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1.
Medicine (Baltimore) ; 98(41): e17533, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593128

RESUMO

BACKGROUND: With the improvements of surgical instruments and surgeons' experience, laparoscopic liver resection has been applied for recurrent tumors. However, the value of laparoscopic repeat liver resection (LRLR) is still controversial nowadays, which compelled us to conduct this meta-analysis to provide a comprehensive evidence about the efficacy of LRLR for recurrent liver cancer. METHODS: A computerized search was performed to identify all eligible trials published up to April 2019. This meta-analysis was conducted to estimate the perioperative data and oncological outcomes of LRLR by compared with open repeat liver resection (ORLR) and laparoscopic primary liver resection (LPLR). A fixed or random-effect modal was established to collect the data. RESULTS: A total of 1232 patients were included in this meta-analysis (LRLR: n = 364; ORLR: n = 396; LPLR: n = 472). LRLR did not increase the operative time compared to ORLR (WMD = 15.92 min; 95%CI: -33.53 to 65.37; P = .53). Conversely, LRLR for patients with recurrent tumors was associated with less intraoperative blood loss (WMD = -187.33 mL; 95%CI: -249.62 to -125.02; P < .00001), lower transfusion requirement (OR = 0.24; 95%CI: 0.06-1.03; P = .05), fewer major complications (OR = 0.42; 95%CI: 0.23-0.76; P = .004), and shorter hospital stays (WMD = -2.31; 95%CI: -3.55 to -1.07; P = .0003). In addition, the oncological outcomes were comparable between the two groups. However, as for the safety of LRLR compared with LPLR, although the operative time in LRLR group was longer than LPLR group (WMD = 58.63 min; 95%CI: 2.99-114.27; P = .04), the blood loss, transfusion rates, R0 resection, conversion, postoperative complications, and mortality were similar between the two groups. CONCLUSIONS: LRLR for recurrent liver cancer could be safe and feasible in selected patients when performed by experienced surgeons.


Assuntos
Laparoscopia/efeitos adversos , Neoplasias Hepáticas/cirurgia , Recidiva Local de Neoplasia/cirurgia , Reoperação/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/métodos , Hepatectomia/tendências , Humanos , Laparoscopia/métodos , Tempo de Internação/tendências , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Seleção de Pacientes , Período Perioperatório , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Reoperação/métodos , Resultado do Tratamento
2.
Khirurgiia (Mosk) ; (8. Vyp. 2): 54-59, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31502594

RESUMO

This article deal with method of multimodal, opioid-free anesthesia for colorectal surgery in the perioperative period. AIM: To improve the quality of treatment for patients with colorectal cancer using non-opioid anesthesia and analgesia in the perioperative period. MATERIAL AND METHODS: The study included 47 patients who underwent laparoscopic colon surgery. This anesthesia method consists of epidural anesthesia with sevoflurane during surgery end epidural analgesia after surgery. We describe the method of non-opioid anesthesia technics during colorectal surgery. The pain syndrome was evaluated at various time intervals. Harvard standard for monitoring during anesthesia is presented. RESULTS: Opioid-free anesthesia is safety method for colorectal surgery. It was also possible to reduce the incidence of postoperative nausea and vomiting, pain, intestinal paresis, the duration of hospitalization, and rise quality of medical care for patient with colorectal cancer.


Assuntos
Analgesia Epidural , Anestésicos Inalatórios/administração & dosagem , Colectomia/métodos , Neoplasias Colorretais/cirurgia , Sevoflurano/administração & dosagem , Humanos , Laparoscopia , Período Perioperatório , Resultado do Tratamento
3.
Einstein (Sao Paulo) ; 17(4): eAO4905, 2019 Sep 09.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31508661

