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1.
Int Heart J ; 61(5): 905-912, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921660

RESUMO

There is little data on management and outcomes of atrial fibrillation (AF) patients on direct oral anticoagulants (DOAC) undergoing general surgery.We retrospectively assessed 98 surgeries in 85 nonvalvular AF patients aged 73 ± 8 (59 men) receiving DOACs. Cardiac, emergency, and minimally invasive surgeries were excluded.The CHA2DS2-VASc score ranged from 0 to 8. The DOACs being given were: dabigatran, 16; rivaroxaban, 25; apixaban, 28; and edoxaban, 16. While the DOACs were not suspended in 11 cases, they were interrupted for a median of 2.0 days before surgery and restarted at a median of 3.0 days after surgery. There were 9 complications (9.2%), 3 instances of thromboembolism and 6 bleeding. Thromboembolism occurred at a mean of 3.0 postoperative days, all of which occurred before resumption of DOACs, while bleeding events occurred at a mean of 4.0 postoperative days. Two of the 3 patients with thromboembolism went into cardiopulmonary arrest during the event, but were resuscitated. There were significantly more patients with congestive heart failure or combined antiplatelets in the patients with complications. The complication group had a significantly higher HAS-BLED score and lower preoperative hemoglobin level. There were no significant differences in the management of DOAC interruption between those with complications and without.The perioperative complication rate in nonvalvular AF patients undergoing elective surgery treating with DOACs was 9.2%. Patients with congestive heart failure, receiving combined therapy with antiplatelets, a higher HAS-BLED score, or lower preoperative hemoglobin level were at higher risk. Further studies evaluating the ideal perioperative DOAC protocol are warranted.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Doenças das Artérias Carótidas/epidemiologia , Infarto Cerebral/epidemiologia , Inibidores do Fator Xa/administração & dosagem , Infarto do Miocárdio/epidemiologia , Assistência Perioperatória/métodos , Hemorragia Pós-Operatória/epidemiologia , Tromboembolia/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Antitrombinas/administração & dosagem , Fibrilação Atrial/complicações , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Dabigatrana/administração & dosagem , Procedimentos Cirúrgicos do Sistema Digestório , Procedimentos Cirúrgicos Eletivos , Embolia/epidemiologia , Endoscopia , Feminino , Humanos , Masculino , Procedimentos Ortopédicos , Complicações Pós-Operatórias/epidemiologia , Pirazóis/administração & dosagem , Piridinas/administração & dosagem , Piridonas/administração & dosagem , Estudos Retrospectivos , Rivaroxabana/administração & dosagem , Tiazóis/administração & dosagem , Tromboembolia/etiologia , Procedimentos Cirúrgicos Urológicos , Procedimentos Cirúrgicos Vasculares
2.
Eur J Cardiothorac Surg ; 58(4): 738-744, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32951033

RESUMO

OBJECTIVES: The goal of this study was to describe the clinical features and outcomes of thoracic surgery patients during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Thirty-five patients were treated at the 12 de Octubre University Hospital in Madrid between 1 March 2020 and 24 April 2020 during the COVID-19 pandemic. Patient demographics, surgical procedures, complications, COVID-19 symptoms and outcomes were recorded. A protocol was introduced to reduce the risk of operating on patients with COVID-19, including symptom screening, a polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 and computed tomography scans of the chest. Surgical activity changed significantly during this time, from an initial period of near-normal activity, through an emergency-only period and finally a recovery period when some oncological surgical cases were restarted. Selection criteria for surgical patients are also described. RESULTS: A total of 34 patients underwent surgery during the pandemic period. We performed 22 lung resections (11 lobectomies and 11 sublobar resections). No hospital deaths were recorded. An elective surgery patient and an emergency surgery patient were diagnosed with COVID-19 (5.88%). The former died within 30 days after surgery. CONCLUSIONS: Severe acute respiratory syndrome coronavirus 2 represents a tremendous limitation for thoracic surgical practice. Preoperative practices to exclude asymptomatic cases infected with the virus allowed us to perform thoracic surgical procedures.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/métodos , Pandemias/prevenção & controle , Assistência Perioperatória/métodos , Pneumonia Viral/prevenção & controle , Procedimentos Cirúrgicos Torácicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Feminino , Alocação de Recursos para a Atenção à Saúde/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Seleção de Pacientes , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Estudos Retrospectivos , Espanha , Centros de Atenção Terciária , Procedimentos Cirúrgicos Torácicos/mortalidade
4.
Curr Opin Anaesthesiol ; 33(5): 655-660, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32826628

