Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 46.197
Filtrar
1.
Anaesthesia ; 75(1): 63-71, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31549413

RESUMO

Delirium is a common complication following hip fracture surgery. We introduced a peri-operative care bundle that standardised management in the emergency department, operating theatre and ward. This incorporated: use of fascia iliaca blocks; rationalisation of analgesia; avoidance of drugs known to trigger delirium; a regular education program for staff; and continuous auditing of compliance. The study was conducted between June 2017 and December 2018. We recruited 150 patients before (control group) and 150 patients after (care bundle group) the introduction of the care bundle. In patients having surgery for a hip fracture, there was a lower incidence of delirium on the third postoperative day in the care bundle group compared with the control group (33 patients (22%) vs. 49 patients (33%)), respectively; p = 0.04). Patients in the care bundle group had an adjusted OR of 2.2 (95%CI 1.1-4.4) (p = 0.03) for the avoidance of delirium on the third postoperative day. There was no difference between groups for the secondary outcome measures (measured at 30 days postoperatively) including: all-cause mortality; composite morbidity; institutionalisation; and walking status. During the study period, compliance with elements of the care bundle improved in the emergency department (49 patients (33%) compared with 85 patients (59%); p < 0.001) and anaesthetic department (40 patients (27%) compared with 104 patients (69%); p < 0.001), while orthogeriatrics maintained a high level of compliance (140 patients (93%) compared with 143 patients (95%); p = 0.45). There was a clinically and statistically significant reduction in the incidence of delirium following hip fracture surgery in patients treated with a multidisciplinary care bundle.


Assuntos
Delírio/prevenção & controle , Fraturas do Quadril/cirurgia , Pacotes de Assistência ao Paciente/métodos , Complicações Pós-Operatórias/prevenção & controle , Melhoria de Qualidade , Idoso , Idoso de 80 Anos ou mais , Delírio/induzido quimicamente , Feminino , Humanos , Incidência , Masculino , Complicações Pós-Operatórias/induzido quimicamente , Estudos Prospectivos
3.
Medicine (Baltimore) ; 98(50): e18047, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852066

RESUMO

BACKGROUND: There currently exists no substantial evidence reporting the efficacy of peritoneal irrigation in reducing the incidence of postoperative intra-abdominal abscess in pediatric patients. The purpose of our study was to perform a meta-analysis to compare rates of intra-abdominal abscess after appendectomy between irrigation and suction alone groups. METHODS: We identified studies by a systematic search in EMBASE, PubMed, Web of Science, and the Cochrane Library to recognize randomized controlled trials and case control studies from the 1950 to May 2019. We limited the English language studies. We checked the reference list of studies to recognize other potentially qualified trials. We analyzed the merged data with use of the Review Manager 5.3. RESULTS: We identified 6 eligible papers enrolling a total of 1633 participants. We found no significant difference in the incidence of postoperative intraabdominal abscess, wound infection, and the length of hospitalization between 2 group, but duration of surgery is longer in irrigation group (MD = 6.76, 95% CI = 4.64 to 8.87, P < .001; heterogeneity, I = 25%, P = .26). CONCLUSION: Our meta-analysis did not provide strong evidence allowing definite conclusions to be drawn, but suggested that peritoneal irrigation during appendectomy did not decrease the incidence of postoperative IAA. This meta-analysis also indicated the need for more high-quality trials to identify methods to decrease the incidence of postoperative IAA in pediatric perforated appendicitis patients.Trial registration number Standardization of endoscopic treatment of acute abdomen in children: 14RCGFSY00150.


Assuntos
Abscesso Abdominal/prevenção & controle , Apendicectomia/métodos , Apendicite/cirurgia , Laparoscopia/métodos , Lavagem Peritoneal/métodos , Complicações Pós-Operatórias/prevenção & controle , Abscesso Abdominal/etiologia , Apendicite/complicações , Criança , Humanos , Período Intraoperatório , Complicações Pós-Operatórias/etiologia
4.
Medicine (Baltimore) ; 98(51): e18309, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860980

RESUMO

This study aimed to investigate the application of the healthcare failure mode and effect analysis (HFMEA) to reduce the incidence of posture syndrome of thyroid surgery (PSTS).Subjects before (n = 78, July 2017-December 2017) and after (n = 114, January 2018-June 2018) HFMEA implementation (The Second Hospital of Nanjing, Nanjing University of Chinese Medicine) were selected. The training for PSTS was optimized using HFMEA.The occurrence of PSTS was reduced from 59% to 18% after HFMEA (P < .001). Symptoms of pain and nausea and vomiting were also decreased after HFMEA (all P < .001). The critical thinking ability of 34 medical personnel to evaluate the reduction of thyroid postoperative posture syndrome increased from 246 ±â€Š19 to 301 ±â€Š14 (P < .001) after HFMEA.HFMEA was used to create preoperative posture training procedures for PSTS, bedside cards for training, innovative preoperative posture training equipment, and a diversified preoperative posture training health education model.