RESUMO

OBJECTIVE: To compare analgesia and opioid consumption for patients undergoing primary total hip arthroplasty with preoperative posterior quadratus lumborum block with patients who did not receive quadratus lumborum block. METHODS: The medical records of patients undergoing unilateral total hip arthroplasty between January 1st, 2017 and March 31, 2018 were reviewed, and 238 patients were included in the study. The primary outcome was postoperative opioid consumption in the first 24 postoperative hours. Secondary outcomes were intraoperative, post anesthesia care unit, and 48-hour opioid consumption, postoperative pain Visual Analog Scale scores, and post-anesthesia care unit length of stay. Primary and secondary endpoint data were compared between patients undergoing primary total hip arthroplasty with preoperative posterior quadratus lumborum block with patients who did not receive quadratus lumborum block. RESULTS: For the patients who received quadratus lumborum block, the 24-hour total oral morphine equivalent (milligram) requirements were lower (53.82mg±37.41), compared to the patients who did not receive quadratus lumborum block (77.59mL±58.42), with p=0.0011. Opioid requirements were consistently lower for the patients who received quadratus lumborum block at each additional assessment time point up to 48 hours. Pain Visual Analog Scale scores were lower up to 12 hours after surgery for the patients who received a posterior quadratus lumborum block, and the post-anesthesia care unit length of stay was shorter for the patients who received quadratus lumborum block. CONCLUSION: Preoperative posterior quadratus lumborum block for primary total hip arthroplasty is associated with decreased opioid requirements up to 48 hours, decreased Visual Analog Scale pain scores up to 12 hours, and shorter post-anesthesia care unit length of stay. Level of evidence: III.


Assuntos
Analgésicos/uso terapêutico , Anestésicos Locais/uso terapêutico , Artroplastia de Quadril , Dor Pós-Operatória/tratamento farmacológico , Músculos Abdominais/inervação , Analgésicos/administração & dosagem , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Período de Recuperação da Anestesia , Anestesia Geral , Raquianestesia , Anestésicos Locais/administração & dosagem , Artroplastia de Quadril/efeitos adversos , Relação Dose-Resposta a Droga , Bloqueio Nervoso/métodos , Manejo da Dor , Dor Pós-Operatória/etiologia , Período Perioperatório/métodos , Estudos Retrospectivos , Fatores de Tempo
4.
Adv Exp Med Biol ; 1161: 27-35, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31562619

RESUMO

Surgery can be a life-saving procedure; however, significant complications may occur after routine procedures especially in older and more frail patients. Perioperative neurocognitive disorders (PNDs), including delirium and postoperative cognitive dysfunction, are the most common complications in older adults following common procedures such as orthopedic or cardiac surgery. The consequences of PNDs can be devastating, with longer in-hospital stay, poorer prognosis, and higher mortality rates. Inflammation is gaining considerable interest as a critical driver of cognitive deficits. In this regard, resolution of inflammation, once thought to be a passive process, may provide novel approaches to treat neuroinflammation and PNDs. Herein we review the role for impaired resolution after surgery and the growing role of specialized pro-resolving mediators (SPMs) in regulating postoperative neuroinflammation and neurological complications after surgery.


Assuntos
Mediadores da Inflamação , Transtornos Neurocognitivos , Complicações Pós-Operatórias , Humanos , Inflamação/fisiopatologia , Mediadores da Inflamação/metabolismo , Transtornos Neurocognitivos/fisiopatologia , Período Perioperatório , Complicações Pós-Operatórias/fisiopatologia
6.
Br J Anaesth ; 123(5): 570-583, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31547969

RESUMO

The systemic stress response triggered by surgical trauma is characterised by sterile inflammation preceding metabolic and neuroendocrine dysregulation. However, the relevance of the classically described 'stress response' is now highly questionable in an era where profound physiological deconditioning is common in older, frail surgical patients. Commonly used assessment techniques do not accurately reflect hypothalamic-pituitary-adrenal axis integrity after major surgery. Clinical interpretation of plasma concentrations of cortisol, the prototypical stress hormone, is rarely accurate, because of study heterogeneity, the inherently dynamic characteristics of cortisol production, and assay variability. Before surgery, chronic psychosocial stress and common cardiorespiratory co-morbidities are clinically relevant modifiers of neuroendocrine activation to acute stress/inflammation. The frequent development of multi-morbidity after major surgery further clouds the compartmentalised, discrete model of neuroendocrine activation after initial tissue injury. Starvation, impaired mobility, and sepsis after surgery generate distinct neuroendocrine profiles that challenge the conventional model of neuroendocrine activation. Basic science studies suggest that high circulating levels of cortisol may directly cause organ injury. Conversely, randomised controlled clinical trials investigating glucocorticoid supplementation have delivered contrasting results, with some suggesting a protective effect in the perioperative period. Here, we consider many of the confounding factors that have emerged to challenge the conventional model of the surgical stress response, and suggest that a more nuanced understanding of changes in hypothalamic-pituitary-adrenal axis physiology is warranted to advance perioperative medicine. Re-examining the perioperative stress response presents opportunities for improving outcomes through enhancing the understanding of the neuroendocrine aspects of preparation for and recovery from surgery.


