioid-free anaesthesia'. While early studies have shown that effective analgesia can be achieved without using opioids, with some reduction in unwanted effects, further research is needed to elucidate which patients may benefit most and how.
Topics: Humans; Anesthesia; Anesthesiology; Analgesia; Analgesics, Opioid; Drug-Related Side Effects and Adverse Reactions
PubMed: 38300677
DOI: 10.12968/hmed.2023.0344 -
Medicina (Kaunas, Lithuania) Oct 2023Giant ovarian tumors are rare, as most cases are diagnosed during routine gynecological check-ups or abdominal ultrasound examinations. They are a challenge for...
Giant ovarian tumors are rare, as most cases are diagnosed during routine gynecological check-ups or abdominal ultrasound examinations. They are a challenge for gynecologists and surgeons. Diagnosis in such patients is difficult due to the limitations of the medical apparatus. Perioperative management requires specialized anesthetic medical care and is associated with high mortality. The paper presents the case of a 23-year-old woman with a giant ovarian serous tumor, characterized by an enlargement of the abdominal circumference, periodic abdominal pain, irregular menstruation, and infertility. The patient attributed these nonspecific symptoms to obesity; therefore, she was hesitant to schedule a doctor's appointment. The patient underwent laparotomy, and the cyst originating from the left ovary was removed along with part of the organ. An intraoperative examination was performed. After confirming the benign nature of the lesion, the operation was completed. In our work, we concentrated on the multidisciplinary care of the patient who required enhanced medical care from the internal medicine, cardiology, anesthesiology, rehabilitation medicine, and gynecology specialists. There were no hemodynamic changes in the heart during hospitalization. There were no significant early or late postoperative complications. In this case, we also paid attention to compression symptoms resulting from a giant ovarian tumor and the high risk of intraoperative complications resulting from its resection.
Topics: Female; Humans; Young Adult; Adult; Ovarian Neoplasms; Ultrasonography; Cysts; Anesthesiology
PubMed: 37893550
DOI: 10.3390/medicina59101833 -
Critical Care (London, England) Oct 2023Based on low-quality evidence, current nutrition guidelines recommend the delivery of high-dose protein in critically ill patients. The EFFORT Protein trial showed that... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Based on low-quality evidence, current nutrition guidelines recommend the delivery of high-dose protein in critically ill patients. The EFFORT Protein trial showed that higher protein dose is not associated with improved outcomes, whereas the effects in critically ill patients who developed acute kidney injury (AKI) need further evaluation. The overall aim is to evaluate the effects of high-dose protein in critically ill patients who developed different stages of AKI.
METHODS
In this post hoc analysis of the EFFORT Protein trial, we investigated the effect of high versus usual protein dose (≥ 2.2 vs. ≤ 1.2 g/kg body weight/day) on time-to-discharge alive from the hospital (TTDA) and 60-day mortality and in different subgroups in critically ill patients with AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria within 7 days of ICU admission. The associations of protein dose with incidence and duration of kidney replacement therapy (KRT) were also investigated.
RESULTS
Of the 1329 randomized patients, 312 developed AKI and were included in this analysis (163 in the high and 149 in the usual protein dose group). High protein was associated with a slower time-to-discharge alive from the hospital (TTDA) (hazard ratio 0.5, 95% CI 0.4-0.8) and higher 60-day mortality (relative risk 1.4 (95% CI 1.1-1.8). Effect modification was not statistically significant for any subgroup, and no subgroups suggested a beneficial effect of higher protein, although the harmful effect of higher protein target appeared to disappear in patients who received kidney replacement therapy (KRT). Protein dose was not significantly associated with the incidence of AKI and KRT or duration of KRT.
CONCLUSIONS
In critically ill patients with AKI, high protein may be associated with worse outcomes in all AKI stages. Recommendation of higher protein dosing in AKI patients should be carefully re-evaluated to avoid potential harmful effects especially in patients who were not treated with KRT.
TRIAL REGISTRATION
This study is registered at ClinicalTrials.gov (NCT03160547) on May 17th 2017.
Topics: Humans; Acute Kidney Injury; Critical Illness; Hospitalization; Intensive Care Units; Length of Stay; Renal Replacement Therapy
PubMed: 37853490
DOI: 10.1186/s13054-023-04663-8 -
Hepatobiliary Surgery and Nutrition Aug 2023Identifying a potentially difficult airway is crucial both in anaesthesia in the operating room (OR) and non-operation room sites. There are no guidelines or expert... (Review)
Review
BACKGROUND
Identifying a potentially difficult airway is crucial both in anaesthesia in the operating room (OR) and non-operation room sites. There are no guidelines or expert consensus focused on the assessment of the difficult airway before, so this expert consensus is developed to provide guidance for airway assessment, making this process more standardized and accurate to reduce airway-related complications and improve safety.
METHODS
Seven members from the Airway Management Group of the Chinese Society of Anaesthesiology (CSA) met to discuss the first draft and then this was sent to 15 international experts for review, comment, and approval. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) is used to determine the level of evidence and grade the strength of recommendations. The recommendations were revised through a three-round Delphi survey from experts.
RESULTS
This expert consensus provides a comprehensive approach to airway assessment based on the medical history, physical examination, comprehensive scores, imaging, and new developments including transnasal endoscopy, virtual laryngoscopy, and 3D printing. In addition, this consensus also reviews some new technologies currently under development such as prediction from facial images and voice information with the aim of proposing new research directions for the assessment of difficult airway.
CONCLUSIONS
This consensus applies to anesthesiologists, critical care, and emergency physicians refining the preoperative airway assessment and preparing an appropriate intubation strategy for patients with a potentially difficult airway.