Assuntos
Análise do Modo e do Efeito de Falhas na Assistência à Saúde , Posicionamento do Paciente/métodos , Complicações Pós-Operatórias/prevenção & controle , Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Adolescente , Adulto , Idoso , Análise do Modo e do Efeito de Falhas na Assistência à Saúde/métodos , Humanos , Incidência , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Melhoria de Qualidade , Síndrome , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia/educação , Tireoidectomia/métodos , Adulto Jovem
6.
Bone Joint J ; 101-B(11): 1402-1407, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674239

RESUMO

AIMS: Bone health assessment and the prescription of medication for secondary fracture prevention have become an integral part of the acute management of patients with hip fracture. However, there is little evidence regarding compliance with prescription guidelines and subsequent adherence to medication in this patient group. PATIENTS AND METHODS: The World Hip Trauma Evaluation (WHiTE) is a multicentre, prospective cohort of hip fracture patients in NHS hospitals in England and Wales. Patients aged 60 years and older who received operative treatment for a hip fracture were eligible for inclusion in WHiTE. The prescription of bone protection medications was recorded from participants' discharge summaries, and participant-reported use of bone protection medications was recorded at 120 days following surgery. RESULTS: Of 5456 recruited patients with baseline data, 2853 patients (52%) were prescribed bone protection medication at discharge, of which oral bisphosphonates were the most common, 4109 patients (75%) were prescribed vitamin D or calcium, and 606 patients (11%) were not prescribed anything. Of those prescribed a bone protection medication, only 932 patients (33%) reported still taking their medication 120 days later. CONCLUSION: These data provide a reference for current prescription and adherence rates. Adherence with oral medication remains poor in patients with hip fracture. Cite this article: Bone Joint J 2019;101-B:1402-1407.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Fraturas do Quadril/cirurgia , Idoso , Cálcio/uso terapêutico , Estudos de Coortes , Denosumab/uso terapêutico , Difosfonatos/uso terapêutico , Humanos , Hidroxicolecalciferóis/uso terapêutico , Adesão à Medicação , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Teriparatida/uso terapêutico , Reino Unido , Vitamina D/uso terapêutico
7.
Bone Joint J ; 101-B(11): 1438-1446, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31674243

RESUMO

AIMS: This study aimed to explore whether intraoperative nerve monitoring can identify risk factors and reduce the incidence of nerve injury in patients with high-riding developmental dysplasia. PATIENTS AND METHODS: We conducted a historical controlled study of patients with unilateral Crowe IV developmental dysplasia of the hip (DDH). Between October 2016 and October 2017, intraoperative nerve monitoring of the femoral and sciatic nerves was applied in total hip arthroplasty (THA). A neuromonitoring technician was employed to monitor nerve function and inform the surgeon of ongoing changes in a timely manner. Patients who did not have intraoperative nerve monitoring between September 2015 and October 2016 were selected as the control group. All the surgeries were performed by one surgeon. Demographics and clinical data were analyzed. A total of 35 patients in the monitoring group (ten male, 25 female; mean age 37.1 years (20 to 46)) and 56 patients in the control group (13 male, 43 female; mean age 37.9 years (23 to 52)) were enrolled. The mean follow-up of all patients was 13.1 months (10 to 15). RESULTS: The two groups had no significant differences in preoperative data. In the monitoring group, ten nerve alerts occurred intraoperatively, and no neural complications were detected postoperatively. In the control group, six patients had neural complications. The rate of nerve injury was lower in the monitoring group than in the control group, but this did not achieve statistical significance. The degree of leg lengthening was significantly greater in the monitoring group than in the control group. In further analyses, patients who had previous hip surgery were more likely to have intraoperative nerve alerts and postoperative nerve injury. CONCLUSION: Nerve injury usually occurred during the processes of exposure and reduction. The use of intraoperative nerve monitoring showed a trend towards reduced nerve injury in THA for Crowe IV DDH patients. Hence, we recommend its routine use in patients undergoing leg lengthening, especially in those with previous hip surgery. Cite this article: Bone Joint J 2019;101-B:1438-1446.