Assuntos
Sistema Hipotálamo-Hipofisário/fisiopatologia , Sistemas Neurossecretores/fisiopatologia , Período Perioperatório , Sistema Hipófise-Suprarrenal/fisiopatologia , Estresse Fisiológico/fisiologia , Idoso , Humanos
8.
Lancet ; 394(10203): 1022-1029, 2019 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-31422895

RESUMO

BACKGROUND: In non-surgical settings, covert stroke is more common than overt stroke and is associated with cognitive decline. Although overt stroke occurs in less than 1% of adults after non-cardiac surgery and is associated with substantial morbidity, we know little about perioperative covert stroke. Therefore, our primary aim was to investigate the relationship between perioperative covert stroke (ie, an acute brain infarct detected on an MRI after non-cardiac surgery in a patient with no clinical stroke symptoms) and cognitive decline 1 year after surgery. METHODS: NeuroVISION was a prospective cohort study done in 12 academic centres in nine countries, in which we assessed patients aged 65 years or older who underwent inpatient, elective, non-cardiac surgery and had brain MRI after surgery. Two independent neuroradiology experts, masked to clinical data, assessed each MRI for acute brain infarction. Using multivariable regression, we explored the association between covert stroke and the primary outcome of cognitive decline, defined as a decrease of 2 points or more on the Montreal Cognitive Assessment from preoperative baseline to 1-year follow-up. Patients, health-care providers, and outcome adjudicators were masked to MRI results. FINDINGS: Between March 24, 2014, and July 21, 2017, of 1114 participants recruited to the study, 78 (7%; 95% CI 6-9) had a perioperative covert stroke. Among the patients who completed the 1-year follow-up, cognitive decline 1 year after surgery occurred in 29 (42%) of 69 participants who had a perioperative covert stroke and in 274 (29%) of 932 participants who did not have a perioperative covert stroke (adjusted odds ratio 1·98, 95% CI 1·22-3·20, absolute risk increase 13%; p=0·0055). Covert stroke was also associated with an increased risk of perioperative delirium (hazard ratio [HR] 2·24, 95% CI 1·06-4·73, absolute risk increase 6%; p=0·030) and overt stroke or transient ischaemic attack at 1-year follow-up (HR 4·13, 1·14-14·99, absolute risk increase 3%; p=0·019). INTERPRETATION: Perioperative covert stroke is associated with an increased risk of cognitive decline 1 year after non-cardiac surgery, and perioperative covert stroke occurred in one in 14 patients aged 65 years and older undergoing non-cardiac surgery. Research is needed to establish prevention and management strategies for perioperative covert stroke. FUNDING: Canadian Institutes of Health Research; The Ontario Strategy for Patient Oriented Research support unit; The Ontario Ministry of Health and Long-Term Care; Health and Medical Research Fund, Government of the Hong Kong Special Administrative Region, China; and The Neurological Foundation of New Zealand.


Assuntos
Disfunção Cognitiva/etiologia , Complicações Pós-Operatórias/etiologia , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Estudos de Casos e Controles , Disfunção Cognitiva/epidemiologia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Delírio do Despertar/epidemiologia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Período Perioperatório , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
9.
J Craniofac Surg ; 30(7): 2217-2223, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31469742

