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Anesthesiology Sep 2023
Topics: Humans; Postoperative Care; Preoperative Care; Postoperative Period
PubMed: 37402270
DOI: 10.1097/ALN.0000000000004637 -
Open Veterinary Journal Aug 2023A cataract is one of the underlying causes of blindness in animals. Phacoemulsification is the standard procedure in cataract surgery for humans and animals. This...
BACKGROUND
A cataract is one of the underlying causes of blindness in animals. Phacoemulsification is the standard procedure in cataract surgery for humans and animals. This procedure has been used to restore vision in cataracts in a variety of animals. However, this technique is difficult in very small animals, such as rodents, due to their small eyes.
CASE DESCRIPTION
A 4-year-old male domestic chinchilla was presented with cloudiness in the lenses for 1 month. The ophthalmic examination revealed cataracts (oculus uterque: both eyes). Positive dazzle reflex oculus sinister; left eye (OS) and negative reflex oculus dexter; right eye (OD) were noted. The electroretinography was low amplitude OS whereas a flat waveform presented OD. In this case, cataract surgery was performed using phacoemulsification without intraocular lens implantation OS. Postoperative, the chinchilla was alert and could jump on and jump off the ledge in a house. When the veterinarian approached closely to OS, the chinchilla displayed an erect body posture and open eyes, whereas the chinchilla was ignored when the veterinarian doing the same OD. The chinchilla was alert and had improved vision observe by this chinchilla can jump on and jump off the ledge in his house throughout the follow-up period 18 months later.
CONCLUSION
In this chinchilla, phacoemulsification was successfully performed and resulted in better overall vision. The chinchilla was alert and could jump on and jump off the ledge in a house after cataract surgery throughout the follow-up period of 18 months.
Topics: Animals; Humans; Male; Phacoemulsification; Chinchilla; Cataract; Postoperative Period
PubMed: 37701661
DOI: 10.5455/OVJ.2023.v13.i8.10 -
Scientific Reports Sep 2023To clarify the association between pre- and postoperative rotational mismatches of the femorotibial components and bones for total knee arthroplasty (TKA) with...
Association between pre- and postoperative rotational mismatches of the femorotibial components and bones in bi-cruciate retaining and posterior stabilized total knee arthroplasty.
To clarify the association between pre- and postoperative rotational mismatches of the femorotibial components and bones for total knee arthroplasty (TKA) with bi-cruciate retaining (BCR) design and with fixed bearing posterior stabilized (PS) design. This retrospective cohort study included 40 BCR TKAs and 50 PS TKAs. Pre- and postoperative rotational mismatches of the femorotibial components and bones were measured by three-dimensional assessment based on computed tomography imaging. The mean value and percentage within ± 5° of pre- and postoperative rotational mismatches were compared between BCR TKA and PS TKA. Correlations between pre- and postoperative rotational mismatches of the femorotibial components and bones were investigated in BCR TKA and PS TKA. There was no significant difference in mean preoperative rotational mismatch of femorotibial components and bones between BCR TKA and PS TKA. Mean postoperative rotational mismatch of femorotibial components and bones was significantly greater in BCR TKA than in PS TKA. Postoperative rotational mismatch of the femorotibial components was within ± 5° in 21 knees (52.5%) for BCR TKA and in 43 knees (86.0%) for PS TKA. The rate of postoperative rotational mismatch of the femorotibial components and bones within ± 5° was significantly lower for BCR TKA than for PS TKA. In BCR TKA, there was a positive correlation between pre- and postoperative rotational mismatches of the femorotibial components and of bones. We consider these results can be attributed to the retention of both cruciate ligaments, which may affect the reduction of rotational permittance of the components and bones.
Topics: Humans; Arthroplasty, Replacement, Knee; Retrospective Studies; Ligaments, Articular; Postoperative Period
PubMed: 37689778
DOI: 10.1038/s41598-023-42243-6 -
Annals of Medicine and Surgery (2012) Mar 2024Postoperative nausea and vomiting (PONV) is a surgical complication defined as any nausea, and vomiting with in the first 24-48 h after surgery in inpatients. Nausea is...
BACKGROUND
Postoperative nausea and vomiting (PONV) is a surgical complication defined as any nausea, and vomiting with in the first 24-48 h after surgery in inpatients. Nausea is the unpleasant desire and urge to vomit, while vomiting is a forcing of gastric contents through the mouth. Nausea and vomiting is the most common complication associated anaesthesia and surgery in the postoperative period. It is considered one of the most common causes of morbidity, and it has significant effects on patient satisfaction.