RESUMO

PURPOSE OF REVIEW: The current systematic review summarizes recent, basic clinical achievements regarding the neuroprotective effects of molecular hydrogen in distinct central nervous system conditions. RECENT FINDINGS: Perioperative neuroprotection remains a major topic of clinical anesthesia. Various gaseous molecules have previously been explored as a feasible therapeutic option in neurological disorders. Among them, molecular hydrogen, which has emerged as a novel and potential therapy for perioperative neuroprotection, has received much attention. SUMMARY: Fundamental and clinical evidence supports the antioxidant, antiinflammation, antiapoptosis and mitochondrial protective effects of hydrogen in the pathophysiology of nervous system diseases. The clinically preventive and therapeutic effects of hydrogen on different neural diseases, however, remain uncertain, and the lack of support by large randomized controlled trials has delayed its clinical application.


Assuntos
Hidrogênio/farmacologia , Doenças do Sistema Nervoso/tratamento farmacológico , Neuroproteção , Fármacos Neuroprotetores/farmacologia , Assistência Perioperatória/métodos , Humanos , Período Perioperatório , Complicações Pós-Operatórias/prevenção & controle
5.
Eur J Cardiothorac Surg ; 58(4): 676-681, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32844172

RESUMO

Early in 2020, coronavirus disease 2019 (COVID-19) quickly spread globally, giving rise to a pandemic. In this critical scenario, patients with lung cancer need to continue to receive optimal care and at the same be shielded from infection with the potentially severe acute respiratory syndrome coronavirus 2. Upgrades to the prevention and control of infection have become paramount in order to lower the risk of hospital contagion. Aerosol-generating procedures such as endotracheal intubation or endoscopic procedures may expose health care workers to a high risk of infection. Moreover, thoracic anaesthesia usually requires highly complex airway management procedures because of the need for one-lung isolation and one-lung ventilation. Therefore, in the current pandemic, providing a fast-track algorithm for scientifically standardized diagnostic criteria and treatment recommendations for patients with lung cancer is urgent. Suggestions for improving existing contagion control guidelines are needed, even in the case of non-symptomatic patients who possibly are responsible for virus spread. A COVID-19-specific intraoperative management strategy designed to reduce risk of infection in both health care workers and patients is also required.


Assuntos
Anestesia/métodos , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Controle de Infecções/métodos , Neoplasias Pulmonares/cirurgia , Pandemias/prevenção & controle , Pneumonectomia/métodos , Pneumonia Viral/prevenção & controle , Manuseio das Vias Aéreas/métodos , Infecções por Coronavirus/transmissão , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Itália , Neoplasias Pulmonares/diagnóstico , Seleção de Pacientes , Assistência Perioperatória/métodos , Pneumonia Viral/transmissão
6.
Eur J Cardiothorac Surg ; 58(4): 752-762, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32862224