Assuntos
Artroplastia de Quadril/métodos , Nervo Femoral/fisiologia , Luxação Congênita de Quadril/cirurgia , Tratamentos com Preservação do Órgão/métodos , Nervo Isquiático/fisiologia , Adulto , Feminino , Nervo Femoral/lesões , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Nervo Isquiático/lesões , Traumatismos do Sistema Nervoso/prevenção & controle , Adulto Jovem
8.
Georgian Med News ; (294): 83-87, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687955

RESUMO

The aim of the research was to investigate the relationship between cerebral microembolization and the development of postoperative cognitive impairment in patients after coronary artery bypass grafting with and without prophylactic administration of nitroglycerin at the end of artificial blood circulation. The study included 72 patients (43 male and 29 female) who had ACBPS using an ABCA. The patients were randomized into two clinical groups. The number of patients in the control group was 34 patients, in the study group - 38 patients. The study of the cognitive sphere was performed using a battery of clinical tests that included MSA and MMSE scales, Trail-making test, Grooved Pageboard, fine hands-motor test, 10 words test by AR Luria, Wexler's test, Schultz tables. The assessment was carried out on a day before the intervention and on the fifth day after the surgical intervention. It was shown that by all patients undergoing aorto-coronary bypass syrgery microembolization within the cerebral blood flow had been determined. The vast majority of microemboli is formed at the beginning of artificial blood circulation, at the moment of clamping aorta, as well as during the restoration of effective cardiac activity. Intraoperative microembolization of cerebral blood flow in excess of 750 microemboli leads to clinically significant deterioration of the brain functions in the early postoperative period. When used as a peripheral vasodilator, nitroglycerin, at a dose of 8-10 µg/kg*min in high (120-130%) volume perfusion rate, decreases the number of microemboluses in the basin of СМА by 2.4%.


Assuntos
Aorta/diagnóstico por imagem , Substitutos Sanguíneos , Ponte Cardiopulmonar/efeitos adversos , Disfunção Cognitiva/etiologia , Ponte de Artéria Coronária/efeitos adversos , Embolia Intracraniana/psicologia , Infarto do Miocárdio/cirurgia , Idoso , Idoso de 80 Anos ou mais , Ponte Cardiopulmonar/métodos , Circulação Cerebrovascular , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Ponte de Artéria Coronária/métodos , Feminino , Humanos , Embolia Intracraniana/complicações , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle
9.
Br J Anaesth ; 123(6): 865-876, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31591020

RESUMO

BACKGROUND: There is growing interest in the effect of postoperative analgesics on oncological outcomes after cancer surgery. We investigated the impact of tramadol after breast cancer surgery on recurrence and mortality and explored the mechanism by which tramadol affects cultured breast cancer cells in vitro. METHODS: Electronic medical records of patients who underwent breast cancer surgery between November 2005 and December 2010 at Severance Hospital in Korea were reviewed. Cox regression analyses were used to identify factors related to postoperative recurrence and mortality. We performed the sensitivity test with propensity score matching to adjust for selection bias. In addition, we investigated the effects of tramadol on human breast adenocarcinoma (Michigan Cancer Foundation-7 [MCF-7]) cells via assessment of cell viability, clonogenic assay, and cell cycle analysis in vitro. RESULTS: Of 2588 breast cancer patients, 36.4% had received tramadol. Those who received tramadol had a 0.71-fold decreased risk of recurrence and a 0.56-fold decrease in mortality. The MCF-7 cell viability assays showed that tramadol had an anti-proliferative effect by cell cycle arrest, suppressing colony formation, and regulation of oestrogen and progesterone receptors. Tramadol induced apoptosis of MCF-7 cells via extracellular signal-regulated kinases by decreasing of 5-hydroxytryptamine (HT)2B receptor and transient receptor potential vanilloid-1 expression. CONCLUSIONS: After breast cancer surgery, patients who received tramadol had a decreased risk of postoperative recurrence and mortality. The anti-tumour effect of tramadol appears to involve inhibition of proliferation, induction of apoptosis, and effects on 5-HT2B receptor and TRPV-1.