PubMed: 37600997
DOI: 10.21037/hbsn-23-46 -
Journal of Cardiovascular Development... Nov 2023Minimally invasive cardiac surgery (MICS) has been used since the 1990s and encompasses a wide range of techniques that lack full sternotomy, including valve and... (Review)
Review
Minimally invasive cardiac surgery (MICS) has been used since the 1990s and encompasses a wide range of techniques that lack full sternotomy, including valve and coronary artery graft surgery as well as transcatheter procedures. Due to the potential benefits offered to patients by MICS, these procedures are becoming more common. Unique anaesthetic knowledge and skills are required to overcome the specific challenges presented by MICS, including mastery of transoesophageal echocardiography (TOE) and the provision of thoracic regional analgesia. This review evaluates the relevance of MICS to the anaesthetist and discusses pre-operative assessment, the relevant adjustments to intra-operative conduct that are necessary for these techniques, as well as post-operative care and what is known about outcomes.
PubMed: 37998520
DOI: 10.3390/jcdd10110462 -
World Journal of Clinical Cases May 2024Myasthenia gravis (MG) is an autoimmune disorder that affects the neuromuscular junction. The primary pathology in MG involves the presence of autoantibodies to...
Myasthenia gravis (MG) is an autoimmune disorder that affects the neuromuscular junction. The primary pathology in MG involves the presence of autoantibodies to acetylcholine receptors (AChRs), which results in qualitative and quantitative reductions in the availability of functional AChRs. Cardiac muscles are also affected, resulting in various perioperative cardiac complications. Antistriational antibodies are commonly reported in MG cases with cardiac involvement. In the presence of thymoma, the prevalence of cardiac manifestations in patients with MG increases to approximately 10%-15%. Cardiac involvement in MG may range from asymptomatic electrocardiogram changes to ventricular tachycardia, myocarditis, conduction disorders, heart failure, and sudden death. Increased incidence of atrial fibrillation, ventricular and supraventricular extra systoles, and prolonged QTc have also been reported in patients with MG. Clinicians should consider the evaluation of autonomic dysfunction and risk of cardiovascular disease in patients with MG.
PubMed: 38808348
DOI: 10.12998/wjcc.v12.i13.2147 -
British Journal of Hospital Medicine... Aug 2023Perioperative neurocognitive disorders are a group of conditions characterised by changes in cognitive function, which affect older people after surgery and anaesthesia....
Perioperative neurocognitive disorders are a group of conditions characterised by changes in cognitive function, which affect older people after surgery and anaesthesia. Multicomponent interventions may reduce the impact of perioperative neurocognitive disorders on patients and healthcare systems.
Topics: Humans; Aged; Anesthesia; Anesthesiology; Cognition; Neurocognitive Disorders
PubMed: 37646546
DOI: 10.12968/hmed.2023.0184 -
The Annals of Thoracic Surgery Apr 2024Enhanced Recovery After Surgery (ERAS) programs have been shown to lessen surgical insult, promote recovery, and improve postoperative clinical outcomes across a number...
Perioperative Care in Cardiac Surgery: A Joint Consensus Statement by the Enhanced Recovery After Surgery (ERAS) Cardiac Society, ERAS International Society, and The Society of Thoracic Surgeons (STS).
Enhanced Recovery After Surgery (ERAS) programs have been shown to lessen surgical insult, promote recovery, and improve postoperative clinical outcomes across a number of specialty operations. A core tenet of ERAS involves the provision of protocolized evidence-based perioperative interventions. Given both the growing enthusiasm for applying ERAS principles to cardiac surgery and the broad scope of relevant interventions, an international, multidisciplinary expert panel was assembled to derive a list of potential program elements, review the literature, and provide a statement regarding clinical practice for each topic area. This article summarizes those consensus statements and their accompanying evidence. These results provide the foundation for best practice for the management of the adult patient undergoing cardiac surgery.
Topics: Humans; Enhanced Recovery After Surgery; Perioperative Care; Cardiac Surgical Procedures; Thoracic Surgery; Surgeons
PubMed: 38284956
DOI: 10.1016/j.athoracsur.2023.12.006 -
Current Pain and Headache Reports Jun 2024Chronic Postsurgical Pain (CPSP) and the risk for long-term opioid dependency are known complications following major surgery. The idea of Transitional Pain Service... (Review)
Review
PURPOSE OF REVIEW
Chronic Postsurgical Pain (CPSP) and the risk for long-term opioid dependency are known complications following major surgery. The idea of Transitional Pain Service (TPS) has been introduced as an interdisciplinary setting to manage pain in the perioperative continuum. We expand on the basic framework and principles of TPS and summarize the current evidence of the TPS and possible interventions to adress postoperative pain. Areas of future work in TPS-related research are discussed.
RECENT FINDINGS
Several studies support the effectiveness of TPS in reducing opioid consumption in the perioperative period and following discharge. Some studies also show an improvement in functional outcome with TPS with patients reporting lower pain severity and pain interference. The TPS aims to halt the progress of acute postoperative pain to CPSP by providing longitudinal support with patient-centered care. While some studies suggest a positive impact of TPS implementation in terms of reduction in postoperative opioid consumption and improvement of some functional outcomes, direct evidence in terms of reduction in the incidence of CPSP is still missing. The cost-effectiveness of TPS and the expansion of TPS through e-health services and digital applications also need to be evaluated.
Topics: Humans; Pain, Postoperative; Pain Management; Chronic Pain; Analgesics, Opioid; Transitional Care
PubMed: 38530574
DOI: 10.1007/s11916-024-01239-1