RESUMO

This study aimed to investigate the clinical efficacy of intracranial pressure (ICP) monitoring regarding the perioperative management of patients with severe traumatic brain injury (sTBI). This was a cohort study performed between Jan 2013 and Jan 2016 and included all patients with sTBI. All patients were split into ICP monitoring and non-ICP monitoring groups. The primary outcomes were in-hospital mortality and Glasgow Outcome Scale (GOS) scores 6 months after injury, whereas the secondary outcomes include rate of successful nonsurgical treatment, rate of decompression craniotomy (DC), the length of stay in the ICU, and the hospital and medical expenses. This retrospective analysis included 246 ICP monitoring sTBI patients and 695 without ICP monitoring sTBI patients. No significant difference between groups regarding patient demographics. All patients underwent a GOS assessment 6 months after surgery. Compared to the non-ICP monitoring group, a lower in-hospital mortality (20.3% vs 30.2%, P < 0.01) and better GOS scores after 6 months (3.3 ±â€Š1.6 vs 2.9 ±â€Š1.6, P < 0.05) with ICP monitoring. In addition, patients in the ICP monitoring group had a lower craniotomy rate (41.1% vs 50.9%, P < 0.01) and a lower DC rate (41.6% vs 55.9%, P < 0.05) than those in the non-ICP monitoring group. ICU length of stay (12.4 ±â€Š4.0 days vs 10.2 ±â€Š4.8 days, P < 0.01) was shorter in the non-ICP monitoring group, but it had no difference between 2 groups on total length of hospital stay (22.9 ±â€Š13.6 days vs 24.6 ±â€Š13.6 days, P = 0.108); Furthermore, the medical expenses were significantly higher in the non-ICP monitoring group than the ICP monitoring group (11.5 ±â€Š7.2 vs 13.3 ±â€Š9.1, P < 0.01). Intracranial pressure monitoring has beneficial effects for sTBI during the perioperative period. It can reduce the in-hospital mortality and DC rate and also can improve the 6-month outcomes. However, this was a single institution and observational study, well-designed, multicenter, randomized control trials are needed to evaluate the effects of ICP monitoring for perioperative sTBI patients.


Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Pressão Intracraniana , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas Traumáticas/cirurgia , Criança , Craniectomia Descompressiva , Feminino , Escala de Resultado de Glasgow , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Período Perioperatório , Estudos Retrospectivos , Adulto Jovem
10.
J Cardiothorac Surg ; 14(1): 152, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31439013

RESUMO

BACKGROUND: Pericardiectomy is the final treatment for constrictive pericarditis. However, this greatest surgical approach is still very controversial. This study pursued to assess the outcomes in patients with recurrent chronic constrictive pericarditis undergoing reoperated pericardiectomy via median sternotomy versus left anterolateral thoracotomy and to explain which surgical approaches might be better for recurrent chronic constrictive pericarditis. METHODS: A total of 24 patients were identified with recurrent chronic constrictive pericarditis and underwent reoperation with pericardiectomy between July 2003 and July 2015. The decision for this surgical approach was mainly dependent on the operating surgeon's preference. Out of 20 patients, 16 patients underwent pericardiectomy via median sternotomy and 8 patients via left anterolateral thoracotomy pericardiectomy. Their data were obtained retrospectively from the case notes. RESULTS: Both groups of patients were similar in age, gender between two operations, and also in peripheral venous pressure, cardiac rhythm and New York Heart Association (NYHA) class distribution. The mortality rates were similar in both groups with one death (12.5%) due to low cardiac output syndrome in the left anterolateral thoracotomy group and two deaths (12.5%) in the median sternotomy group. All the deaths were associated with cardiac complications and happened in the perioperative period. NYHA functional class status enhanced in most of the patients. Patients in both groups had a similar and significant improvement in their NYHA status that improved from 3.4 ± 0.7 to 1.8 ± 0.1 (P = 0.001) in the left anterolateral thoracotomy group and reduced from 3.3 ± 0.6 to 1.9 ± 0.4 (P = 0.001) in the median sternotomy group. There was a significantly greater rate of pulmonary infection in the thoracotomy group than in the median sternotomy group (50% versus 25%, P = 0.02). Nevertheless, there was a significantly greater occurrence of wound infections in the median sternotomy group in 3 patients versus in one patient of the left anterolateral thoracotomy group (18.8% versus 12.5%, P = 0.02). CONCLUSIONS: Left thoracotomy incision was preferred to sternotomy in the current setting of this situation and was done safely without CPB. It avoided life-threatening sternal infection and it also has showed an equal as well las significant enhancement of NYHA status of the patients.


Assuntos
Pericardiectomia/métodos , Pericardite Constritiva/cirurgia , Reoperação , Esternotomia/métodos , Toracotomia/métodos , Adolescente , Adulto , Baixo Débito Cardíaco/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pericardiectomia/efeitos adversos , Pericardiectomia/mortalidade , Pericardite Constritiva/mortalidade , Pericardite Constritiva/fisiopatologia , Período Perioperatório , Pneumonia/etiologia , Recidiva , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologia , Adulto Jovem
11.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(7): 801-810, 2019 07.
Artigo em Chinês | MEDLINE | ID: mdl-31441400