RESUMO

OBJECTIVES: There is widespread acknowledgement that coronavirus disease 2019 (COVID-19) has disrupted surgical services. The European Society of Thoracic Surgeons (ESTS) sent out a survey to assess what impact the COVID-19 pandemic has had on the practice of thoracic oncology surgery. METHODS: All ESTS members were invited (13-20 April 2020) to complete an online questionnaire of 26 questions, designed by the ESTS learning affairs committee. RESULTS: The response rate was 23.0% and the completeness rate was 91.2%. The number of treated COVID-positive cases per hospital varied from fewer than 20 cases (30.6%) to more than 200 cases (22.7%) per hospital. Most hospitals (89.1%) postponed surgical procedures. All hospitals performed patient screening with a nasopharyngeal swab, but only 6.7% routinely tested health care workers. A total of 20% of respondents reported that multidisciplinary meetings were completely cancelled and 66%, that multidisciplinary decisions were not different from normal practice. Trends were recognized in prioritizing surgical patients based on age (younger than 70), type of surgery (lobectomy or less), size of tumour (T1-2) and lymph node involvement (N1). Sixty-three percent of respondents reported that surgeons were involved in daily care of COVID-19-positive patients. Fifty-three percent mentioned that full personal protective equipment was available to them when treating a COVID-19-positive patient. CONCLUSIONS: The COVID-19 pandemic has created issues for the safety of health care workers, and surgeons have been forced to change their routine practice. However, there was no consensus about surgical priorities in lung cancer patients, demonstrating the need for the production of specific guidelines.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Padrões de Prática Médica/tendências , Neoplasias Torácicas/cirurgia , Procedimentos Cirúrgicos Torácicos/tendências , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Europa (Continente) , Saúde Global , Alocação de Recursos para a Atenção à Saúde/tendências , Humanos , Controle de Infecções/métodos , Controle de Infecções/tendências , Assistência Perioperatória/métodos , Assistência Perioperatória/tendências , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Sociedades Médicas
7.
Transplantation ; 104(8): 1560-1565, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732832

RESUMO

The 25th Annual Congress of the International Liver Transplantation Society was held in Toronto, Canada, from May 15 to 18, 2019. Surgeons, hepatologists, anesthesiologists, critical care intensivists, radiologists, pathologists, and research scientists from all over the world came together with the common aim of improving care and outcomes for liver transplant recipients and living donors. Some of the featured topics at this year's conference included multidisciplinary perioperative care in liver transplantation, worldwide approaches to organ allocation, donor steatosis, and updates in pediatrics, immunology, and radiology. This report presents excerpts and highlights from invited lectures and select abstracts, reviewed and compiled by the Vanguard Committee of International Liver Transplantation Society. This will hopefully contribute to further advances in clinical practice and research in liver transplantation.


Assuntos
Congressos como Assunto , Seleção do Doador/organização & administração , Transplante de Fígado , Assistência Perioperatória/métodos , Sociedades Médicas/organização & administração , Adulto , Fatores Etários , Canadá , Criança , Cuidados Críticos/métodos , Cuidados Críticos/organização & administração , Seleção do Doador/métodos , Doença Hepática Terminal/cirurgia , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Hepatectomia/efeitos adversos , Humanos , Imunossupressão/efeitos adversos , Imunossupressão/métodos , Cooperação Internacional , Doadores Vivos , Preservação de Órgãos/instrumentação , Preservação de Órgãos/métodos , Segurança do Paciente , Seleção de Pacientes , Perfusão/instrumentação , Perfusão/métodos , Melhoria de Qualidade , Alocação de Recursos/organização & administração , Resultado do Tratamento
8.
Am Surg ; 86(9): 1091-1093, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32804548

RESUMO

OBJECTIVES: The highest rates of surgical site infections (SSIs) are associated with colorectal operations (up to 30%). A sentinel paper showed that the use of intravenous (IV) cefazolin and metronidazole was associated with decreased rates of SSI compared with cefoxitin (6% vs 13%). We reviewed the association of SSI with prophylactic antibiotic choice. We specifically investigated the regimens of ceftriaxone and metronidazole IV, cefoxitin IV, or ertapenem. METHODS: We conducted a retrospective review of 532 colon surgeries between 2016 and 2018. Inclusion criteria were patients 18-89 years of age undergoing elective colon surgery who received ceftriaxone/metronidazole, cefoxitin, or ertapenem for prophylaxis. All emergent cases were excluded. This resulted in 241 elective colon cases for review. The primary endpoint was to determine if the use of ceftriaxone/metronidazole decreased the rate of SSI. RESULTS: In total, there were 241 elective colon cases with 21 SSI. We compared SSI rates in the ceftriaxone/metronidazole group to those patients receiving either cefoxitin or ertapenem (4.5% vs 12.2%; P = .035). We then compared SSI in ceftriaxone/metronidazole to SSI in cefoxitin (4.5% vs 10%; P = .13). Finally, we compared SSI in the ceftriaxone/metronidazole group to SSI in the ertapenem group (4.5% vs 14%; P = .03). Comorbidities and underlying factors were similar across all antibiotic groups. CONCLUSION: In our experience, the use of ceftriaxone/metronidazole is associated with a decreased SSI rate. Furthermore, ceftriaxone/metronidazole use is superior to the use of ertapenem, with a trend toward superiority over cefoxitin. Based on this study, we recommend ceftriaxone/metronidazole as antibiotic prophylaxis for elective colon surgery.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Colectomia/efeitos adversos , Doenças do Colo/cirurgia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Assistência Perioperatória/métodos , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
9.
Plast Reconstr Surg ; 146(2): 423-435, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740600

