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2.
Zhonghua Yi Xue Za Zhi ; 104(25): 2323-2329, 2024 Jul 02.
Artigo em Chinês | MEDLINE | ID: mdl-38951104

RESUMO

Objective: To investigate the effectiveness and safety of multimodal analgesia in patients with end-stage head and neck cancer in open gastrostomy surgery. Methods: This was a randomized controlled trial. From June to December 2023, 50 patients with end-stage head and neck cancer who underwent elective open gastrostomy surgery in Beijing Tongren Hospital Affiliated to Capital Medical University were prospectively selected. The patients were divided into multimodal analgesia group and local anesthesia group using the random number table method according to different anesthesia methods, with 25 cases in each group. In multimodal analgesia group, a multimodal analgesia regimen was adopted: ultrasound-guided abdominal wall nerve block (rectus sheath block and transverse abdominis plane block)+intravenous injection of oxycodone+intravenous injection of flurbiprofen axetil and dexamethasone. In local anesthesia group, local infiltration anesthesia with ropivacaine was adopted. The main outcome measure was the incidence of intraoperative pain numeric rating scale (NRS) score>3 points in the two groups. The secondary observation indicators included NRS score and hemodynamic indexes [mean arterial pressure (MAP) and heart rate (HR)] at various time points during surgery [before anesthesia (T0), at the time of incision (T1), 10 minutes after surgery (T2), during gastric body traction (T3), and at the end of surgery (T4)], incidence of adverse reactions, postoperative patient satisfaction score, as well as the NRS scores at rest and activity (coughing) within 24 hours after surgery. Results: The multimodal analgesia group included 21 males and 4 females, aged (61.4±9.9) years. There were 19 males and 6 females in the local anesthesia group, aged (58.6±10.8) years. The incidence of intraoperative NRS score>3 points and the incidence of salvage analgesia in the multimodal analgesia group were both 12.0% (3/25), which were lower than 60.0% (15/25) in the local anesthesia group, and the differences were statistically significant (all P<0.001); The NRS score [M (Q1, Q3)] at T3 in the multimodal analgesia group was 2 (2, 3) points, which were lower than 5 (3, 6) points in the local anesthesia group (P<0.05). There were smaller variabilities in MAP and HR in the multimodal analgesia group than those in the local anesthesia group (all P<0.05). The incidence of intraoperative tachycardia, surgical traction reaction, and nausea in the multimodal analgesia group was lower than that in the local anesthesia group (all P<0.05). The postoperative satisfaction score of patients in the multimodal analgesia group was (9.25±0.71) points, which were higher than (7.33±0.87) points in the local anesthesia group (P<0.001). NRS score during postoperative activity within 24 hours in the multimodal analgesia group were (2.36±0.75) points, which were lower than (3.03±0.81) points of the local anesthesia group (P=0.005). No adverse reactions such as urinary retention, nausea, vomiting and dizziness occurred in both groups. Conclusion: Compared with local anesthesia, the multimodal analgesic strategy could provide better analgesic effect and longer duration, better hemodynamic stability, and fewer intraoperative adverse reactions in patients with end-stage head and neck cancer undergoing open gastrostomy.


Assuntos
Analgesia , Gastrostomia , Neoplasias de Cabeça e Pescoço , Bloqueio Nervoso , Humanos , Neoplasias de Cabeça e Pescoço/cirurgia , Analgesia/métodos , Bloqueio Nervoso/métodos , Gastrostomia/métodos , Masculino , Anestesia Local , Dor Pós-Operatória , Feminino , Manejo da Dor/métodos , Estudos Prospectivos , Anestésicos Locais/administração & dosagem , Pessoa de Meia-Idade , Medição da Dor
7.
Dtsch Med Wochenschr ; 149(13): 785-791, 2024 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-38863148

RESUMO

When critically ill patients require long-term enteral nutrition, insertion of a feeding tube is indicated. The method of choice is percutaneous endoscopic gastrostomy (PEG) tube placement, known in everyday clinical practice as a PEG tube or simply PEG. When performed in a standardized manner and with consideration of contraindications, PEG placement is a less invasive and well-established standard of care in the ICU.


