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1.
BMJ Case Rep ; 14(9)2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493561

RESUMO

Methaemoglobin is a form of haemoglobin with oxidised ferric (+3) iron rather than ferrous (+2) iron, which causes a leftward shift in the oxyhaemoglobin dissociation curve and prevents oxygen delivery. Anaesthesiologists need to be familiar with this differential diagnosis for hypoxia given the use of drugs in the perioperative setting known to induce methaemoglobinaemia, including benzocaine and lidocaine, antibiotics such as dapsone and anaesthetic gases, including nitric oxide. This case report details an interesting case of symptomatic methaemoglobinaemia in the perioperative period in the setting of dapsone use and an erector spinae block performed with ropivacaine.


Assuntos
Metemoglobinemia , Benzocaína , Dapsona/uso terapêutico , Humanos , Metemoglobina , Metemoglobinemia/induzido quimicamente , Metemoglobinemia/diagnóstico , Período Perioperatório
2.
Medicine (Baltimore) ; 100(32): e26890, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397911

RESUMO

ABSTRACT: Studies on perioperative cardiac arrest in Chinese hospitals have rarely been retrieved from international journals. This survey evaluated the incidence, causes, and outcomes of perioperative cardiac arrests in a Chinese tertiary general hospital between July 2013 and December 2020. The incidence of cardiac arrest within 24 hours of anesthesia administration was retrospectively identified using an anesthesia database in Liaocheng People's Hospital. During the study period, there were 118,152 anesthetics. Data collected included patient characteristics, surgical procedures (elective or emergency), American Society of Anesthesiologists (ASA) physical status score, type of surgery, anesthesia technique, and outcome. Cardiac arrests were grouped into one of 3 groups: totally anesthesia-related, partially anesthesia-related, or anesthesia-unrelated. In total, 41 cardiac arrests (3.5:10,000) and 26 deaths (2.2:10,000) were found. Major risk factors for cardiac arrest were children under 1 year, adults between 19 and 65 years, and the elderly (>80 years) (P < .001), male patients (P = .02), emergency surgery (P < .001), and ASA grade V patients without anesthesia (P = .009). There were 19 anesthesia-related cardiac arrests (1.6:10,000) - 2 were totally related, and 17 were partially related to anesthesia. There were 9 anesthesia-related deaths (0.8:10,000), all of which were partially related to anesthesia. Perioperative cardiac arrests were correlated with age, gender, ASA grade and surgical procedures. The 2 most important patient factors leading to cardiac arrest were hemorrhagic shock from trauma and septic shock, respectively.


Assuntos
Parada Cardíaca/epidemiologia , Medição de Risco/métodos , Procedimentos Cirúrgicos Operatórios , Centros de Atenção Terciária/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China/epidemiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
3.
AANA J ; 89(4): 319-324, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34342569

RESUMO

Anesthesia providers are regularly responsible for assessing, diagnosing, and determining pharmacologic treatment of a problem. This critical workflow often includes medication preparation. Decision making in anesthesia frequently requires rapid intervention, and caring for the pediatric population poses additional challenges, such as needing to quickly calculate the weight-based dosing of medications. The objective of this review article was to identify and describe themes related to pediatric medication errors associated with anesthesia. Additional goals of the review consisted of identifying and comparing various error reduction strategies with a primary goal of communicating the most effective methods to reduce medication errors in the pediatric population. Screening criteria were set, and 17 published scholarly articles meeting inclusion criteria were evaluated using a systematic process. Common themes found leading to medication errors were incorrect dosing, incorrect medication, syringe swap, wrong patient, and wrong dosing interval. The most valuable and sustainable error reduction strategies found were standardized labeling, prefilled syringes, and 2-person medication checks. It is believed that this review will expound on the factors that can be controlled or minimized to decrease the incidence of anesthesia-related pediatric medication errors and facilitate implementation of risk mitigation strategies immediately into clinical practice.


Assuntos
Anestesia/normas , Relação Dose-Resposta a Droga , Erros de Medicação/prevenção & controle , Erros de Medicação/estatística & dados numéricos , Pediatria/normas , Período Perioperatório/normas , Guias de Prática Clínica como Assunto , Adolescente , Anestesia/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Período Perioperatório/estatística & dados numéricos , Estados Unidos
4.
Medicine (Baltimore) ; 100(31): e26736, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397814

RESUMO

BACKGROUND: To explore the effects of psychological nursing on improving the mental health status of young patients with lung cancer surgery during the perioperative period. METHODS: seventy-eight young patients (From February 2018 to February 2019) underwent lung cancer operation were selected. All these patients were randomly allocated to intervention group and control group. The patients in the control group were treated with general routine care. The patients in the intervention group were treated with a comprehensive and systematic family participation psychological nursing. The mental health status of the patients in the 2 groups were compared and analyzed. RESULTS: The self-rating anxiety scale scores and self-rating depression scale scores of patients were significantly reduced in the intervention group compared with the control group (P < .05). The scores of somatization, obsessive symptoms, interpersonal relationship, depression, anxiety, hostile, phobic neurosis, stubborn, paranoia and psychosis were also significantly reduced in the intervention group compared with the control group (P < .05). CONCLUSION: the comprehensive and systematic psychological nursing intervention improved the mental health status of young patients with lung cancer surgery during the perioperative period.