Assuntos
Adenocarcinoma/cirurgia , Analgésicos Opioides/farmacologia , Neoplasias da Mama/cirurgia , Recidiva Local de Neoplasia/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Tramadol/farmacologia , Adulto , Idoso , Apoptose/efeitos dos fármacos , Mama/efeitos dos fármacos , Mama/cirurgia , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Feminino , Humanos , Técnicas In Vitro , Células MCF-7 , Mastectomia , Pessoa de Meia-Idade , República da Coreia , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Resultado do Tratamento , Células Tumorais Cultivadas
10.
Rev Lat Am Enfermagem ; 27: e2939, 2019.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31596404

RESUMO

OBJECTIVE: to estimate the prevalence and avoidability of surgical adverse events in a teaching hospital and to classify the events according to the type of incident and degree of damage. METHOD: cross-sectional retrospective study carried out in two phases. In phase I, nurses performed a retrospective review on a simple randomized sample of 192 records of adult patients using the Canadian Adverse Events Study form for case tracking. Phase II aimed at confirming the adverse event by an expert committee composed of physicians and nurses. Data were analyzed by univariate descriptive statistics. RESULTS: the prevalence of surgical adverse events was 21.8%. In 52.4% of the cases, detection occurred on outpatient return. Of the 60 cases analyzed, 90% (n = 54) were preventable and more than two thirds resulted in mild to moderate damage. Surgical technical failures contributed in approximately 40% of the cases. There was a prevalence of the infection category associated with health care (50%, n = 30). Adverse events were mostly related to surgical site infection (30%, n = 18), suture dehiscence (16.7%, n = 10) and hematoma/seroma (15%, n = 9). CONCLUSION: the prevalence and avoidability of surgical adverse events are challenges faced by hospital management.


Assuntos
Hospitais de Ensino/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios/normas , Deiscência da Ferida Operatória/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia
11.
Acta Gastroenterol Belg ; 82(3): 389-395, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31566326

RESUMO

BACKGROUND AND AIM: Preoperative biliary drainage (PBD) in patients with pancreatic cancer remains debatable. The aim of this study was to analyse the indications for PBD in patients performing pancreaticoduodenectomy (PD) and to evaluate the impact of this procedure on postoperative outcome. METHODS: Observational retrospective cohort study of patients undergoing PD for pancreatic cancer. Clinical data and postoperative outcome, namely complications and 90-day mortality, were prospectively collected and compared between patients performing PBD or direct surgery (DS). RESULTS: Eighty-two patients were included: 40 underwent PBD and 42 performed DS. Major complications (27.5% vs 33.3%, P=0.156) and 90-day mortality (10% vs 16.7%, P=0.376) were similar between the two groups. There was a trend for higher mean total bilirubin in patients with PBD (P=0.073). The indication for PBD was suspicion of cholangitis/choledocholithiasis or need to perform neoadjuvant chemotherapy in 24 (60%) patients. In the remaining, elevated bilirubin was probably the only reason to perform PBD. Length of hospital stay was longer in PBD group (P=0.003). On multiple logistic regression, 90-day mortality was not related with preoperative bilirubin levels, biliary drainage or its indication, but solely with age (OR 1.15, 95%CI 1.05-1.31, P=0.008). CONCLUSIONS: PBD is often performed in patients undergoing PD without a formal indication, mainly due to high bilirubin levels. No increased morbidity/mortality was observed but length of hospital stay was prolonged in patients performing PBD.


Assuntos
Drenagem/efeitos adversos , Pancreaticoduodenectomia/métodos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Bilirrubina/sangue , Drenagem/métodos , Humanos , Pancreaticoduodenectomia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
12.
Medicine (Baltimore) ; 98(38): e17196, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567967