RESUMO

Plastic surgery patients span the nutritional spectrum from generally healthy, nutritionally competent patients to inherently catabolic, nutritionally deficient, and chronic wound patients. Therefore, plastic and reconstructive surgery affords the opportunity to investigate the impact of nutrition across a heterogeneous patient population following a wide variety of procedures. Although patients may be nutritionally deficient in certain vitamins warranting perioperative repletion, other supplements have the potential to benefit all patients, regardless of nutritional status. Despite these putative benefits, there is a dearth of information regarding nutritional optimization, with the limited, available literature focusing mostly on herbal supplements and their potential side effects. A significant barrier to supplement use is the lack of education and available supporting information regarding the indications, contraindications, and physiology of these adjuncts. The goal of this article is to provide a comprehensive, evidence-based review of available nutritional supplements that can be considered for the plastic surgery patient in the perioperative period to optimize surgical outcomes while minimizing risk. Prospective, well-designed studies using validated, high-quality supplements will be critical in determining the significance that perioperative supplementation can have for surgical outcomes. Until well-done prospective studies are performed, the supplement, dose, and duration should be determined on an individual, patient-per-patient basis at the discretion of the operating surgeon.


Assuntos
Medicina Baseada em Evidências/métodos , Desnutrição/dietoterapia , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Humanos , Desnutrição/complicações , Desnutrição/diagnóstico , Estado Nutricional , Complicações Pós-Operatórias/etiologia
10.
AORN J ; 112(3): 217-224, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32857402

RESUMO

The novel coronavirus SARS-CoV-2 first appeared in Wuhan, China, in December 2019 and led to the Coronavirus Disease 2019 (COVID-19), which quickly spread globally. Protocols for surgical patients with COVID-19 were lacking, particularly for pregnant women undergoing cesarean deliveries. Perioperative nurses at Tongji Hospital in Wuhan retrospectively analyzed the perioperative nursing process, including OR preparation, intraoperative care, and OR cleanup, for women with COVID-19 undergoing cesarean deliveries. Preparation involved altering the layout of the surgical suite, educating staff members, providing personal protective equipment, and creating new in-house guidelines to help protect personnel and patients. This article describes how perioperative personnel strategized to prevent the transmission of COVID-19 in the OR and presents a multiple-case summary of six pregnant patients with COVID-19 who underwent cesarean deliveries at Tongji Hospital in January and February 2020.


Assuntos
Cesárea/estatística & dados numéricos , Infecções por Coronavirus/terapia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Assistência Perioperatória/métodos , Pneumonia Viral/terapia , Resultado da Gravidez/epidemiologia , Betacoronavirus , China , Infecções por Coronavirus/cirurgia , Feminino , Humanos , Pandemias , Equipamento de Proteção Individual/estatística & dados numéricos , Pneumonia Viral/cirurgia , Gravidez , Complicações Infecciosas na Gravidez/terapia
12.
Ann Surg ; 272(2): 277-283, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32675540

RESUMO

: Since their discovery, neutrophil extracellular traps (NETs) have been implicated in a broad array of functions, both beneficial and detrimental to the host. Indeed, NETs have roles in infection, sepsis, wound healing, thrombotic disease, and cancer propagation, all of which are directly implicated in the care of surgical patients. Here we provide an updated review on the role of NETs in the perioperative period with specific emphasis on perioperative infections, wound healing, vascular complications, cancer propagation, as well as discussing ongoing, and future therapeutic targets. Surgeons will benefit from understanding the latest discoveries in neutrophil biology and how these novel functions affect the care of surgical patients. Furthermore, novel anti-NET therapies are being developed which may have profound effects on the care of surgical patients.