OBJECTIVE
The study aimed to assess the incidence and associated factors of postoperative nausea and vomiting.
METHODS
A cross-sectional study was conducted from 1 February to 30 April 2022. All adult, elective patients who underwent elective surgery under anaesthesia during the study period were included. A total of 677 patients underwent elective surgery at the time of the study, of which 634 patients were included in the study. Data collection method included chart review and patient interview.
RESULT
The overall prevalence of postoperative nausea and vomiting among post-surgical patients was 35.4%. Factors that had statistically significant relationship with PONV were history of motion sickness [adjusted odds ratio (AOR) 4.04, 95% CI 1.486-10.988], smoking history (AOR 0.37, 95% CI 0.128-1.042) and intraoperative opioid use (AOR 3.59, 95% CI 1.345-9.618).
CONCLUSION
The prevalence of this study is higher than studies conducted in the recent years. This result showed that the appropriate practice of PONV prophylactic regimens and anaesthesia management are required to decrease the risk of PONV.
PubMed: 38463094
DOI: 10.1097/MS9.0000000000001678 -
Foot & Ankle Specialist Feb 2024Hallux valgus is a common condition with a complex etiology resulting in numerous treatment options. Recurrence of the deformity can occur following correction. Surgical...
BACKGROUND
Hallux valgus is a common condition with a complex etiology resulting in numerous treatment options. Recurrence of the deformity can occur following correction. Surgical technique and possibly also postoperative care play a role in reducing recurrence rates. This article highlights a postoperative surgical dressing technique which allows for semirigid support during the immediate postoperative period.
METHODS
A wooden tongue depressor placed along the medial border of the hallux comprises the primary support for the dressing. The rigidity of the tongue depressor allows for the hallux to be drawn toward the depressor, encouraging neutral alignment of the hallux. Dressings are removed 2 weeks postoperatively, with new dressings applied in similar fashion and maintained in place until 6 weeks postoperatively.
RESULTS
Based upon our observations, our surgical dressing technique provides sufficient support following hallux valgus correction surgery while being straightforward to replicate without the need for frequent dressing changes. The dressing materials are of negligible cost and are typically readily available. No associated wound complications have been observed.
CONCLUSIONS
We present an easily replicable and affordable option for postoperative hallux valgus correction surgical dressings.
LEVELS OF EVIDENCE
Level V: Expert Opinion.
Topics: Humans; Hallux Valgus; Splints; Osteotomy; Metatarsophalangeal Joint; Bunion; Bandages; Treatment Outcome
PubMed: 37154096
DOI: 10.1177/19386400231169376 -
Sports Medicine and Health Science Mar 2024Decreased mechanical loading after orthopaedic surgery predisposes patients to develop muscle atrophy. The purpose of this review was to assess whether the evidence... (Review)
Review
Decreased mechanical loading after orthopaedic surgery predisposes patients to develop muscle atrophy. The purpose of this review was to assess whether the evidence supports oral protein supplementation can help decrease postoperative muscle atrophy and/or improve patient outcomes following orthopaedic surgery. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). PubMed (MEDLINE), Embase, Scopus, and Web of Science were searched for randomized controlled trials that assessed protein or amino acid supplementation in patients undergoing orthopaedic surgery. Two investigators independently conducted the search using relevant Boolean operations. Primary outcomes included functional or physiologic measures of muscle atrophy or strength. Fourteen studies including 611 patients (224 males, 387 females) were analyzed. Three studies evaluated protein supplementation after ACL reconstruction (ACLR), 3 after total hip arthroplasty (THA), 5 after total knee arthroplasty (TKA), and 3 after surgical treatment of hip fracture. Protein supplementation showed beneficial effects across all types of surgery. The primary benefit was a decrease in muscle atrophy compared to placebo as measured by muscle cross sectional area. Multiple authors also demonstrated improved functional measures and quicker achievement of rehabilitation benchmarks. Protein supplementation has beneficial effects on mitigating muscle atrophy in the postoperative period following ACLR, THA, TKA, and surgical treatment of hip fracture. These effects often correlate with improved functional measures and quicker achievement of rehabilitation benchmarks. Further research is needed to evaluate long-term effects of protein supplementation and to establish standardized population-specific regimens that maximize treatment efficacy in the postoperative period.
PubMed: 38463662
DOI: 10.1016/j.smhs.2023.08.002 -
Heliyon Feb 2024Postoperative nausea and vomiting (PONV) and pain are common and distressing complications in patients undergoing surgery. However, it remains uncertain whether timing...