RESUMO

BACKGROUND: The use of octreotide prophylaxis following pancreatic surgery is controversial. We aimed to evaluate the effectiveness of octreotide for the prevention of postoperative complications after pancreatic surgery through this systematic review and meta-analysis. METHODS: Literature databases (including the MEDLINE, EMBASE, and Cochrane databases) were searched systematically for relevant articles. Only randomized controlled trials (RCTs) were eligible for inclusion in our research. We extracted the basic information regarding the patients, intervention procedures, and all complications after pancreatic surgery and then performed the meta-analysis. RESULTS: Thirteen RCTs involving 2006 patients were identified. There were no differences between the octreotide group and the placebo group with regard to pancreatic fistulas (PFs) (relative risk [RR] = 0.79, 95% confidence interval [CI] = 0.62-0.99, P = .05), clinically significant PFs (RR = 1.01, 95% CI = 0.68-1.50, P = .95), mortality (RR = 1.21, 95% CI = 0.78-1.88, P = .40), biliary leakage (RR 0.84, 95% CI = 0.39-1.82, P = .66), delayed gastric emptying (RR = 0.83, 95% CI = 0.54-1.27, P = .39), abdominal infection (RR = 1.00, 95% CI = 0.66-1.52, P = 1.00), bleeding (RR = 1.16, 95% CI = 0.78-1.72, P = .46), pulmonary complications (RR = 0.73, 95% CI = 0.45-1.18, P = .20), overall complications (RR = 0.80, 95% CI = 0.64-1.01, P = .06), and reoperation rates (RR = 1.18, 95% CI = 0.77-1.81, P = .45). In the high-risk group, octreotide was no more effective at reducing PF formation than placebo (RR = 0.81, 95% CI = 0.67-1.00, P = .05). In addition, octreotide had no influence on the incidence of PF (RR = 0.38, 95% CI = 0.14-1.05, P = .06) after distal pancreatic resection and local pancreatic resection. CONCLUSION: The present best evidence suggests that prophylactic use of octreotide has no effect on reducing complications after pancreatic resection.


Assuntos
Fármacos Gastrointestinais/uso terapêutico , Octreotida/uso terapêutico , Pancreatectomia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Humanos , Pâncreas/cirurgia
13.
Anticancer Res ; 39(10): 5761-5765, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31570479

RESUMO

BACKGROUND/AIM: To clarify the usefulness of intraoperative colonoscopy (CS) for preventing postoperative anastomotic leakage and bleeding in rectal cancer surgery. PATIENTS AND METHODS: The data of rectal cancer patients who underwent circular-stapled anastomosis from January 2008 to December 2016 were compared between 162 patients who received intraoperative CS (the CS group) and 23 patients who did not receive intraoperative CS (the non-CS group). RESULTS: Anastomotic leakage rate in the CS group (8.6%) was similar to that in the non-CS group (4.3%) (p=0.70). Postoperative anastomotic bleeding rate was also similar between the CS and non-CS groups (2.4% vs. 0%, p=0.50). Although a positive air leak test was observed in two patients in the CS group, no postoperative leakage developed by adding intraoperative treatment. CONCLUSION: Although intraoperative CS did not significantly reduce the incidence of postoperative anastomotic leakage or bleeding, it can be useful for certain cases.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Neoplasias Retais/cirurgia , Reto/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , Fístula Anastomótica/prevenção & controle , Colonoscopia/métodos , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Hemorragia Pós-Operatória/prevenção & controle , Período Pós-Operatório , Estudos Prospectivos , Estudos Retrospectivos
14.
Ned Tijdschr Tandheelkd ; 126(10): 527-532, 2019 Oct.
Artigo em Holandês | MEDLINE | ID: mdl-31613282

RESUMO

Recent literature indicates that in a healthy patient, who has sufficient bone volume to allow implant placement, it is justified to refrain from prophylactic administration of antibiotics. The patient should, however, rinse with chlorhexidine digluconate 1 day prior to treatment and at least 1 week postoperatively. In the case of an immune-compromised patient, a single antibiotic gift is indicated 1 hour before the procedure (2 grams of amoxicillin orally or 2 grams of cefazoline intravenously). In the case of a healthy patient, antibiotic (AB) prophylaxis is also indicated if autologous bone, a bone filler or membranes are applied. Although AB prophylaxis is not necessary when harvesting extraoral bone grafts, it is indicated because the harvested bone is applied intraorally in the same treatment session. The question whether postoperative administration of antibiotics is still needed remains open.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Implantes Dentários , Complicações Pós-Operatórias/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Amoxicilina , Implantação Dentária Endo-Óssea , Falha de Restauração Dentária , Humanos
15.
Vet Clin North Am Small Anim Pract ; 49(6): 981-991, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31581985

RESUMO

Surgery is the mainstay of therapy for canine and human solid cancers. Alarmingly, evidence suggests that the process of surgery may exacerbate metastasis and accelerate the kinetics of cancer progression. Understanding the mechanisms by which cancer progression is accelerated as a result of surgery may provide pharmacologic interventions. This review discusses surgery-induced cancer progression. It focuses on immunomodulatory properties of anesthesia and opioids and evidence that studies evaluating the role of opioids in tumor progression are indicated. It concludes by discussing why companion animals with spontaneously arising cancer are an ideal model for clinical trials to investigate this phenomenon.