Assuntos
Nutrição Enteral , Gastrostomia , Humanos , Gastrostomia/métodos , Gastrostomia/instrumentação , Nutrição Enteral/instrumentação , Nutrição Enteral/métodos , Estado Terminal/terapia , Intubação Gastrointestinal/métodos , Intubação Gastrointestinal/instrumentação
9.
J Pediatr Surg ; 59(8): 1531-1537, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38735807

RESUMO

BACKGROUND: Gastrostomy insertion is one of the most frequently performed procedures by specialist paediatric surgeons. We aimed to determine practice across the United Kingdom (UK) and in particular to identify areas where there was consistency or variation in practice between practitioners and centres. METHODS: A structured survey was distributed to all consultant practitioners who insert gastrostomies in the UK. Practice surrounding a range of aspects of gastrostomy care including insertion technique, device use, post-operative management and subsequent care were determined. RESULTS: Of total 135 practitioners who insert gastrostomies, responses were received from 103 (76%) with responses received from all UK centres. There was variation between centres in the provision of pre-operative information, and between practitioners in preferred device, insertion techniques, post-operative feeding practice and change/removal procedures. The most frequently preferred device for primary gastrostomy insertion was a Freka® PEG (36%) button device (30%), CorFlo™ PEG (21%), or G-tube (10%). Laparoscopy was always used when inserting either PEG or button device by over 50% of respondents and selectively used by the majority of the remainder. Feeds were started between 1 and 24 h post-insertion, most practitioners (64%) plan a minimum one night hospital stay but a third plan for more than one night. CONCLUSION: There is considerable variation in practice for most stages of the pathway for children having a gastrostomy. Further work is warranted to understand the relationship between different practices and patient outcomes, resource use and cost and subsequently to develop best practice guidelines.


Assuntos
Gastrostomia , Pesquisas sobre Atenção à Saúde , Padrões de Prática Médica , Gastrostomia/estatística & dados numéricos , Gastrostomia/métodos , Humanos , Reino Unido , Padrões de Prática Médica/estatística & dados numéricos , Criança , Nutrição Enteral/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Laparoscopia/métodos , Pediatria/estatística & dados numéricos , Cuidados Pós-Operatórios/estatística & dados numéricos , Cuidados Pós-Operatórios/métodos
10.
World J Gastroenterol ; 30(17): 2298-2301, 2024 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-38813046

RESUMO

The article by Ker et al explores the treatment of peripancreatic fluid collection (PFC). The use of percutaneous drainage, endoscopy, and surgery for managing PFC are discussed. Percutaneous drainage is noted for its low risk profile, while endoscopic cystogastrostomy is more effective due to the wider orifice of the metallic stent. Surgical cystogastrostomy is a definitive treatment with a reduced need for reintervention, especially for cases with extensive collections and significant necrosis. The choice of treatment modality should be tailored to individual patient characteristics and disease factors, considering the expertise available.


Assuntos
Drenagem , Gastrostomia , Stents , Humanos , Drenagem/métodos , Resultado do Tratamento , Gastrostomia/métodos , Gastrostomia/efeitos adversos , Pseudocisto Pancreático/cirurgia
11.
Hosp Pediatr ; 14(6): 413-420, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38738287

