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International Journal of Environmental... Aug 2021Unintentional hypothermia (core temperature < 36 °C) is a common side effect in patients undergoing surgery. Several patient-centred and external factors, e.g., drugs,... (Review)
Review
Unintentional hypothermia (core temperature < 36 °C) is a common side effect in patients undergoing surgery. Several patient-centred and external factors, e.g., drugs, comorbidities, trauma, environmental temperature, type of anaesthesia, as well as extent and duration of surgery, influence core temperature. Perioperative hypothermia has negative effects on coagulation, blood loss and transfusion requirements, metabolization of drugs, surgical site infections, and discharge from the post-anaesthesia care unit. Therefore, active temperature management is required in the pre-, intra-, and postoperative period to diminish the risks of perioperative hypothermia. Temperature measurement should be done with accurate and continuous probes. Perioperative temperature management includes a bundle of warming tools adapted to individual needs and local circumstances. Warming blankets and mattresses as well as the administration of properly warmed infusions via dedicated devices are important for this purpose. Temperature management should follow checklists and be individualized to the patient's requirements and the local possibilities.
Topics: Blood Transfusion; Body Temperature; Humans; Hypothermia; Postoperative Period; Surgical Wound Infection
PubMed: 34444504
DOI: 10.3390/ijerph18168749 -
Brazilian Journal of Cardiovascular... May 2022Early mobilization of patients in the postoperative period of cardiac surgery who are hospitalized in the intensive care unit (ICU) is a practice that has a positive... (Review)
Review
INTRODUCTION
Early mobilization of patients in the postoperative period of cardiac surgery who are hospitalized in the intensive care unit (ICU) is a practice that has a positive impact.
METHODS
This is a systematic review of studies published until September 2020 in the Medical Literature Analysis and Retrieval System Online (or MEDLINE®), Embase, Physiotherapy Evidence Database (or PEDro), Scientific Electronic Library Online (or SciELO), and Latin American and Caribbean Health Sciences Literature (or LILACS) databases. Randomized clinical trials describing mobilization protocols performed early in ICU patients after cardiac surgery were included.
RESULTS
According to the eligibility criteria, only 14 of the 1,128 articles found were included in the analysis. Early mobilization protocols were initiated in the immediate postoperative period or first postoperative day. The resources and technics used were progressive mobilization, cycle ergometer, early bed activities, walking protocols, resistance exercise, and virtual reality. Intensity of the mobilization activities was determined using the Borg scale and heart rate.
CONCLUSION
Early mobilization protocols are generalist (not individual), and low-intensity exercises are used, through progressive mobilization, with two daily physical therapy sessions, during 10 to 30 minutes.
Topics: Cardiac Surgical Procedures; Early Ambulation; Humans; Intensive Care Units; Postoperative Period; Prescriptions
PubMed: 35244377
DOI: 10.21470/1678-9741-2021-0140 -
JAMA Jan 2022
Topics: Anesthesia, General; Humans; Postoperative Period
PubMed: 34928317
DOI: 10.1001/jama.2021.22465 -
Der Chirurg; Zeitschrift Fur Alle... Feb 2020An appropriate perioperative infusion management is pivotal for the perioperative outcome of the patient. Optimization of the perioperative fluid treatment often results... (Review)
Review
An appropriate perioperative infusion management is pivotal for the perioperative outcome of the patient. Optimization of the perioperative fluid treatment often results in enhanced postoperative outcome, reduced perioperative complications and shortened hospitalization. Hypovolemia as well as hypervolemia can lead to an increased rate of perioperative complications. The main goal is to maintain perioperative euvolemia by goal-directed therapy (GDT), a combination of fluid management and inotropic medication, to optimize perfusion conditions in the perioperative period; however, perioperative fluid management should also include the preoperative and postoperative periods. This encompasses the preoperative administration of carbohydrate-rich drinks up to 2 h before surgery. In the postoperative period, patients should be encouraged to start per os hydration early and excessive i.v. fluid administration should be avoided. Implementation of a comprehensive multimodal, goal-directed fluid management within an enhanced recovery after surgery (ERAS) protocol is efficient but the exact status of indovodual items remains unclear at present.
Topics: Fluid Therapy; Humans; Perioperative Care; Perioperative Period; Postoperative Complications; Postoperative Period
PubMed: 32025774
DOI: 10.1007/s00104-020-01134-6 -
Anesthesiology Clinics Sep 2021Neuromuscular monitoring is essential for optimal management of neuromuscular blocking drugs. Postoperative residual neuromuscular blockade continues to occur with an... (Review)
Review
Neuromuscular monitoring is essential for optimal management of neuromuscular blocking drugs. Postoperative residual neuromuscular blockade continues to occur with an unacceptably high incidence and is associated with adverse patient outcomes. Use of a peripheral nerve stimulator and subjective tactile or visual assessment is useful for intraoperative management of neuromuscular blockade, especially when the patient's hand is accessible. Quantitative monitoring is necessary for confirmation of adequate reversal and for identification of patients who have recovered spontaneously and therefore should not receive pharmacologic reversal agents. Guidelines, as well as more user-friendly monitoring equipment, have created momentum toward improving routine perioperative neuromuscular monitoring.
Topics: Electric Stimulation; Humans; Neuromuscular Blockade; Neuromuscular Monitoring; Postoperative Period
PubMed: 34392879
DOI: 10.1016/j.anclin.2021.05.001 -
Journal of Vascular Surgery Sep 2019
Topics: Aortic Aneurysm, Abdominal; Humans; Kidney Diseases; Postoperative Period
PubMed: 31445646
DOI: 10.1016/j.jvs.2019.05.024 -
American Journal of Obstetrics and... Oct 2020
Topics: Cesarean Section; Enhanced Recovery After Surgery; Female; Humans; Length of Stay; Postoperative Period; Pregnancy
PubMed: 32497606
DOI: 10.1016/j.ajog.2020.05.054 -
Anesthesia and Analgesia Dec 2019
Topics: Acute Kidney Injury; Aorta, Thoracic; Double-Blind Method; Humans; Ischemic Preconditioning; Postoperative Period
PubMed: 31743210
DOI: 10.1213/ANE.0000000000004458 -
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 -
Best Practice & Research. Clinical... Mar 2020It is common for patients of all ages to experience some degree of cognitive disturbance following surgery. In most cases, impairment appears mild and is restricted to... (Review)
Review
It is common for patients of all ages to experience some degree of cognitive disturbance following surgery. In most cases, impairment appears mild and is restricted to the acute post-operative period, resolving steadily and speedily. In a small number of cases, however, deficits may be more pronounced and/or endure for longer periods, significantly delaying recovery and increasing the risk of serious clinical complications. The ability to accurately measure postoperative cognition, and track recovery of function, is an important clinical task. This review explores practical and methodological issues that may confound this process, examining how best to obtain reliable and meaningful measures of cognition before and after surgery. It considers neuropsychological test selection, administration, analysis and interpretation and offers evidence-based practice points for clinicians and researchers.
Topics: Cognition; Cognition Disorders; Humans; Neuropsychological Tests; Postoperative Complications; Postoperative Period
PubMed: 32334791
DOI: 10.1016/j.bpa.2018.11.002