Assuntos
Analgésicos Opioides/uso terapêutico , Doenças do Cão/tratamento farmacológico , Manejo da Dor/veterinária , Dor/veterinária , Animais , Progressão da Doença , Cães , Metástase Neoplásica , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Neoplasias/cirurgia , Neoplasias/veterinária , Dor/tratamento farmacológico , Manejo da Dor/métodos , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/veterinária
16.
Br J Anaesth ; 123(6): 898-913, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31587835

RESUMO

Postoperative pulmonary complications (PPCs) occur frequently and are associated with substantial morbidity and mortality. Evidence suggests that reduction of PPCs can be accomplished by using lung-protective ventilation strategies intraoperatively, but a consensus on perioperative management has not been established. We sought to determine recommendations for lung protection for the surgical patient at an international consensus development conference. Seven experts produced 24 questions concerning preoperative assessment and intraoperative mechanical ventilation for patients at risk of developing PPCs. Six researchers assessed the literature using questions as a framework for their review. The modified Delphi method was utilised by a team of experts to produce recommendations and statements from study questions. An expert consensus was reached for 22 recommendations and four statements. The following are the highlights: (i) a dedicated score should be used for preoperative pulmonary risk evaluation; and (ii) an individualised mechanical ventilation may improve the mechanics of breathing and respiratory function, and prevent PPCs. The ventilator should initially be set to a tidal volume of 6-8 ml kg-1 predicted body weight and positive end-expiratory pressure (PEEP) 5 cm H2O. PEEP should be individualised thereafter. When recruitment manoeuvres are performed, the lowest effective pressure and shortest effective time or fewest number of breaths should be used.


Assuntos
Cooperação Internacional , Pneumopatias/prevenção & controle , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Respiração Artificial/métodos , Humanos , Cuidados Intraoperatórios/métodos
17.
Medicine (Baltimore) ; 98(39): e17307, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574859

RESUMO

To investigate the cognitive and psychological outcomes of pediatric allogeneic HSCT survivors in China.A total of 135 3 to 18 years old children and adolescents who underwent allo-HSCT and survived at least 3 months post-HSCT were recruited and completed the assessments. Cognitive and psychological functions were assessed via age-appropriate standardized measures. Clinical information was extracted from the medical records.Forty one 3 to 6 years old children completed Psychological Questionnaires for 3 to 6 years Children. The scores of 21(51.2%) children in cognitive development dimension, 18(43.9%) in motor development dimension, 16(39.0%) in language development and social development dimension, 15(36.6%) in emotion and will dimension and 14(34.1%) in living habits dimension were less than the standard. Fifty six 8 to 16 years old children and adolescents completed the Depression Self-rating Scale for Children and 9 (16.1%) of these met the criteria of depression. Sixty nine 7 to 16 years old children and adolescents completed the screening for Child Anxiety Related Disorders and 7 (10.1%) of these met the criteria of anxiety, especially social phobia and school phobia. Eighty nine 6 to 18 years old children and adolescents completed the Symptom Checklist-90 and 43.8% to 77.5% of these experienced mild symptoms like obsession-compulsion (77.5%), hostility (64%), and interpersonal sensitivity (60.7%). Children treated with total body irradiation (TBI) showed more cognitive impairments like motor deficits than those without TBI. Also older children and adolescents had more symptoms like psychoticism.These findings demonstrated cognitive and psychological late effects of pediatric allo-HSCT survivors in a single center in China and highlighted that the survivors conditioned with TBI had more cognitive impairments and older children and adolescents had more symptoms. Early intervention in these children and adolescents might minimize the cognitive losses and psychological effects.