Assuntos
Armadilhas Extracelulares/metabolismo , Neutrófilos/metabolismo , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos , Infecção da Ferida Cirúrgica/metabolismo , Cicatrização/fisiologia , Animais , Biomarcadores/metabolismo , Feminino , Humanos , Masculino , Camundongos , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/metabolismo , Medição de Risco , Sensibilidade e Especificidade , Infecção da Ferida Cirúrgica/diagnóstico
13.
Zhonghua Wai Ke Za Zhi ; 58(8): 642-645, 2020 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-32727197

RESUMO

With the development and progress in the concepts and techniques of perioperative management, especially the latest reports of clinical trials, the prospect of prevention and treatment of postoperative ileus (POI) is promising. Proper nutritional support therapy, optimized surgical and anesthetic treatment, individualized fluid management, timely psychosocial intervention, and active anti-inflammation and traditional Chinese medicine treatment can effectively reduce occurrence of POI. Nevertheless, how to optimize and combine perioperative treatments to comprehensively prevent and treat POI still needs further study.


Assuntos
Íleus/prevenção & controle , Assistência Perioperatória/métodos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Humanos , Íleus/etiologia , Íleus/terapia , Procedimentos Cirúrgicos Operatórios/métodos
14.
Perfusion ; 35(6): 465-473, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32666887

RESUMO

Coronavirus disease 2019 (COVID-19) is a serious health concern which affects all healthcare professionals worldwide. The pandemic puts health services, including cardiac surgery units, under escalating pressure. There are significant challenges caused by this novel virus and ensuing disease that leads to great uncertainty. While it has been advocated to delay elective surgeries, most cardiac surgical patients present in a more urgent manner which elevates the critical nature for intervention, which may make the surgical decision inevitable. To date, no definitive treatments to the pandemic have been promoted. Cardiac surgical centers may experience an increasing number of COVID-19 patients in clinical practice. Preparation for managing these patients will require a change in the current modalities for perioperative care. Therefore, the goal of this report is to share our own experiences, combined with a review of the emerging literature, by highlighting principles for the adult cardiac surgery community regarding treatment of patients scheduled for surgery. The following report will recommend perioperative guidance in patient management to include safety precautions for the heart team, the conduct of extracorporeal circulation and related equipment, and covering the early period in intensive care in the context of the current pandemic.


Assuntos
Betacoronavirus , Ponte Cardiopulmonar/métodos , Infecções por Coronavirus/complicações , Pandemias , Assistência Perioperatória/métodos , Pneumonia Viral/complicações , Doença da Artéria Coronariana , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/métodos , Saúde Global , Humanos , Morbidade/tendências , Pneumonia Viral/epidemiologia
15.
Medicine (Baltimore) ; 99(27): e21071, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629738

RESUMO

BACKGROUND: Only few studies have yet investigated whether perioperative administration of pregabalin can reduce the incidence of postoperative chronic neuropathic pain after total hip arthroplasty (THA). This prospective, randomized study compared placebo with pregabalin in the hope that a lower pregabalin dose would improve analgesia without increasing side-effects after THA. METHODS: This study was a prospective randomized blinded study, with a parallel design and an allocation ratio of 1:1 for the treatment groups. The study was approved by the Institutional Review Board in Weifang People's Hospital and written informed consent was obtained from all subjects before enrolment. A total of 120 patients who meet inclusion criteria are randomized to either pregabalin or placebo group. The primary objective of the study was visual analog scale score. As secondary outcomes, opioid consumption measurement, Harris Hip Score, hip range of motion, patient satisfaction, and complications were made at different time points throughout the study for comparison. RESULTS: The null hypothesis of this study was that pregabalin would reduce pain after THA. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5669).


Assuntos
Analgésicos/uso terapêutico , Artroplastia de Quadril/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Pregabalina/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos/administração & dosagem , Estudos de Casos e Controles , China/epidemiologia , Método Duplo-Cego , Humanos , Incidência , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Manejo da Dor/métodos , Dor Pós-Operatória/epidemiologia , Satisfação do Paciente/estatística & dados numéricos , Assistência Perioperatória/métodos , Placebos/administração & dosagem , Pregabalina/administração & dosagem , Estudos Prospectivos , Amplitude de Movimento Articular/efeitos dos fármacos , Escala Visual Analógica , Adulto Jovem
16.
J Visc Surg ; 157(4): 317-327, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32600823

RESUMO

Bariatric/metabolic surgery was paused during the Covid-19 pandemic. The impact of social confinement and the interruption of this surgery on the population with obesity has been underestimated, with weight gain and worsened comorbidities. Some candidates for this surgery are exposed to a high risk of mortality linked to the pandemic. Obesity and diabetes are two major risk factors for severe forms of Covid-19. The only currently effective treatment for obesity is metabolic surgery, which confers prompt, lasting benefits. It is thus necessary to resume such surgery. To ensure that this resumption is both gradual and well-founded, we have devised a priority ranking plan. The flow charts we propose will help centres to identify priority patients according to a benefit/risk assessment. Diabetes holds a central place in the decision tree. Resumption patterns will vary from one centre to another according to human, physical and medical resources, and will need adjustment as the epidemic unfolds. Specific informed consent will be required. Screening of patients with obesity should be considered, based on available knowledge. If Covid-19 is suspected, surgery must be postponed. Emphasis must be placed on infection control measures to protect patients and healthcare professionals. Confinement is strongly advocated for patients for the first month post-operatively. Patient follow-up should preferably be by teleconsultation.


Assuntos
Cirurgia Bariátrica/normas , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/normas , Obesidade/cirurgia , Pandemias/prevenção & controle , Assistência Perioperatória/normas , Pneumonia Viral/prevenção & controle , Cirurgia Bariátrica/métodos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Procedimentos Clínicos/normas , Humanos , Controle de Infecções/métodos , Consentimento Livre e Esclarecido/normas , Obesidade/complicações , Seleção de Pacientes , Assistência Perioperatória/métodos , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico
17.
Br J Anaesth ; 125(3): 321-329, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32636084

RESUMO

BACKGROUND: Cardiac cycle efficiency (CCE) derived from a pressure-recording analytical method is a unique parameter to assess haemodynamic performance from an energetic view. This study investigated changes of CCE according to an anatomical diagnosis group, and its association with early postoperative outcomes in children undergoing cardiac surgery. METHODS: Ninety children were included with a ventricular septal defect (VSD; n=30), tetralogy of Fallot (TOF; n=40), or total anomalous pulmonary venous connection (TAPVC; n=20). CCE along with other haemodynamic parameters, was recorded from anaesthesia induction until 48 h post-surgery. Predictive CCE (CCEp) was defined as the average of CCE at post-modified ultrafiltration and CCE at the end of surgery. The relationship between CCE and early outcomes was assessed by the comparison between the high-CCEp group (CCEp ≥75th centile) and the low-CCEp group (CCEp ≤25th centile). RESULTS: There was a significant time × diagnostic group interaction effect in the trend of CCE. Compared with the high-CCEp group (n=23), the low-CCEp group (n=22) required more inotropics post-surgery, had higher lactate concentrations at 8 and 24 h post-surgery, a longer intubation time and longer ICU stay, and higher frequency of peritoneal fluid. CONCLUSIONS: Perioperative changes of CCE vary according to anatomical diagnosis in children undergoing cardiac surgery. Children with TOF have an unfavourable trend of CCE compared with children with VSD or TAPVC. A decline in CCE is associated with adverse early postoperative outcomes. CLINICAL TRIAL REGISTRATION: ChiCTR1800014996.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas/cirurgia , Coração/fisiopatologia , Hemodinâmica/fisiologia , Assistência Perioperatória/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Prognóstico , Estudos Prospectivos , Resultado do Tratamento
18.
Bone Joint J ; 102-B(9): 1136-1145, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32634023

RESUMO

AIMS: During the COVID-19 pandemic, many patients continue to require urgent surgery for hip fractures. However, the impact of COVID-19 on perioperative outcomes in these high-risk patients remains unknown. The objectives of this study were to establish the effects of COVID-19 on perioperative morbidity and mortality, and determine any risk factors for increased mortality in patients with COVID-19 undergoing hip fracture surgery. METHODS: This multicentre cohort study included 340 COVID-19-negative patients versus 82 COVID-19-positive patients undergoing surgical treatment for hip fractures across nine NHS hospitals in Greater London, UK. Patients in both treatment groups were comparable for age, sex, body mass index, fracture configuration, and type of surgery performed. Predefined perioperative outcomes were recorded within a 30-day postoperative period. Univariate and multivariate analysis were used to identify risk factors associated with increased risk of mortality. RESULTS: COVID-19-positive patients had increased postoperative mortality rates (30.5% (25/82) vs 10.3% (35/340) respectively, p < 0.001) compared to COVID-19-negative patients. Risk factors for increased mortality in patients with COVID-19 undergoing surgery included positive smoking status (hazard ratio (HR) 15.4 (95% confidence interval (CI) 4.55 to 52.2; p < 0.001) and greater than three comorbidities (HR 13.5 (95% CI 2.82 to 66.0, p < 0.001). COVID-19-positive patients had increased risk of postoperative complications (89.0% (73/82) vs 35.0% (119/340) respectively; p < 0.001), more critical care unit admissions (61.0% (50/82) vs 18.2% (62/340) respectively; p < 0.001), and increased length of hospital stay (mean 13.8 days (SD 4.6) vs 6.7 days (SD 2.5) respectively; p < 0.001), compared to COVID-19-negative patients. CONCLUSION: Hip fracture surgery in COVID-19-positive patients was associated with increased length of hospital stay, more admissions to the critical care unit, higher risk of perioperative complications, and increased mortality rates compared to COVID-19-negative patients. Risk factors for increased mortality in patients with COVID-19 undergoing surgery included positive smoking status and multiple (greater than three) comorbidities. Cite this article: Bone Joint J 2020;102-B(9):1136-1145.


Assuntos
Artroplastia de Quadril/efeitos adversos , Infecções por Coronavirus/epidemiologia , Fraturas do Quadril/cirurgia , Mortalidade Hospitalar , Pneumonia Viral/epidemiologia , Complicações Pós-Operatórias/mortalidade , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Artroplastia de Quadril/métodos , Causas de Morte , Estudos de Coortes , Feminino , Fraturas do Quadril/epidemiologia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pandemias , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/fisiopatologia , Valores de Referência , Medição de Risco , Reino Unido
19.
J Thorac Cardiovasc Surg ; 160(4): 937-947.e2, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32624303

RESUMO

BACKGROUND: The onset of the coronavirus disease 2019 (COVID-19) pandemic has forced our cardiac surgery program and hospital to enact drastic measures that has forced us to change how we care for cardiac surgery patients, assist with COVID-19 care, and enable support for the hospital in terms of physical resources, providers, and resident training. METHODS: In this review, we review the cardiovascular manifestations of COVID-19 and describe our system-wide adaptations to the pandemic, including the use of telemedicine, how a severe reduction in operative volume affected our program, the process of redeployment of staff, repurposing of residents into specific task teams, the creation of operation room intensive care units, and the challenges that we faced in this process. RESULTS: We offer a revised set of definitions of surgical priority during this pandemic and how this was applied to our system, followed by specific considerations in coronary/valve, aortic, heart failure and transplant surgery. Finally, we outline a path forward for cardiac surgery for the near future. CONCLUSIONS: We recognize that individual programs around the world will eventually face COVID-19 with varying levels of infection burden and different resources, and we hope this document can assist programs to plan for the future.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Betacoronavirus , Procedimentos Cirúrgicos Cardíacos , Infecções por Coronavirus , Alocação de Recursos para a Atenção à Saúde , Acesso aos Serviços de Saúde/organização & administração , Pandemias , Assistência Perioperatória/métodos , Pneumonia Viral , Adulto , Betacoronavirus/isolamento & purificação , Procedimentos Cirúrgicos Cardíacos/tendências , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Doenças Cardiovasculares/virologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Feminino , Alocação de Recursos para a Atenção à Saúde/métodos , Alocação de Recursos para a Atenção à Saúde/organização & administração , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Unidades de Terapia Intensiva/organização & administração , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Salas Cirúrgicas/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Telemedicina/métodos , Telemedicina/organização & administração
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