INTRODUCTION
Postoperative nausea and vomiting (PONV) and pain are common and distressing complications in patients undergoing surgery. However, it remains uncertain whether timing of the postoperative course or the diel rhythm influences the occurrence of PONV or severe pain. Therefore, we aimed to explore the temporal distribution of PONV and severe pain.
MATERIAL AND METHODS
In this prospective observational study, we enrolled patients aged 18-65 years with American Society of Anesthesiologists classifications I-III, who were scheduled for surgery under general anesthesia. Patients were visited postoperatively at regular intervals (every 6 h over a 24-h period). Incidence of PONV was recorded and categorized based on real-time divisions: before dawn (00:00-05:59), morning (06:00-11:59), afternoon (12:00-17:59), and evening (18:00-23:59) and as sequential periods (i.e., 0-6, 6-12, 12-18, and 18-24 h). Severe pain and use of additional remedies were also recorded.
RESULTS
A total of 724 patients were included in the final analysis. Of these, 14.92 % experienced PONV within the first 6 h, and 8.29 % received antiemetic therapy. Occurrence of PONV and administration of remedies declined over the 24-h postoperative period. The lowest rate of PONV was observed during the pre-dawn hours (5.66 %). There was no statistically significant difference in the incidence of PONV 24-h postoperatively between surgeries with different end times. Patients underwent orthopedic surgeries had the highest incidence of PONV during 18:00-23:59, gynecological surgery patients had the highest incidence at 12:00-17:59, and 6:00-11:59 for other surgery patients. All patients had the lowest incidence during 0:00-5:59. During the initial 6-h postoperative period, 24.59 % of patients experienced severe pain, which declined in the remaining episodes. Patients who underwent orthopedic and gynecological surgeries exhibited similar temporal patterns and distribution characteristics of PONV and severe pain.
DISCUSSION
Both PONV and severe pain declined within the 24-h postoperative period, particularly within the first 6 h. Additionally, the onset patterns of PONV vary among patients undergoing different types of surgeries, all patients demonstrated decreased susceptibility to PONV between 00:00-05:59. Our findings enhance prevention and treatment strategies within an optimized timeframe during the postoperative course.
PubMed: 38322925
DOI: 10.1016/j.heliyon.2024.e25160 -
Arquivos Brasileiros de Cirurgia... 2023Weight regain in the postoperative period after bariatric surgery is directly related to the relapse of preoperative comorbidities and a negative impact on the patients'...
BACKGROUND
Weight regain in the postoperative period after bariatric surgery is directly related to the relapse of preoperative comorbidities and a negative impact on the patients' biochemical profile.
AIMS
To assess the metabolic impact of weight regain on preoperative comorbidities and on patients' biochemical profiles, in order to show the impact of the complications on the metabolic outcomes of bariatric surgery.
METHODS
A retrospective study was carried out with 75 women in the late postoperative period of bariatric surgery who presented pathological weight regain (≥20% of the maximum weight loss). Data of interest consisted of glycemic, lipid, and inflammatory profile measurements at three different moments of evaluation: preoperative period, at the weight nadir (minimum weight), and after weight regain. A multivariate analysis was performed.
RESULTS
The mean age was 46.39±12.09 years. Preoperative body mass index was 40.10±4.11 kg/m2. There was an overall increase of 3.36 points in the mean body mass index between the nadir and after regain: from 26.30±3.9 kg/m2 to 29.66±4.66 kg/m2. The mean time to reach the nadir was 18±7.6 months, with an average percentage of excess weight loss of 91.08±11.8%. The median time for pathological weight regain was 48 months, and the mean regain amongst the sample was 8.85±5.65 kg. There was a significant correlation between pathological weight regain and levels of insulin (r=0.351; p<0.011), C-peptide (r=0.303; p<0.011), C-reactive protein (r=0.402; p<0.001), and vitamin D (r=-0.435; p<0.001), the last two being the most influenced by the percentage of weight regained.
CONCLUSIONS
The pathological weight regain in the postoperative period of bariatric surgery results in losses in the patients' metabolic and inflammatory profiles. However, the biochemical benefits are sustained up to the preoperative levels of the parameters analyzed.
Topics: Humans; Female; Adult; Middle Aged; Weight Gain; Retrospective Studies; Bariatric Surgery; Weight Loss; Multivariate Analysis; Postoperative Period; Metabolome; Obesity, Morbid
PubMed: 37585909
DOI: 10.1590/0102-672020230037e1755 -
Orthopaedic Journal of Sports Medicine Nov 2023Recent studies have shown that legislation regulating opioid prescriptions in the United States has been successful in reducing the morphine milligram equivalent (MME)...