RESUMO

OBJECTIVE: Decision-making about antireflux procedures (ARPs) to treat gastroesophageal reflux disease in children with neurologic impairment and gastrostomy tubes is challenging and likely influenced by physicians' experience and perspectives. This study will explore physician attitudes about ARPs and determine if there are relationships to clinical practice and personal characteristics. METHODS: This is a national observational cross-sectional study that used an electronic questionnaire addressing reported practice, attitudes regarding the ARPs, and responses to clinical vignettes. Participants were physicians in Canadian tertiary-care pediatric settings. Descriptive statistics were used to analyze physician attitudes. Multivariable logistic regression modeling was used to determine associations between physician and practice characteristics and likelihood to consider ARP. RESULTS: Eighty three respondents represented 12 institutions, with a majority from general or complex care pediatrics. There was a wide disparity between likelihood to consider ARP in each clinical scenario. Likelihood to consider ARP ranged from to 19% to 78% depending on the scenario. Two scenarios were equally split in whether the respondent would offer an ARP. None of the demographic characteristics were significantly associated with likelihood to consider ARP. Often, gastrojejunostomy tubes alone were considered (56% to 68%). CONCLUSIONS: There is considerable variability in physician attitudes toward and recommendations regarding ARPs to treat gastroesophageal reflux disease. We did not find a significant association with clinical experience or location of practice. More research is needed to define indications and outcomes for ARPs. This is a scenario where shared decision-making, bringing together physician and family knowledge and expertise, is likely the best course of action.


Assuntos
Atitude do Pessoal de Saúde , Refluxo Gastroesofágico , Padrões de Prática Médica , Humanos , Refluxo Gastroesofágico/terapia , Estudos Transversais , Canadá , Masculino , Feminino , Padrões de Prática Médica/estatística & dados numéricos , Criança , Doenças do Sistema Nervoso/terapia , Inquéritos e Questionários , Gastrostomia , Tomada de Decisão Clínica , Fundoplicatura , Adulto
13.
Pediatr Surg Int ; 40(1): 123, 2024 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-38704451

RESUMO

PURPOSE: Enhanced recovery after surgery (ERAS) pathways have been shown to improve surgical outcomes and patient satisfaction. The aim of the study was to assess whether the implementation of a perioperative enhanced recovery after percutaneous endoscopic gastrostomy (ERaPEG) pathway based on ERAS principles was safe, satisfactory to parents and improved outcomes. METHODS: Following a quality improvement project, a multimodal ERaPEG pathway was introduced as standard practice within the department and children undergoing elective same-day admission percutaneous endoscopic gastrostomy (PEG) at a single UK tertiary center were prospectively enrolled. Exclusion criteria were patients undergoing other concurrent procedures and those who underwent a laparoscopic assisted/open procedure. Data included patient demographics, underlying diagnosis, indication, length of stay (LOS) and 30-day readmission. Parental experience and satisfaction were determined using a questionnaire including 5-point Likert scales. A retrospective cohort was used for comparison. Data were analyzed using Chi-Square test and Mann-Whitney U tests. RESULTS: Ninety-five patients met the inclusion criteria: 50 pre and 45 post the implementation of ERaPEG. Median age was 3 and 2 years, respectively. Neurodisability was the underlying diagnosis in most patients (84%-pre-ERaPEG; 76%-post-ERaPEG). Most common PEG indication was medication/nutritional supplementation (52%-pre-ERaPEG; 51%-post-ERaPEG). The LOS significantly decreased from a median of 51.5 h (pre-ERaPEG) to 32 h (post-ERaPEG) (p < 0.001). Thirty-day readmission rates were similar (6% vs 11%). Most parents felt that the educational material was easy to access and understand. Post-operatively the majority of parents (≥ 80%) were confident in managing the gastrostomy device, setting up/giving the feeds and also felt that the LOS was appropriate. CONCLUSION: This study shows that the implementation of an ERaPEG pathway significantly reduced LOS following PEG. In addition, the pathway was satisfactory to parents and offered the benefit of improved resource utilization.