RESUMO

OBJECTIVE: Adult patients who underwent cardiac surgery usually need nutrition support therapy because of malnutrition or nutrition risk. There are quite a few studies about nutrition support therapy for patients in perioperative period of surgery after cardiopulmonary bypass, and also different opinions about how to normalize nutrition support therapy and improve prognosis in academic circles at present. Consequently, according to the experience of nutrition support therapy in critical patient and combining the trait of cardiac surgery, Chinese consensus guideline for nutrition support therapy in the perioperative period of adult cardiac surgery in 2019 is formulated by Cardiac Critical Care Medicine of China Internationgnal Exchange and Promotion for Medical and Healthcare and Nutrition Support Expert Committee of Chinese Cardiac Critical Care Medicine to provide proper suggestions. The content of consensus is included with screening nutrition risk, the timing of starting nutrition support, the utilization of enteral nutrition and parenteral nutrition, and pharmaceutical nutrition, etc.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Apoio Nutricional , Adulto , China , Humanos , Nutrição Parenteral , Período Perioperatório
12.
Medicine (Baltimore) ; 98(35): e16626, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464899

RESUMO

Gastric cancer (GC) is one of the common malignant tumors in China, with a high morbidity and mortality. With the development and application of high-throughput sequencing technologies and metagenomics, a great quantity of studies have shown that gastrointestinal microbiota is closely related to digestive system diseases. Although some studies have reported the effect of long-term follow-up after subtotal gastrectomy on intestinal flora changes in patients with GC. However, the features of gut microbiota and their shifts in patients with GC in perioperative period remain unclear.This study was designed to characterize fecal microbiota shifts of the patients with GC before and after the radical distal gastrectomy (RDG) during their hospital staying periods. Furthermore, fecal microbiota was also compared between the GC patients and healthy individuals.Patients who were diagnosed with advanced gastric adenocarcinoma at distal stomach were enrolled in the study. The bacterial burden within fecal samples was determined using quantitative polymerase chain reaction. To analyze the diversity and composition of gut microbiota from fecal DNA of 20 GC patients and 22 healthy controls, amplicons of the 16S rRNA gene from all subjects were pyrosequenced. To study gut microbiota shifts, the fecal microbiota from 6 GC patients before and after RDG was detected and subsequently analyzed. Short-chain fatty acids were also detected by chromatography spectrometer in these 6 GC patients.RDG had a moderate effect on bacterial richness and evenness, but had pronounced effects on the composition of postoperative gut microbiota compared with preoperative group. The relative abundances of genera Akkermansia, Esherichia/Shigella, Lactobacillus, and Dialister were significant changed in perioperative period. Remarkably, higher abundances of Escherichia/Shigella, Veillonella, and Clostridium XVIII and lower abundances of Bacteroides were observed in gut microbiota of overall GC patients compared to healthy controls.This study is the first study to characterize the altered gut microbiota within fecal samples from GC patients during perioperative period, and provide a new insights on such microbial perturbations as a potential effector of perioperative period phenotype. Further research must validate these discoveries and may evaluate targeted microbiota shifts to improve outcomes in GC patients.


Assuntos
Bactérias/classificação , RNA Ribossômico 16S/genética , Análise de Sequência de DNA/métodos , Neoplasias Gástricas/cirurgia , Adulto , Bactérias/genética , Bactérias/isolamento & purificação , China , DNA Bacteriano/genética , DNA Ribossômico/genética , Feminino , Gastrectomia , Microbioma Gastrointestinal , Humanos , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Filogenia , Neoplasias Gástricas/microbiologia
13.
Medicine (Baltimore) ; 98(34): e16929, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441880

RESUMO

To examine the characteristics and short-term outcome of perioperative myocardial infarction (PMI), a single-center retrospective study was carried out. The electronic medical records of 278,939 patients aged 45 years or older who underwent non-cardiac surgery at Renji Hospital from January 2003 to December 2015 were screened based on diagnostic codes (ICD121, ICD121.0, ICD121.1, ICD121.2, ICD121.3, ICD121.4, or ICD121.9). The incidence and characteristics of PMI and mortality risk factors were analyzed after non-cardiac surgery. PMI was reported in 45 patients, with an incidence rate of 1.61 per 10,000 and a mortality rate of 75.6% (34/45). The PMI incidence rate increased significantly with age. The PMI incidence rate was the highest for vascular surgery (5.82 per 10,000 cases). PMI occurs mainly within 48 h of surgery, with most cases showing an onset in the general wards. Logistic analysis showed that the use of nitrates is the independent protective factor for the outcomes of patients with PMI. The incidence of PMI in non-cardiac surgery is approximately 2 of 10,000 in patients aged 45 years or older, and increased significantly with age. The use of nitrates might be helpful for their survival.