BACKGROUND
Recent studies have shown that legislation regulating opioid prescriptions in the United States has been successful in reducing the morphine milligram equivalent (MME) prescribed after certain orthopaedic procedures.
PURPOSE
To (1) determine the effect of Ohio's legislation limiting opioid prescriptions after shoulder arthroscopy and (2) identify risk factors associated with prolonged opioid use and increased postoperative opioid dosing.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
We reviewed the data of patients who underwent shoulder arthroscopy between January 1, 2016, and March 31, 2020. Patients were classified according to the date of legislation passage (August 31, 2017) as before legislation (PRE) or on/after legislation (POST). Patients were also classified based on the number of opioid prescriptions filled within 30 days of surgery as opioid-tolerant (at least 1 prescription) or opioid-naïve (zero prescriptions). We recorded patient characteristics, medical comorbidities, and surgical details, as well as the number of opioid prescriptions, MME per prescription from 30 days preoperatively to 90 days postoperatively, and the number of gamma-aminobutyric acid (GABA) analogues and benzodiazepine prescriptions from 30 days preoperatively to the date of surgery. Differences between cohorts were compared with the Fisher exact test and Wilcoxon test. A covariate-adjusted regression analysis was used to evaluate risk factors associated with increased postoperative opioid dosing.
RESULTS
Overall, 279 patients (n = 97 PRE; n = 182 POST; n = 42 opioid-tolerant; n = 237 opioid-naïve) were included in the final analysis. There was a significant reduction in the cumulative MME prescribed in the immediate (0-7 days) postoperative period (PRE, 450 MME vs POST, 315 MME), the first 30 postoperative days (PRE, 590 MME vs POST, 375 MME), and the first 90 postoperative days (PRE, 600 MME vs POST, 420 MME) ( < .001 for all). The opioid-tolerant cohort had higher MME at every time point in the postoperative period ( < .001). Consumption of preoperative opioid (β = 1682.5; < .001), benzodiazepine (β = 468.09; < .001), and GABA analogue (β = 251.37; = .04) was associated with an increase in the cumulative MME prescribed.
CONCLUSION
Opioid prescription-limiting legislation in Ohio significantly reduced the cumulative MME prescribed in the first 30 days postoperatively for both opioid-naïve and opioid-tolerant patients after shoulder arthroscopy. Consumption of opioids, benzodiazepines, and GABA analogues preoperatively was associated with increased postoperative opioid dosage.
PubMed: 38021300
DOI: 10.1177/23259671231202242 -
Scientific Reports Jul 2023We aimed to evaluate the effect of the patient's clinical and paraclinical condition before and after surgery on short-term mortality and complication and long-term...
We aimed to evaluate the effect of the patient's clinical and paraclinical condition before and after surgery on short-term mortality and complication and long-term mortality. A retrospective cohort study was conducted and multivariate logistic regression was applied to determine the effect of demographic characteristics (sex, age, AO/OTA classification, height, weight, body mass index), medical history (hypertension, ischemic heart disease, diabetes mellitus, thyroid malfunction, cancer, osteoporosis, smoking) lab data (Complete blood cell, blood sugar, Blood Urea Nitrogen, Creatinine, Na, and K), surgery-related factors (Anesthesia time and type, implant, intraoperative blood transfusion, postoperative blood transfusion, and operation time), duration of admission to surgery and anticoagulant consumption on short-term mortality and complication and long-term mortality. Three hundred ten patients from November 2016 to September 2020 were diagnosed with an intertrochanteric fracture. 3.23% of patients died in hospital, 14.1% of patients confronted in-hospital complications, and 38.3% died after discharge till the study endpoint. ΔNumber of Neutrophiles is the primary determinant for in-hospital mortality in multivariate analysis. Age and blood transfusion are the main determinants of long-term mortality, and Na before surgery is the primary variable associated with postoperative complications. Among different analytical factors Na before surgery as a biomarker presenting dehydration was the main prognostic factor for in hospital complications. In hospital mortality was mainly because of infection and long-term mortality was associated with blood transfusion.
Topics: Humans; Retrospective Studies; Hip Fractures; Postoperative Complications; Postoperative Period; Morbidity; Treatment Outcome; Risk Factors
PubMed: 37495718
DOI: 10.1038/s41598-023-38667-9