Assuntos
Recuperação Pós-Cirúrgica Melhorada , Gastrostomia , Centros de Atenção Terciária , Humanos , Gastrostomia/métodos , Masculino , Feminino , Pré-Escolar , Reino Unido , Estudos Retrospectivos , Criança , Lactente , Estudos Prospectivos , Satisfação do Paciente/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Melhoria de Qualidade , Gastroscopia/métodos , Readmissão do Paciente/estatística & dados numéricos
14.
Pediatr Surg Int ; 40(1): 116, 2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38695977

RESUMO

PURPOSE: Existing guidelines provide weak recommendations on the surgical management of nutritional problems in children. The objective was to design a management pathway to address the best nutritional surgery (NS) procedure in a given patient. METHODS: Retrospective analysis of children treated at our department from January 2015 to December 2019. The sample was divided into two groups according to presence or absence of neurological impairment (NI). Patients with NI (Group 1) were classified in three subgroups based on presenting symptoms: A-Dysphagia without gastroesophageal reflux (GER); B-GER with or without dysphagia; C-Symptoms associated with a delayed gastric emptying. RESULTS: A total of 154 patients were included, 111 with NI. One-hundred-twenty-eight patients underwent only one procedure. Complications and mortality were superior in Group 1. In subgroup A, isolated gastrostomy was the first NS in all patients. In subgroup B most of patients were subjected to a Nissen fundoplication, while in 5 cases total esophagogastric dissociation (TEGD) was the first intervention. Considering the entire sample, 92.3% patients who underwent a TEGD did not require further procedures. CONCLUSION: NS encompasses various procedures depending on presenting symptoms and neurological status. A management flowchart for these patients is proposed.


Assuntos
Transtornos de Deglutição , Humanos , Estudos Retrospectivos , Feminino , Masculino , Criança , Pré-Escolar , Lactente , Transtornos de Deglutição/etiologia , Refluxo Gastroesofágico/cirurgia , Gastrostomia/métodos , Adolescente , Doenças do Sistema Nervoso , Fundoplicatura/métodos , Complicações Pós-Operatórias/epidemiologia
15.
Muscle Nerve ; 70(1): 94-100, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38695638

RESUMO

INTRODUCTION/AIMS: Patients with amyotrophic lateral sclerosis (ALS) are susceptible to malnutrition, with appropriate management of nutritional interventions an active area of investigation. We sought to determine the impact of gastrostomy tube placement in ALS patients, exploring the correlation between forced vital capacity (FVC), malnutrition, and perioperative complications. METHODS: A retrospective review was performed of clinically diagnosed ALS patients treated at two multidisciplinary clinics (University of Kansas, University of Nebraska) from January 2009 to September 2020 who were referred for gastrostomy. Data collected included demographics, disease characteristics, and key gastrostomy related dates/outcomes. RESULTS: Two hundred thirty-nine patients were included with a median age of 65 years and median of 589 days from symptom onset to gastrostomy (interquartile range, 404-943). The population was predominantly Non-Hispanic White with bulbar-onset ALS. 30-day mortality was 4% and 30-day morbidity was 13%. Weight loss, body mass index, and predicted FVC at placement showed no increased 30-day morbidity or mortality association. Bulbar-onset ALS patients exhibited higher overall mortality postplacement than limb onset (odds ratio: 1.85, 95% confidence interval: 1.03-3.33). There was a 5% incidence of symptoms suggestive of refeeding syndrome. DISCUSSION: Rates of major/minor complications and 30-day mortality related to gastrostomy placement in our population were similar compared with prior studies in ALS. The lack of difference in outcomes based on FVC at procedure may suggest this is not predictive of outcome, or perhaps, high-quality perioperative respiratory management. Alternative reasons may account for the increased morbidity and mortality of gastrostomy placement in the ALS population.


Assuntos
Esclerose Lateral Amiotrófica , Nutrição Enteral , Gastrostomia , Humanos , Esclerose Lateral Amiotrófica/terapia , Esclerose Lateral Amiotrófica/complicações , Masculino , Feminino , Nutrição Enteral/métodos , Idoso , Estudos Retrospectivos , Pessoa de Meia-Idade , Resultado do Tratamento , Desnutrição/etiologia , Desnutrição/terapia , Capacidade Vital/fisiologia
17.
JPEN J Parenter Enteral Nutr ; 48(5): 605-613, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38715451

RESUMO

BACKGROUND: Feeding difficulty is widely recognized in patients with Down syndrome, and many patients require gastrostomy tube (G-tube) placement for nutrition. No reliable factors have been identified to predict the expected duration of G-tube feeds in patients with Down syndrome. This descriptive cohort study aimed to determine the factors affecting the duration of G-tube feeds. We also investigated change in body mass index (BMI) from G-tube placement to discontinuation. METHODS: Medical records of patients with Down syndrome seen by a pediatric gastroenterologist at a tertiary care center between September 1986 and December 2021 were reviewed. Data collection included demographics, anthropometrics, comorbidities, and feeding route. Comparison was performed between patients who discontinued G-tube feeds and those who did not. RESULTS: Two hundred twenty patients (45% female) were included. The median age at G-tube placement was 5 months (interquartile range [IQR]: 0.2-1.3 years). There were 113 (51%) patients who discontinued G-tube feeds, after a median duration of 31.6 months (IQR: 15.6-55.7 months). Tracheostomy was the only covariant associated with a longer duration of G-tube feeds (158 months vs 53 months; P = 0.002). Neither age at G-tube placement nor any comorbidities were associated with BMI status at discontinuation of G-tube. CONCLUSION: In our cohort of patients with Down syndrome, age at placement of G-tube did not impact the duration of G-tube feeds. Most patients who had a G-tube placed were likely to require enteral feeds for at least 1 year. Those who had a tracheostomy needed their G-tube for a longer time.


Assuntos
Síndrome de Down , Nutrição Enteral , Gastrostomia , Humanos , Síndrome de Down/complicações , Gastrostomia/métodos , Feminino , Masculino , Nutrição Enteral/métodos , Lactente , Estudos de Coortes , Fatores de Tempo , Estudos Retrospectivos , Índice de Massa Corporal , Traqueostomia/métodos , Resultado do Tratamento , Pré-Escolar , Estado Nutricional , Intubação Gastrointestinal/métodos
18.
J Surg Res ; 299: 43-50, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38701703

RESUMO

INTRODUCTION: Patients admitted with principal cardiac diagnosis (PCD) can encounter difficult inpatient stays that are often marked by malnutrition. In this setting, enteral feeding may improve nutritional status. This study examined the association of PCD with perioperative outcomes after elective enteral access procedures. METHODS: Adult patients who underwent enteral access procedures between 2018 and 2020 at a tertiary care institution were reviewed retrospectively. Differences in baseline characteristics between patients with and without PCD were adjusted using entropy balancing. Multivariable logistic and linear regressions were subsequently developed to evaluate the association between PCD and nutritional outcomes, perioperative morbidity and mortality, length of stay, and nonelective readmission after enteral access. RESULTS: 912 patients with enteral access met inclusion criteria, of whom 84 (9.2%) had a diagnosis code indicating PCD. Compared to non-PCD, patients with PCD more commonly received percutaneous endoscopic gastrostomy by general surgery and had a higher burden of comorbidities as measured by the Charlson comorbidity index. Multivariable risk adjustment generated a strongly balanced distribution of baseline covariates between patient groups (standardized differences ranged from -2.45 × 10-8 to 3.18 × 108). After adjustment, despite no significant association with in-hospital mortality, percentage change prealbumin, length of stay, or readmission, PCD was associated with an approximately 2.25-day reduction in time to meet goal feeds (95% CI -3.76 to -0.74, P = 0.004) as well as decreased odds of reoperation (adjusted odds ratio 0.28, 95% CI 0.09-0.86, P = 0.026) and acute kidney injury (adjusted odds ratio 0.24, 95% CI 0.06-0.91, P = 0.035). CONCLUSIONS: Despite having more comorbidities than non-PCD, adult enteral access patients with PCD experienced favorable nutritional and perioperative outcomes.