Assuntos
Infarto do Miocárdio/mortalidade , Período Perioperatório/mortalidade , Complicações Pós-Operatórias/mortalidade , Idoso , China , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/prevenção & controle , Nitratos/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
14.
Kyobu Geka ; 72(8): 599-603, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31353352

RESUMO

FreeStyle Libre (flash glucose monitoring) is useful to control the blood sugar levels of outpatients with diabetes. We used FreeStyle Libre for a patient with type 1 diabetes mellitus during the perioperative period of cardiac surgery except during and just after surgery. We adjusted the insulin amount according to the glucose level of the device before surgery and prevented prolonged hypoglycemia. After surgery, we could also adjust the blood sugar levels using the device until discharge. All data were within zones A and B of the Clarke error grid analysis when referred to as arterial blood sugar levels in the intensive care unit. In the general ward after surgery, 95% of the data referred to as venous blood sugar levels were within zones A and B. FreeStyle Libre was useful for adjusting the amount of insulin for a patient with type 1 diabetes mellitus during the perioperative period of cardiac surgery in the ward and also might be useful for decreasing the frequency of arterial blood collection in the intensive care unit.


Assuntos
Diabetes Mellitus Tipo 1 , Hipoglicemia , Glicemia , Automonitorização da Glicemia , Humanos , Assistência Perioperatória , Período Perioperatório
15.
Cancer Immunol Immunother ; 68(8): 1341-1350, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31324947

RESUMO

Gastric cancer (GC) is the most common malignant tumor in digestive organs, and the prognosis of GC patients who have undergone surgery remains poor because of frequent recurrence. Therefore, the identification of new markers to predict the outcome of these patients is needed. Monocyte count is a negative prognostic factor associated with inflammation. We investigated the relationship between peripheral monocytes in the peri-operative period and prognosis in GC patients. A high pre-operative monocyte count was identified as a prognostic factor in a retrospective analysis of 278 stage II and III GC patients who underwent curative gastrectomy. In contrast, an increased post-operative monocyte count compared to the pre-operative monocyte count was a marker of poor prognosis, particularly for early relapse. In a prospective analysis of 75 GC patients, a subset of the increased post-operative monocytes was similar to CD14+ HLA-DR- CD11b+ CD33+ cells by flow cytometry, and these monocytes produced IDO and arginase and suppressed T cell functions; therefore, we classified these cells as monocytic myeloid-derived suppressive cells (M-MDSCs). Peri-operative neutrophils and C-reactive protein (CRP), which are also related to inflammation, did not affect the prognosis of GC patients, and a neutrophil immunosuppressive function was not observed. These results suggest that peripheral monocytes in the peri-operative period in GC patients are a useful marker for the prognosis of GC patients, and a subset of increased post-operative monocytes may be characterized as M-MDSCs.


Assuntos
Biomarcadores Tumorais , Contagem de Células/métodos , Monócitos/patologia , Células Supressoras Mieloides/patologia , Neoplasias Gástricas/diagnóstico , Idoso , Células Cultivadas , Feminino , Citometria de Fluxo , Gastrectomia , Humanos , Masculino , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Período Perioperatório , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/imunologia , Neoplasias Gástricas/mortalidade , Análise de Sobrevida
16.
Rev Lat Am Enfermagem ; 27: e3143, 2019 Jul 18.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31340340

RESUMO

OBJECTIVE: to develop, evaluate and correlate the acceptability of an educational mobile application to patients submitted to orthognathic surgery. METHOD: methodological study based on systematic instructional design with contents aimed at patient learning through a mobile application. Usability and user satisfaction were evaluated by 30 patients in the perioperative stage through an electronic questionnaire sent by social networks, e-mail and business card, measured using the System Usability Scale instrument validated in Portuguese and user satisfaction with an instrument based on another study, after its applications. Data were analyzed with descriptive statistics and Spearman correlation. RESULTS: the application named "OrtogApp" features content validated in a previous study included five learning content sessions essential for managing perioperative care, and it is available on IOS and Android platforms. Usability corresponded to 79.8 + 15.4 points and the satisfaction index was 82.9%; correlation of age, schooling and uses of the application with the instruments was not significant. CONCLUSION: OrtogApp is an educational application with content validated by professionals, resulting in high user satisfaction and good usability. Patients may use the application as supportive educational material to supplement guidance provided by perioperative nurses and/or surgeons during perioperative care.


Assuntos
Aplicativos Móveis , Cirurgia Ortognática , Período Perioperatório/educação , Cuidados Pós-Operatórios/educação , Adulto , Brasil , Telefone Celular/instrumentação , Comportamento do Consumidor , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Autocuidado/métodos , Inquéritos e Questionários , Telemedicina/métodos , Adulto Jovem
17.
J Craniofac Surg ; 30(7): 2018-2022, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31261324

RESUMO

PURPOSE: The Pediatric Craniofacial Collaborative Group recently reported pooled perioperative data from 31 North American centers performing open cranial vault remodeling procedures. The authors sought to determine if outcomes were different at a single higher-volume center and if identified, ascertain reasons for any differences and propose strategies for improvement. METHODS: A retrospective review was performed of all open pediatric cranial vault procedures performed at our center during the identical 3.25-year period reported by the Collaborative group, including demographic, perioperative management and outcome data, to permit multiple comparative analyses. RESULTS: The 310 procedures were performed by our center during this time period, compared to 1223 by the combined 31 institutions (median: 29.5 cases/center; interquartile range: 12-54.5). Multiple outcome differences were found: our higher-volume center had a significantly lower overall red blood cell transfusion rate (≤2 years: 7.5 percent vs 91 percent, P <0.001), those requiring transfusions were transfused considerably smaller volumes (≤2 years: 3.8mL/kg vs 45.3 mL/kg, P <0.001), and exposure to ≥3 blood donors was significantly less (none vs 20 percent, P <0.001). There were no mortalities in either group, but almost all matched adverse events were less common at our center. Both the intensive care unit and hospital lengths of stay were significantly shorter at our center (1 vs 2 days, 2 vs 4 days, both P <0.001). CONCLUSIONS: Perioperative outcomes following pediatric craniosynostosis corrections performed at a single higher-volume center compare favorably to median national data. Multiple potential strategies to reduce blood utilization, minimize perioperative complications, and shorten hospitalizations are proposed.


Assuntos
Craniossinostoses/cirurgia , Transfusão de Sangue , Criança , Humanos , Período Perioperatório , Estudos Retrospectivos , Crânio/cirurgia , Resultado do Tratamento
18.
JAMA ; 322(1): 82, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31265093
19.
JAMA ; 322(1): 82-83, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31265096
20.
Schmerz ; 33(4): 287-294, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31342162

RESUMO

BACKGROUND: Dipyrone (metamizole) is widely used for perioperative pain management in countries where it is marketed; however, uncertainty exists concerning the safe use of this drug, specifically considering the rare adverse event of an agranulocytosis. METHODS: As evidence from published studies was lacking, an expert panel developed recommendations for the perioperative use of dipyrone. After a formal, structured consensus process, the recommendations were approved by the involved medical societies. RESULTS: The panel agreed that blood cell counts shall not be standard for short-term perioperative use in patients unless they are at risk for neutropenia. The medical staff shall be aware of the symptoms and course of action when agranulocytosis is suspected. Patients shall be informed about the risks and benefits of dipyrone and about potential alternatives. The expert group concluded that dipyrone has a relatively positive risk-benefit ratio compared to other nonopioid analgesics. The group strongly recommended educating patients about the symptoms of agranulocytosis if they have received dipyrone over several days and/or treatment is to be continued after discharge, because agranulocytosis can occur several days after discontinuation of metamizole. Further recommendations refer to the information of the physician taking over the patient's care after discharge and the avoidance of re-exposure in patients having previously suffered from dipyrone-induced agranulocytosis. CONCLUSION: The group's recommendations shall be communicated in order to raise medical staff's and patients' awareness of the appropriate use of dipyrone in the perioperative period.


Assuntos
Agranulocitose , Dipirona , Dor Aguda/tratamento farmacológico , Dor Aguda/prevenção & controle , Agranulocitose/induzido quimicamente , Agranulocitose/prevenção & controle , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Anestesiologia/normas , Associação , Cuidados Críticos , Dipirona/administração & dosagem , Dipirona/efeitos adversos , Humanos , Período Perioperatório
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