Assuntos
Ansiedade , Disfunção Cognitiva , Depressão , Transplante de Células-Tronco Hematopoéticas , Complicações Pós-Operatórias , Qualidade de Vida , Adolescente , Ansiedade/diagnóstico , Ansiedade/etiologia , Ansiedade/prevenção & controle , Criança , Pré-Escolar , China/epidemiologia , Cognição , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/prevenção & controle , Depressão/diagnóstico , Depressão/etiologia , Depressão/prevenção & controle , Intervenção Médica Precoce/métodos , Feminino , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Masculino , Destreza Motora , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Técnicas Psicológicas , Sobreviventes/psicologia
18.
Medicine (Baltimore) ; 98(42): e17450, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626100

RESUMO

BACKGROUND: Cerebral aneurysm surgery has significant mortality and morbidity rate. Inflammation plays a key role in the pathogenesis of intracranial aneurysms, their rupture, subarachnoid hemorrhage and neurologic complications. Proinflammatory cytokine level in blood and cerebrospinal fluid (CSF) is an indicator of inflammatory response. Cytokines contribute to secondary brain injury and can worsen the outcome of the treatment. Lidocaine is local anesthetic that can be applied in neurosurgery as regional anesthesia of the scalp and as topical anesthesia of the throat before direct laryngoscopy and endotracheal intubation. Besides analgesic, lidocaine has systemic anti-inflammatory and neuroprotective effect.Primary aim of this trial is to determine the influence of local anesthesia with lidocaine on the perioperative levels of pro-inflammatory cytokines interleukin-1ß, interleukin-6, and tumor necrosis factor-α in plasma and CSF in cerebral aneurysm patients. METHODS: We will conduct prospective randomized clinical trial among patients undergoing craniotomy and cerebral aneurysm clipping surgery in general anesthesia. Patients included in the trial will be randomly assigned to the lidocaine group (Group L) or to the control group (Group C). Patients in Group L, following general anesthesia induction, will receive topical anesthesia of the throat before endotracheal intubation and also regional anesthesia of the scalp before Mayfield frame placement, both done with lidocaine. Patients in Group C will have general anesthesia only without any lidocaine administration. The primary outcomes are concentrations of cytokines interleukin-1ß, interleukin-6 and tumor necrosis factor-α in plasma and CSF, measured at specific timepoints perioperatively. Secondary outcome is incidence of major neurological and infectious complications, as well as treatment outcome in both groups. DISCUSSION: Results of the trial could provide insight into influence of lidocaine on local and systemic inflammatory response in cerebrovascular surgery, and might improve future anesthesia practice and treatment outcome. TRIAL IS REGISTERED AT CLINICALTRIALS.GOV:: NCT03823482.


Assuntos
Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Citocinas/efeitos dos fármacos , Aneurisma Intracraniano/cirurgia , Lidocaína/administração & dosagem , Adolescente , Adulto , Idoso , Anestesia por Condução/métodos , Anestesia Geral/métodos , Craniotomia/métodos , Citocinas/sangue , Citocinas/líquido cefalorraquidiano , Feminino , Humanos , Aneurisma Intracraniano/sangue , Aneurisma Intracraniano/líquido cefalorraquidiano , Intubação Intratraqueal/métodos , Laringoscopia/métodos , Masculino , Pessoa de Meia-Idade , Faringe , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Couro Cabeludo , Resultado do Tratamento , Adulto Jovem
19.
Am Surg ; 85(9): 1044-1050, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638522

RESUMO

Enhanced recovery after surgery (ERAS) may improve patients' postoperative course. Our center implemented the ERAS protocol for the colorectal service in 2016, and then expanded to multiple service lines over the course of 1.5 years. Our aim was to determine whether broad implementation of ERAS protocols across different service lines could improve patient care. All ERAS patients from 2018 were captured prospectively. For each service line using ERAS, one full year of data preceding ERAS was compared. ERAS service lines included colorectal, gynecology laparoscopic, gynecology open, hepatopancreaticobiliary, urology - nephrectomy and cystectomy, spinal fusion, cardiac surgery-coronary artery bypass grafting. ERAS and pre-ERAS services were compared based on length of stay (LOS), complications, readmission, and mortality rates. In addition, hospital costs were collected during this time frame. ERAS protocols significantly decreased LOS for colorectal, gynecology, and spine. Complications were significantly decreased in colorectal, gynecology, urology, and spine. Readmissions did not significantly increase in any service line except spine. There was no significant change in mortality. ERAS proved to save the hospital 1847 days and cost saving of almost $5 million in 2018. Implementing ERAS broadly improved patient outcomes (LOS, complications, readmission, and mortality) while providing cost savings to the hospital.