Assuntos
Neoplasias Pulmonares/cirurgia , Saúde Mental/normas , Período Perioperatório/enfermagem , Adulto , Feminino , Humanos , Neoplasias Pulmonares/psicologia , Masculino , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Relações Enfermeiro-Paciente , Período Perioperatório/estatística & dados numéricos , Inquéritos e Questionários
5.
Medicine (Baltimore) ; 100(31): e26807, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397837

RESUMO

ABSTRACT: Several studies have demonstrated that the dynamic factor at the mobile segment affects the severity of myelopathy in patients with cervical ossification of the posterior longitudinal ligament (C-OPLL), and posterior decompression supplemented with posterior instrumented fusion at the mobile segment provides good neurological improvement. However, there have been few reports of changes in range of motion at the mobile segment (segmental ROM) after laminoplasty (LP). The aim of this study was thus to retrospectively investigate changes in segmental ROM after LP and the impacts of these changes on neurological improvement in patients with C-OPLL.A total of 51 consecutive patients who underwent LP for C-OPLL since May 2010 and were followed for at least 2 years after surgery were included in this study. Neurological status was assessed using the Japanese Orthopaedic Association (JOA) score before surgery and at 2-year follow-up. Segmental ROM at the responsible level for myelopathy was measured preoperatively and at 2-year follow-up using lateral flexion-extension radiographs of the cervical spine.The mean JOA score improved significantly from 10.7 points preoperatively to 13.5 points at 2 years after surgery (mean recovery rate, 45.0%). The mean segmental ROM decreased significantly from 6.5 degrees before surgery to 3.2 degrees at 2 years after surgery. In the good clinical outcome group (recovery rate of the JOA score ≥50%; n = 22), the mean segmental ROM decreased significantly from 5.8 degrees preoperatively to 3.0 degrees postoperatively. It also decreased significantly from 7.1 degrees to 3.4 degrees in the poor clinical outcome group (recovery rate of the JOA score <50%; n = 29).This study showed that segmental ROM was stabilized after LP in most patients with C-OPLL. Neither preoperative nor postoperative segmental ROM showed significant differences between the good and poor clinical outcome groups and neither a postoperative increase nor decrease of segmental ROM significantly affected the recovery rate of the JOA score.


Assuntos
Vértebras Cervicais , Laminoplastia , Exame Neurológico , Ossificação do Ligamento Longitudinal Posterior , Amplitude de Movimento Articular , Fusão Vertebral , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/fisiopatologia , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/métodos , Feminino , Humanos , Japão/epidemiologia , Laminoplastia/efeitos adversos , Laminoplastia/métodos , Imageamento por Ressonância Magnética/métodos , Masculino , Exame Neurológico/métodos , Exame Neurológico/estatística & dados numéricos , Ossificação do Ligamento Longitudinal Posterior/diagnóstico , Ossificação do Ligamento Longitudinal Posterior/fisiopatologia , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Avaliação de Resultados em Cuidados de Saúde/métodos , Período Perioperatório/métodos , Período Perioperatório/estatística & dados numéricos , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
6.
Medicine (Baltimore) ; 100(34): e27045, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34449490

RESUMO

BACKGROUND: Laryngeal microsurgery (LMS) causes hemodynamic instability and postoperative agitation, cough, pain, nausea, and vomiting. Moreover, because of a short operation time, it is associated with challenging anesthetic management. The aim of this study was to compare the usefulness of continuous administration of dexmedetomidine and remifentanil in inducing general anesthesia in patients undergoing LMS. METHODS: This is a prospective randomized control design. Continuous intravenous infusion of dexmedetomidine (group D) or remifentanil (group R) was administered from 10 minutes before the induction of anesthesia to the end of surgery. In both groups, 1.5 mg/kg propofol and 0.5 mg/kg rocuronium were administered for the induction of anesthesia, and desflurane were titrated during the measurement of the bispectral index. We recorded hemodynamic data, recovery time, grade of cough, pain score, and analgesic requirements during the perioperative period. RESULTS: 61 patients were finally analyzed (30 for group D, 31 for group R). The incidence of moderate to severe postoperative sore throat was higher in group R than in group D (42% vs 10%, P = .008), and the quantity of rescue fentanyl used in post-anesthesia care unit was significantly higher in group R than in group D (23.2 ±â€Š24.7 mg vs 3.3 ±â€Š8.6 mg; P < .001); however, the time required for eye opening was significantly longer in group D than in group R (599.4 ±â€Š177.9 seconds vs 493.5 ±â€Š103.6 seconds; P = .006). The proportion of patients with no cough or single cough during extubation was comparable between the 2 groups (group D vs group R: 73% vs 70%) as was the incidence of hemodynamic instability. CONCLUSION: Although there was a transient delay in emergence time, dexmedetomidine reduced postoperative opioid use and the incidence of sore throat. Dexmedetomidine may be used as an alternative agent to opioids in patients undergoing LMS.


Assuntos
Dexmedetomidina/uso terapêutico , Hemodinâmica/efeitos dos fármacos , Hipnóticos e Sedativos/uso terapêutico , Laringe/cirurgia , Remifentanil/uso terapêutico , Adulto , Idoso , Analgésicos Opioides/administração & dosagem , Período de Recuperação da Anestesia , Tosse/etiologia , Feminino , Humanos , Masculino , Microcirurgia , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/prevenção & controle , Período Perioperatório , Estudos Prospectivos , Índice de Gravidade de Doença , Adulto Jovem
7.
Clin J Pain ; 37(9): 688-697, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34265790

RESUMO

OBJECTIVES: Pain catastrophizing in children and adolescents has been associated to unfavorable postsurgical outcomes. However, pain catastrophizing is rarely measured throughout the perioperative period. Using a prospective longitudinal approach, the present study aimed to identify how pain catastrophizing changes over the perioperative period in pediatric surgical patients with adolescent idiopathic scoliosis. MATERIALS AND METHODS: Adolescent patients undergoing spinal fusion surgery completed the Pain Catastrophizing Scale for Children and additional questionnaires to assess pain intensity, state and trait anxiety, and kinesiophobia before surgery, and 1, 2, 5 days, 6 weeks, and 6 months after surgery. RESULTS: Patients who had higher levels of pain catastrophizing before surgery were more likely to be anxious, avoid activity that may cause pain, report higher pain intensity before surgery and anticipate more pain after surgery. Low pain catastrophizers increased into a moderate level of pain catastrophizing before decreasing after discharge from the hospital. Meanwhile, moderate and high pain catastrophizers both decreased into lower and moderate levels of catastrophizing, respectively, after discharge from the hospital. DISCUSSION: These findings demonstrate that pain catastrophizing in adolescents changes over the perioperative period. Observing changes in pain catastrophizing throughout the perioperative period may help in recognizing when patients are most vulnerable during this time. Decreasing pain catastrophizing before surgery or in the acute postoperative period through therapies that target pain catastrophizing may help reduce the patient's likelihood of experiencing unfavorable postoperative outcomes.


Assuntos
Catastrofização , Escoliose , Adolescente , Criança , Humanos , Dor Pós-Operatória , Período Perioperatório , Estudos Prospectivos , Escoliose/cirurgia
8.
Anticancer Res ; 41(8): 3875-3884, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34281849

RESUMO

BACKGROUND/AIM: An excessive postoperative inflammatory response is correlated with the development of pneumonia and an unfavourable prognosis in patients undergoing esophagectomy for esophageal cancer. We assessed the influence of OSK-0028, a synthetic human ghrelin on inflammatory response and energy metabolism, on the postoperative course of patients following radical esophagectomy. PATIENTS AND METHODS: Esophageal cancer patients were randomly assigned to low-dose (LD; 0.25 µg/kg/h) or high-dose (HD; 0.5 µg/kg/h) intravenous OSK-0028 or placebo for 7 days after esophagectomy. The primary endpoint was serum interleukin-6 level on postoperative day (POD) 3. RESULTS: A total of 75 patients were enrolled (23 LD, 26 HD, 26 placebo). The median interleukin-6 levels on POD 3 were 40.95, 35.85, and 64.50 pg/ml in the placebo, LD, and HD groups, respectively, with no significant differences (p=0.78). Postoperative complications did not differ between groups. Bodyweight loss was significantly lower in patients receiving OSK-0028 than in those receiving placebo (-0.17% vs. 1.78%, p=0.043). CONCLUSION: Although OSK-0028 did not attenuate inflammatory response after esophagectomy, it prevented postoperative bodyweight loss.


Assuntos
Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/cirurgia , Esofagectomia , Grelina/uso terapêutico , Administração Intravenosa , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Neoplasias Esofágicas/sangue , Feminino , Grelina/efeitos adversos , Humanos , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Resultado do Tratamento , Perda de Peso/efeitos dos fármacos
9.
Int J Mol Sci ; 22(13)2021 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-34281253

RESUMO

Radical cystectomy is the primary treatment for muscle-invasive bladder cancer; however, approximately 50% of patients develop metastatic disease within 2 years of diagnosis, which results in dismal prognosis. Therefore, systemic treatment is important to improve the prognosis of muscle-invasive bladder cancer. Currently, several guidelines recommend cisplatin-based neoadjuvant chemotherapy before radical cystectomy, and adjuvant chemotherapy is recommended in patients who have not received neoadjuvant chemotherapy. Immune checkpoint inhibitors have recently become the standard treatment option for metastatic urothelial carcinoma. Owing to their clinical benefits, several immune checkpoint inhibitors, with or without other agents (including other immunotherapy, cytotoxic chemotherapy, and emerging agents such as antibody drug conjugates), are being extensively investigated in perioperative settings. Several studies for perioperative immunotherapy have shown that immune checkpoint inhibitors have promising efficacy with relatively low toxicity, and have explored the predictive molecular biomarkers. Herein, we review the current evidence and discuss the future perspectives of perioperative systemic treatment for muscle-invasive bladder cancer.


Assuntos
Neoplasias da Bexiga Urinária/terapia , Quimioterapia Adjuvante/métodos , Quimioterapia Adjuvante/tendências , Cisplatino/uso terapêutico , Cistectomia , Humanos , Imunoterapia/métodos , Imunoterapia/tendências , Terapia Neoadjuvante/métodos , Terapia Neoadjuvante/tendências , Invasividade Neoplásica/patologia , Assistência Perioperatória/métodos , Assistência Perioperatória/tendências , Período Perioperatório , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia
10.
Clin Interv Aging ; 16: 1201-1213, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34211269

RESUMO

Background: Inappropriate perioperative medications among elderly patients increase the risk of adverse events and undermine surgical outcomes. This study aimed to assess the prevalence of high-risk medications in elderly surgical patients and verify the effectiveness of a new-developed high-risk perioperative medications (HRPOMs) list for the elderly. Methods: A cross-sectional, single-center study was conducted at Jinshan Hospital of Fudan University. A total of 810 elderly surgical patients were included in the study. The HRPOMs list was applied to patients' data to identify the HRPOMs including chronic medications and medications related to surgery. Results: A total of 2113 HRPOMs were identified in 810 patients who fulfilled the inclusion criteria. Of these, 1067 (50.5%) involved medications related to surgery, and 982 (46.5%) involved chronic medications. The prevalence of HRPOM exposure, which was defined as at least one HRPOM was 76.3%. Patients that were 70 years or older (adjusted odds ratio [AOR] =2.118, 95% confidence interval [CI], 1.420~3.159), hospitalized over two weeks (AOR =4.192, 95% CI, 1.493~11.771), with more than 2 distinct diagnoses (AOR =3.407, 95% CI, 2.224~5.220) and with 16 or more medications during hospitalization were more likely to be exposed to HRPOMs. Patients who underwent surgeries of Grade IV were at 1.73 increased odds of HRPOM exposure compared with those who received surgeries of Grade III or lower (P=0.071). Conclusion: HRPOMs are more common in patients of 70 years or older, with 3 or more distinct diagnoses, with 16 or more medications and hospitalized for 15 days or longer. Our study showed the validity of the HRPOMs list in the perioperative medication review for the elderly and may induce further research to reveal the impact of HRPOMs upon the surgical outcomes of the elderly.


Assuntos
Hospitalização/estatística & dados numéricos , Prescrição Inadequada/estatística & dados numéricos , Período Perioperatório/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , China , Estudos Transversais , Feminino , Humanos , Tempo de Internação , Masculino , Polimedicação , Prevalência , Índice de Gravidade de Doença
11.
Anesth Analg ; 133(2): 393-405, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34081049

RESUMO

While intraoperative mortality has diminished greatly over the last several decades, the risk of death within 30 days of surgery remains stubbornly high and is ultimately related to perioperative organ failure. Perioperative strokes, while rare (<2% in noncardiac surgery), are associated with a more than 10-fold increase in mortality. Rapid identification and treatment are key to maximizing long-term outcomes. Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are separate but related perioperative neurological disorders, both of which are associated with poor long-term outcomes. To date, there are few known interventions that can ameliorate the risk of perioperative central nervous system dysfunction. Major adverse cardiac events (MACE) are a major contributor to adverse clinical outcomes following surgical procedures. Recently, advances in diagnostic strategies (eg, high-sensitivity cardiac troponin [hs-cTn] assays) have improved our understanding of MACE. Recently, the dabigatran in patients with myocardial injury after noncardiac surgery (MINS; Management of myocardial injury After NoncArdiac surGEry) trial demonstrated that a direct thrombin inhibitor could improve outcomes following MINS. While the risk of acute respiratory distress syndrome (ARDS) after surgery is approximately 0.2%, other less severe complications (eg, pneumonia, reintubation) are closer to 2%. While intensive care unit (ICU) concepts related to ARDS have migrated into the operating room, whether or not adverse pulmonary outcomes impact long-term outcomes in surgical patients remains a matter of debate. The standardization of acute kidney injury (AKI) definition has improved the ability of clinicians to measure and study the incidence of this important source of perioperative morbidity. AKI is associated with increased mortality as well as nonrenal morbidity (eg, myocardial infarction) after major surgery. Gastrointestinal complications after surgery range from ileus (common in abdominal procedures and associated with an increased length of stay) to less common complications such as mesenteric ischemia and gastrointestinal bleeding, both of which are associated with very high mortality. Outside of cardiothoracic surgery, the incidence of perioperative hepatic injury is not well described but, in this population, is associated with worsened long-term outcomes. Hyperglycemia is a common perioperative complication and occurs in patients undergoing both cardiac and noncardiac surgery. Both hyper- and hypoglycemia are associated with worsened long-term outcomes in cardiac and noncardiac surgery. Better diagnosis and increased understanding of perioperative organ injury has led to an increased appreciation for the specific role that particular organ systems play in poor long-term outcomes and has set the stage for targeted therapeutic interventions.


Assuntos
Período Perioperatório , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Mortalidade Hospitalar , Humanos , Incidência , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/fisiopatologia , Medição de Risco , Fatores de Risco , Procedimentos Cirúrgicos Operatórios/mortalidade , Fatores de Tempo , Resultado do Tratamento
12.
Medicine (Baltimore) ; 100(23): e26310, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115041

RESUMO

ABSTRACT: Cohort study.This study aimed to determine the effectiveness of the universal approach of full endoscopy and percutaneous transpedicular fixation via a medial central approach (ACM) performed to surgically treat patients with lumbar degenerative surgical pathologies.Alternatives to interventionist treatments available to patients with lumbar degenerative surgical pathologies are related to recovery from minimally invasive surgery. Considering this, full endoscopic spinal decompression (full endoscopy) and percutaneous transpedicular fixation via an ACM represent advances in neurosurgical procedures, in particular, spinal surgery. Thus, the introduction of endoscopic and minimally invasive surgeries for the lumbar region has become 1 of the most important advances in modern surgery.A cohort of 79 patients undergoing full endoscopy and percutaneous transpedicular fixation was evaluated 6 times in 1 year. Pain intensity was measured using the visual analog scale (VAS), and lumbar functionality was measured using the Oswestry Disability Index (ODI). Six evaluations were performed: before surgery and on discharge after surgery as well as at 1, 3, 6, and 12 months after surgery.Before the ACM was applied, the VAS pain score was 8.52. At 11 hours post-surgery, the pain score reduced to 2.59 points (a difference of 5.73 points; P = 0.001). Of the 10 ODI domains evaluated, a difference was found between the period prior to surgery and 1 month later (P < 0.01).The universal approach to full endoscopy and lumbar percutaneous transpedicular fixation via an ACM is highly effective for patients with lumbar surgical degenerative pathologies.


Assuntos
Descompressão Cirúrgica , Endoscopia , Degeneração do Disco Intervertebral/cirurgia , Laminectomia , Dor Lombar , Vértebras Lombares , Fusão Vertebral , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/métodos , Endoscopia/efeitos adversos , Endoscopia/métodos , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico , Laminectomia/efeitos adversos , Laminectomia/métodos , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Dor Lombar/cirurgia , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Masculino , México , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Medição da Dor/métodos , Período Perioperatório/métodos , Recuperação de Função Fisiológica , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos
13.
Medicina (Kaunas) ; 57(5)2021 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-34066351

RESUMO

Background and Objective: Total knee arthroplasty (TKA) is one of the most painful procedures and perioperative pain usually requires the use of many analgesics to relieve it. The appropriate use of analgesics to relieve patient pain is an important issue of TKA. To characterize the drug utilization for pain management during perioperative period of TKA in China using real-world data of electronic medical records. Materials and Methods: This research used the data of all inpatients who received TKA at 145 hospitals covered 31 provinces in China from 1 January 2016 to 31 December 2018. The exclusion criteria included pregnancy and cancer diagnosis. In the analysis of drug utilization mode (DUM), medicines were classified into 5 groups: non-steroidal anti-inflammatory drugs (NSAIDs), opioids, non-opioid central analgesics, acetaminophen and others. Results: Among the 2017 patients included in this study, there were 1537 (76.20%) female and 480 (23.80%) male, aged 65.77 ± 7.73 years. Regarding the surgery characteristics, 1658 (82.20%) were unilateral; 1220 (60.49%) was graded Level 4; 1312 (65.05%) used local anesthesia as the main anesthesia method, and 1450 (71.89%) lasted for more than 2 h. The most common DUM was "NSAIDs + opioids" (55.92%), followed by "NSAIDs only" (17.85%), and "NSAIDs + Opioids + Non-opioid central analgesics" (17.15%). The results of the Chi-square test showed that differences in DUM were associated with surgery types, surgery levels, surgery duration, and types of anesthesia used. Up to 81.14% of the total drug expenses for pain management was spent on NSAIDs. Due to the limitation of database, this study could not subdivide operation stages, anesthesia methods, dosage forms of drugs. Conclusion: In China, the use of analgesics in perioperative period of TKA was diversified and influenced by a number of surgery characteristics. The rational use of analgesics should be considered in combination with surgery type, surgery level, surgery duration and anesthesia method.


Assuntos
Artroplastia do Joelho , Analgésicos Opioides/uso terapêutico , China/epidemiologia , Uso de Medicamentos , Feminino , Humanos , Masculino , Manejo da Dor , Dor Pós-Operatória/tratamento farmacológico , Período Perioperatório , Estudos Retrospectivos
14.
Int J Mol Sci ; 22(11)2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34064140

RESUMO

Matrix metalloproteinase 9 (MMP-9) expression is upregulated in vascular inflammation and participates in vascular remodeling, including aneurysm dilatation and arterial neointima development. Neointima at the arteriovenous (AV) fistula anastomosis site primarily causes AV fistula stenosis and failure; however, the effects of MMP-9 on perioperative AV fistula remodeling remain unknown. Therefore, we created AV fistulas (end-to-side anastomosis) in wild-type (WT) and MMP-9 knockout mice with chronic kidney disease to further clarify this. Neointima progressively developed in the AV fistula venous segment of WT mice during the four-week postoperative course, and MMP-9 knockout increased the lumen area and attenuated neointima size by reducing smooth muscle cell and collagen components. Early perioperative AV fistula mRNA sequencing data revealed that inflammation-related gene sets were negatively enriched in AV fistula of MMP-9 knockout mice compared to that in WT mice. qPCR results also showed that inflammatory genes, including tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1), interleukin-6 (IL-6), intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1), were downregulated. In addition, Western blot results showed that MMP-9 knockout reduced CD44 and RAC-alpha serine/threonine-protein kinase (Akt) and extracellular signal-regulated kinases (ERK) phosphorylation. In vitro, MMP-9 addition enhanced IL-6 and MCP-1 expression in vascular smooth muscle cells, as well as cell migration, which was reversed by an MMP-9 inhibitor. In conclusion, MMP-9 knockout attenuated AV fistula stenosis by reducing perioperative vascular inflammation.


Assuntos
Fístula Arteriovenosa/genética , Inflamação/genética , Metaloproteinase 9 da Matriz/genética , Neointima/genética , Animais , Movimento Celular/genética , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Músculo Liso Vascular/patologia , Miócitos de Músculo Liso/patologia , Período Perioperatório , Remodelação Vascular/genética
15.
Zhonghua Xin Xue Guan Bing Za Zhi ; 49(6): 610-614, 2021 Jun 24.
Artigo em Chinês | MEDLINE | ID: mdl-34126729

RESUMO

Objective: To observe the changes of parameters derived from transthoracic echocardiography (TTE) before and after left ventricular assist device (LVAD) implantation, and to evaluate the clinical value of TTE in the perioperative period of LVAD implantation. Methods: This is a retrospective study. The data of patients who underwent LVAD implantation in Fuwai Hospital from January 2018 to December 2020 were analyzed retrospectively. The TTE parameters, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and total bilirubin (TBil) before and 1 month after LVAD implantation were collected and analyzed. Results: A total of 12 male patients undergoing LVAD implantation were included in this study. The mean age was (43.3±8.6) years. The left atrial volume index ((41.4±12.8)ml/m2 vs. (74.9±30.7)ml/m2, P<0.001), left ventricular end-diastolic volume index ((152.1±35.3)ml/m2 vs. (205.5±35.7)ml/m2, P<0.001), left ventricular end-systolic volume index ((112.5±27.9)ml/m2 vs. (155.1±29.1)ml/m2, P<0.001), right atrial diameter index ((23.7±3.5)mm/m2 vs. (27.2±5.8)mm/m2, P=0.023), right ventricular internal diameter at end-diastole ((24.6±2.7)mm vs. (30.0±4.8)mm, P<0.001), tricuspid annular plane systolic excursion ((11.5±2.9)mm vs. (14.6±2.8)mm, P=0.007), systolic pulmonary arterial pressure ((29.2±4.8) mmHg vs. (55.1±19.3) mmHg, P<0.001, 1 mmHg=0.133 kPa) were significantly reduced at 1 month post LVAD implantation as compared to before LVAD implantation. The aortic sinus diameter ((33.8±4.7)mm vs. (31.6±5.1)mm, P=0.007), left ventricular ejection fraction ((26.3±3.0)% vs. (23.8±4.4)%, P=0.016), right ventricular fractional area change ((31.0±8.6)% vs. (23.8±5.5)%, P=0.004) at 1 month post LVAD implantation were significantly higher than before LVAD implantation. The degree of mitral and tricuspid regurgitation decreased, and the inspiratory collapse rate of inferior vena cava increased (all P<0.05). NT-proBNP ((1 418.4±812.6)ng/L vs. (5 097.5±3 940.4)ng/L, P=0.004) and TBil ((12.4±5.4)µmol/L vs. (27.5±14.0)µmol/L, P=0.001) decreased significantly at 1 month post LVAD implantation. Conclusions: TTE results show that LVAD could effectively relieve left ventricular load and improve right ventricular function. TTE can monitor the cardiac structural and functional changes during the perioperative period of LVAD implantation, and provide the imaging evidence for clinical evaluation of the therapeutic effect of LVAD.


Assuntos
Insuficiência Cardíaca , Coração Auxiliar , Adulto , Ecocardiografia , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Estudos Retrospectivos , Volume Sistólico , Função Ventricular Esquerda
16.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 56(6): 557-564, 2021 Jun 09.
Artigo em Chinês | MEDLINE | ID: mdl-34098671

RESUMO

Objective: To investigate the effect of antibiotics application in perioperative period on carotid artery and serum interluekin-6 (IL-6) in chronic periodontitis (CP) rats with hyperlipidemia (HL) or diabetes mellitus (DM). Methods: The models of CP rats with HL or DM were established in different batches. The rats were divided into groups as follows: A and A' were normal control groups, n=7 in each group; B(HL) and B'(DM) were groups of HL and DM, n=7 in each; C(HL+CP) and C'(DM+CP) were groups of CP with HL and CP with DM, n=21 in each. After the establishment of the models, groups C and C' were divided into C1 and C1' non-intervention group, C2 and C2' simple tooth extraction group and C3 and C3' antibiotic-assisted tooth extraction, with 7 rats in each of the groups. Two time interventions were performed to extract experimental teeth (bilateral maxillary first and second molars) in groups C2, C2', C3 and C3'. Serum samples were collected at 5 time points before and after tooth extraction (T1: before the first tooth extraction; T2: one week after the first tooth extraction; T3, T4, T5: the first, third and fifth week after the second tooth extraction), respectively. The absolute content of IL-6 in serum was detected by enzyme-linked immunosorbent assay (ELISA). Ratio of the absolute content in the experimental groups and control groups were calculated as the relative content of IL-6. At the end of the experiments, all rats were euthanasia and the bifurcation vascular tissues of carotid artery were collected for the observation of the carotid artery pathology and plaque formation and the measurement of the thickness of carotid intimal-medial layer (IMT). Results: Carotid artery pathology observation showed the IMT in group C was significantly thickened and the group C2 was the most thickened one (compared with group A, P<0.01). Elastic fibers in groups C1 and C2 were disordered or even broken and disappeared, presenting typical atherosclerotic plaques, which were diffuse calcium salt deposits in the intimal-medial layers and protrude into the lumen. Elastic fibers in group C3 were ranged in ordered relatively without obvious fracture and the number of plaques was significantly reduced. The vascular walls in rats of groups B' and C' were incomplete, the IMTs had no obvious changes, elastic fibers were ranged disorderly and broken and the smooth muscle cells had vacuolar changes. In group C2', the vascular wall was significantly thinned and calcified plaques appeared in the artery, which showed multiple calcification lesions penetrating through the intimal-medial layer or even the whole layer. The vascular wall of group C3' was integrity and the elastic fibers arranged relatively clutter-free, the number of plaques was reduced. Results of detections of IL-6 showed the relative contents of IL-6 in groups B, B', C1, and C1' increased with time. At T3 time point, the relative contents of IL-6 in groups C2 and C3 reached the peak, C2 was 10.4 times of group A and C3 was 9.5 times of group A, and then decreased to different low levels. At T5 point, comparisons of the relative contents of IL-6 showed C3 < C2 < C1 (3.2 times, 5.4 times, 9.6 times of group A, respectively). The relative contents of IL-6 in groups C2' and C3' reached the peak at T2 point (4.9 times and 4.5 times of group A, respectively), and then decline with time. At T5 point, comparisons of the relative contents of IL-6 showed C3'< C2'< C1' (1.2 times, 1.4 times and 3.1 times of group A, respectively). Conclusions: Blood vessels were observed more obvious thickened in the tooth extraction without antibiotic of HL+CP rats with calcifications increase. Blood vessels of DM+CP rats became thin and fragile and even the integrity was damaged. Perioperative use of antibiotics might reduce the carotid artery lesions and decrease serum levels of inflammatory cytokines.


Assuntos
Diabetes Mellitus , Hiperlipidemias , Animais , Antibacterianos , Artérias Carótidas , Humanos , Interleucina-6 , Período Perioperatório , Ratos , Ratos Sprague-Dawley
17.
Anticancer Res ; 41(6): 3059-3065, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34083298

RESUMO

BACKGROUND: Peri-operative variables associated with prolonged Intensive Care Unit (ICU) admission following cytoreductive surgery for ovarian cancer were investigated. PATIENTS AND METHODS: A retrospective review was carried out of patients admitted to the ICU following cytoreductive surgery for ovarian cancer in a single tertiary referral centre from 2015-2019. Patients were categorized according to length of ICU stay (<48 h and ≥48 h), and peri-operative variables were compared across the two groups. RESULTS: A total of 56 patients were admitted to the ICU post-operatively, 37 for <48 h and 19 for ≥48 h (range=3-11 days). Greater duration of procedure and estimated blood loss, bowel resection, higher post-operative lactate level, lower post-operative albumin level and requirement for post-operative blood products were associated with prolonged ICU stay. Increased intraoperative fluid requirement was an independent predictor of extended ICU stay. CONCLUSION: Utilizing identified intra-operative risk factors to perform individualized risk assessments might improve planning of ICU resources. Optimizing intraoperative fluid management may improve short-term patient outcomes.


Assuntos
Procedimentos Cirúrgicos de Citorredução/métodos , Unidades de Terapia Intensiva , Tempo de Internação , Neoplasias Ovarianas/cirurgia , Perda Sanguínea Cirúrgica , Transfusão de Sangue , Feminino , Humanos , Intestinos/cirurgia , Pessoa de Meia-Idade , Período Perioperatório , Fatores de Tempo
18.
Rev. SOBECC ; 26(2): 99-106, 30-06-2021.
Artigo em Português | LILACS | ID: biblio-1283861

RESUMO

Objetivo: Identificar se há riscos consecutivos do posicionamento cirúrgico, por meio da aplicação da Escala de Avaliação de Risco para o Desenvolvimento de Lesões Decorrentes do Posicionamento Cirúrgico (ELPO). Método: Estudo observacional, descritivo, transversal, com abordagem quantitativa, executado em um hospital de ensino do norte do estado do Ceará. Foram utilizados dois intrumentos, um de perfil clínico-epidemiológico com base em entrevista estruturada e a ELPO, aplicada no período perioperatório a 31 pacientes cirúrgicos. Resultados: A maioria dos pacientes era do sexo biológico masculino, parda, na faixa etária entre 18 e 39 anos. Os procedimentos mais frequentes foram debridamentos e reduções de fraturas, em conformidade com as internações por acidentes motociclísticos. Quando avaliados quanto ao risco de lesões decorrentes do posicionamento cirúrgico, todos os pacientes apresentaram escore ELPO≤19, isto é, em menor risco para o desenvolvimento de lesões. Conclusão: O estudo oportunizou conhecer o perfil dos pacientes submetidos a procedimentos cirúrgicos na instituição, assim como a caracterização dos participantes quanto ao risco de desenvolver lesões decorrentes da posição cirúrgica, que foi classificado como baixo.


Objective: To identify whether there are consecutive risks of surgical positioning through the application of the Risk Assessment Scale for the Development of Injuries due to Surgical Positioning (ELPO). Method: Observational, descriptive, cross-sectional study with a quantitative approach, carried out in a teaching hospital located in the north of the state of Ceará, Brazil. Two instruments were used, a clinical-epidemiological profile based on a structured interview and the ELPO scale, applied in the perioperative period to 31 surgical patients. Results: Most patients were men, mixed-race, and aged between 18 and 39 years. The most frequent procedures were debridement and fracture reduction, in accordance with hospitalizations due to motorcycle accidents. When evaluating the patients as for the risk of injuries due to surgical positioning, all subjects had ELPO score≤19, that is, they presented a lower risk for the development of injuries. Conclusion: The study allows for the profile of patients undergoing surgical procedures in the institution to be known, as well as the characterization of the participants regarding the risk of developing injuries due to surgical positioning, which was classified as low


Objetivo: Identificar el riesgo, mediante la aplicación de la Escala de Evaluación de Riesgos para el Desarrollo de Lesiones Derivadas del Posicionamiento Quirúrgico (ELPO). Método: Estudio observacional, descriptivo, transversal con abordaje cuantitativo, realizado en un hospital universitario del norte del estado de Ceará. Se utilizaron dos instrumentos, uno con perfil clínico-epidemiológico basado en entrevista estructurada y el ELPO, aplicado en el período perioperatorio a 31 pacientes quirúrgicos. Resultados: La mayoría de los pacientes eran hombres biológicos, pardos, con edades entre 18 y 39 años. La mayor frecuencia de procedimientos fue el desbridamiento y reducción de fracturas, en consenso con las hospitalizaciones por accidentes de motocicleta. Cuando se evaluó el riesgo de lesiones por posicionamiento quirúrgico, todos los pacientes tuvieron un puntaje ELPO≤19, es decir, un menor riesgo de desarrollar lesiones. Conclusión: El estudio permitió conocer el perfil de los pacientes sometidos a procedimientos quirúrgicos en la institución, así como la caracterización de los participantes en cuanto al riesgo de desarrollar lesiones derivadas de la posición quirúrgica, el cual fue clasificado como bajo.


Assuntos
Humanos , Procedimentos Cirúrgicos Operatórios , Medição de Risco , Período Perioperatório , Pacientes , Acidentes , Fraturas Ósseas
20.
Molecules ; 26(9)2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33946587

RESUMO

Acute and chronic transplant rejections due to alloreactivity are essential contributors to graft loss. However, the strength of alloreactivity is biased by non-immunological factors such as ischemia reperfusion injury (IRI). Accordingly, protection from IRI could be favorable in terms of limiting graft rejection. Caveolin-1 (Cav-1) is part of the cell membrane and an important regulator of intracellular signaling. Cav-1 has been demonstrated to limit IRI and to promote the survival of a variety of cell types including renal cells under stress conditions. Accordingly, Cav-1 could also play a role in limiting anti-graft immune responses. Here, we evaluated a possible association between pre-transplant serum concentrations of Cav-1 and the occurrence of rejection during follow-up in a pilot study. Therefore, Cav-1-serum concentrations were analyzed in 91 patients at the time of kidney transplantation and compared to the incidence of acute and chronic rejection. Higher Cav-1 levels were associated with lower occurrence of acute cellular tubulointerstitial rejection episodes.


Assuntos
Caveolina 1/sangue , Rejeição de Enxerto/sangue , Transplante de Rim/efeitos adversos , Nefrite Intersticial/sangue , Nefrite Intersticial/etiologia , Adulto , Idoso , Biomarcadores , Feminino , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Nefrite Intersticial/diagnóstico , Nefrite Intersticial/mortalidade , Período Perioperatório , Prognóstico , Traumatismo por Reperfusão/diagnóstico , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/metabolismo
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