Assuntos
Nutrição Enteral , Cardiopatias , Humanos , Estudos Retrospectivos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Nutrição Enteral/estatística & dados numéricos , Cardiopatias/mortalidade , Cardiopatias/terapia , Tempo de Internação/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Mortalidade Hospitalar , Estado Nutricional , Idoso de 80 Anos ou mais , Gastrostomia/estatística & dados numéricos , Desnutrição/diagnóstico , Desnutrição/terapia , Desnutrição/epidemiologia , Desnutrição/etiologia , Hospitalização/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia
19.
Ann Otol Rhinol Laryngol ; 133(7): 679-685, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38712740

RESUMO

OBJECTIVE: to investigate the ability of mandibular distraction osteogenesis (MDO) to avoid gastrostomy tube (G-tube). DATA SOURCES: PubMed, EBSCOhost, Cochrane, and Embase. REVIEW METHODS: We retrospectively reviewed the number of MDO cases performed at our institution for patients with Robin Sequence (RS) over the past 10 years. In our institutional review, patients were excluded if they had a G-tube already placed at the time of surgery. We also performed a systematic review of the literature. Articles were excluded if they did not detail feeding outcomes after MDO, or if MDO was performed on patients that did not have RS. RESULTS: In our systematic review, 12 articles were included that comprised a total of 209 neonates with RS that underwent MDO. A total of 174 (83.3%) patients avoided a G-tube once MDO was performed. A total of 14 patients met the inclusion criteria at our institution. Of the 14 RS patients, 9 (64%) avoided having a G-tube placed and all (14/14) avoided tracheostomy. The average birth weight of patients avoiding a G-tube was 3.11 kg compared to 2.25 kg (P = .045) in the group requiring a G-tube. In the group avoiding a G-tube, the average weight at time of operation was 3.46 kg compared to 2.83 kg (P = .037) in the group requiring a G-tube. CONCLUSION: MDO may be considered as a surgical option to prevent G-tube placement for neonates with non-syndromic RS who have difficulty with PO feeding but whose airway obstruction is not severe enough to require respiratory support. Based on our institutional experience, a minimum weight of 3.00 kg correlated with higher success rates of PO intake and avoiding a G-tube.


Assuntos
Gastrostomia , Osteogênese por Distração , Síndrome de Pierre Robin , Humanos , Síndrome de Pierre Robin/cirurgia , Recém-Nascido , Gastrostomia/métodos , Osteogênese por Distração/métodos , Estudos Retrospectivos , Mandíbula/cirurgia , Masculino , Feminino , Nutrição Enteral/métodos , Intubação Gastrointestinal/métodos
20.
BMJ Case Rep ; 17(5)2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38697681

RESUMO

A man in his late 50s presented with severe dysphagia caused by a complex refractory benign stenosis that was completely obstructing the middle oesophagus. The patient was unsatisfied with the gastrostomy tube placed via laparotomy as a long-term solution. Therefore, we performed robot-assisted minimally invasive oesophagectomy (video). Mobilisation of the stomach and gastric conduit preparation were more difficult due to the previously inserted gastrostomy tube; thus, the conduit blood supply was assessed using indocyanine green fluorescence. After an uncomplicated course, the patient was referred directly to inpatient rehabilitation on the 16th postoperative day. At 9 months after surgery, the motivated patient returned to full-time work and achieved level 7 on the functional oral intake scale (total oral diet, with no restrictions). At the 1-year follow-up, he positively confirmed all nine key elements of a good quality of life after oesophagectomy.


Assuntos
Esofagectomia , Gastrostomia , Procedimentos Cirúrgicos Robóticos , Humanos , Masculino , Esofagectomia/métodos , Gastrostomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Pessoa de Meia-Idade , Estenose Esofágica/cirurgia , Estenose Esofágica/etiologia , Transtornos de Deglutição/etiologia , Qualidade de Vida , Resultado do Tratamento
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