Assuntos
Protocolos Clínicos , Procedimentos Cirúrgicos Eletivos/economia , Procedimentos Cirúrgicos Eletivos/normas , Custos Hospitalares , Cuidados Pós-Operatórios/economia , Cuidados Pós-Operatórios/normas , Melhoria de Qualidade , Mortalidade Hospitalar , Humanos , Tempo de Internação/economia , Readmissão do Paciente/economia , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/prevenção & controle
20.
Nutr. hosp ; 36(5): 1150-1156, sept.-oct. 2019. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-184639

RESUMO

Objetivo: evaluar el impacto de la inmunonutrición oral preoperatoria y postoperatoria en la prevención de la desnutrición y las complicaciones posquirúrgicas en cáncer colorrectal. Pacientes y método: estudio retrospectivo descriptivo observacional con una única cohorte. Se incluyeron todos los pacientes sometidos a cirugía por cáncer colorrectal desde junio de 2014 a diciembre de 2015, sin ningún criterio de exclusión. En un pequeño número de casos (28 pacientes) no se suministró suplementación nutricional oral y se consideran pérdidas del estudio. Se realizó una evaluación del estado nutricional preoperatorio (NSR-2002). Se pautó inmunonutrición durante los cinco o diez días previos a la intervención en función del resultado. En el postoperatorio, se añadió inmunonutrición al tercer día postoperatorio hasta el séptimo o hasta el alta hospitalaria. Los pacientes con albúmina < 2,5 g/dl o íleo prolongado recibieron nutrición parenteral. El análisis de los datos se realizó con el paquete estadístico SPSS 21.0. Resultados: se incluyeron 220 pacientes con cáncer colorrectal, de los cuales 28 fueron pérdidas del estudio. La suplementación preoperatoria mejoró significativamente las cifras de prealbúmina y transferrina al ingreso. En el postoperatorio recibieron nutrición enteral 121 pacientes y 41 nutrición parenteral. Los pacientes que no tomaron suplementos nutricionales preoperatorios tuvieron más complicaciones (50% vs. 28,1%; p = 0,019) y la estancia media fue superior (14,64 ± 11,86 vs. 9,36 ± 5,5; p < 0,005). Los pacientes que no tomaron suplementos en el postoperatorio tuvieron más complicaciones (24% vs. 18,2%; p < 0,005), destacando más infección de herida (1,9% vs. 0,8%) y más dehiscencia anastomótica (1,9% vs. 0,8%). Tuvieron también una estancia media superior (9,15 ± 4,6 vs. 7,57 ± 2,5 días; p = 0,021). Conclusión: la administración de suplementos nutricionales orales previo a la intervención y en el postoperatorio en la cirugía del cáncer colorrectal se ha asociado a menos complicaciones y estancia media


Introduction: the aim of the study is to evaluate the effect of preoperative and postoperative oral nutritional therapy in the prevention of malnutrition and postsurgical complications in colorectal cancer Patients and methods: patients who underwent oncological colorectal surgery between June 2014 and December 2015 are included. An evaluation of preoperative nutritional status is performed. Patients received IMPACT(R) (2/day) for 5-10 days previous surgery. In the postoperative period, patients received IMPACT(R)/24h from 3rd to 7th postoperative day. Patients with low rates of albumin (< 2.5) or postoperative ileus received parenteral nutrition. Data were analyzed with the statistical package SPSS 21.0. Results: two hundred and twenty colorectal cancer patients were included. Twenty-eight patients did not take the preoperative oral supplements. Following the intake of nutritional supplements, an improvement of prealbumin and transferrin was noticed. One hundred and twenty-one patients received oral nutrition and 41 received parenteral nutrition in the postoperative period. There were more postoperative complications among patients without preoperative nutritional supplements (50% vs 28.1%; p = 0.019), and hospital stay was higher 14.64 ± 11.86 vs 9.36 ± 5.5; p < 0.005). There were more complications among patients without postoperative oral nutritional supplements (24% vs 18.2%; p < 0.005), with more wound infection (1.9% vs 0.8%) and leaks (1.9% vs 0.8%). They also had a higher average stay (9.15 4.6 vs 7.57 2.5 days; p = 0.021). Conclusion: in our study, patients that received oral nutritional supplements prior and following colorectal surgery had a lower rate of complications and a shorter hospital stay


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estado Nutricional/imunologia , Cirurgia Colorretal , Desnutrição/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Suplementos Nutricionais , Apoio Nutricional , Neoplasias Colorretais/cirurgia , Estudos Retrospectivos , Nutrição Parenteral/métodos , Soluções de Nutrição Parenteral , Desnutrição/imunologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA