Perioperative Assessment and Intraoperative Core Concepts in the Complex Kidney Patient

AbstractPurposeLife span and sense of well-being continue to improve post-transplantation in patients with end-stage kidney disease, despite referral of an older and more medically complex population for transplantation. In this issue of the journal, we review existing evidence about risk assessment in kidney transplant candidates from the perspective of the anesthesiologist. The authors explore cardiovascular assessment and risk in the context of intraoperative events that can influence short- and long-term outcomes.Recent FindingsThe number of patients referred for kidney transplantation continues to increase and has far exceeded the number of donor organs available. Many of these patients have become more complex with higher rates of congestive heart failure, diabetes, obesity, collagen vascular disease, and end organ dysfunction. The risk of cardiovascular disease in the end-stage renal disease patient is higher than the general population, and many studies have looked at identifying which patients are higher risk for a post-transplant cardiovascular event. Despite this, tests to detect and guide interventions are not sensitive enough to prevent early cardiovascular complications leading to graft loss and patient death. To address this issue, we explore the strengths and limitations of current cardiovascular risk evaluation paradigms and add information about physiological events during transplant surgery that can affect short- and long-term patient and graft outcomes.Sum...
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research

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The objective of this study was to determine the impact of obesity on quality of life as measured by the BREAST-Q, in women undergoing breast reconstruction. Methods A review of the breast reconstruction database (n = 336) at the Flinders Breast Reconstruction Service was performed, with demographic data, complication rates, and BREAST-Q data being extracted and analyzed. Participants were divided into 2 groups: nonobese (BMI
Source: Annals of Plastic Surgery - Category: Cosmetic Surgery Tags: Breast Surgery Source Type: research
The reconstruction of finger defects requires improved functional outcomes and acceptable esthetic outcomes, and small free flaps present a good alternative technique for repairing finger skin defects. From January 2006 to December 2018, we investigated the number and diameter of proximal digital artery perforators, medial plantar artery perforators, and peroneal proper plantar digital arteries of the hallux by dissection and then transplanted free digital arterial perforator flaps, free medial plantar flaps, and free peroneal flaps from the hallux to repair small finger skin defects. The number (SD) of perforators from th...
Source: Annals of Plastic Surgery - Category: Cosmetic Surgery Tags: Microsurgery Source Type: research
This study compares the postoperative pain and opioid use in patients managed for surgery with general anesthesia (GA) with patients who were given combined epidural and general anesthesia (E/GA) with continuing postoperative epidural analgesia. Methods All patients who underwent penile inversion vaginoplasty between May of 2016 and May of 2018 under the care of single surgeon were identified retrospectively, 18 patients of which met the inclusion criteria. A retrospective chart review was conducted. Outcome measures were postoperative pain using visual analog scale, type and dosage of postoperatively administered intra...
Source: Annals of Plastic Surgery - Category: Cosmetic Surgery Tags: Reconstructive Surgery Source Type: research
This study aimed to develop and evaluate a human extracorporeal free flap perfusion model using an extracorporeal membrane oxygenation device. Five patients undergoing esthetic abdominoplasty participated in this study. Deep inferior epigastric artery perforator flaps were obtained abdominoplasty flaps, which are normally medical waste, used in this model. Deep inferior epigastric artery perforator flaps were extracorporeally perfused with a mean of 6 days. The biochemical and pathological evaluations of the perfusions were discussed in the article.
Source: Annals of Plastic Surgery - Category: Cosmetic Surgery Tags: Transplantation Surgery and Research Source Type: research
Conclusions We present a quick, simple, and affordable method to decellularize a muscle flap through the vascular network. Our proposed method is efficient and can be completed in a significantly shorter time when compared with other methods. It is also safe and does not affect integrity of tissue, and this is essential for a reliable recellularization.
Source: Annals of Plastic Surgery - Category: Cosmetic Surgery Tags: Transplantation Surgery and Research Source Type: research
Polylactic acid (PLA) nanofiber nonwovens have recently come under more vigorous investigation for their use as tissue engineering scaffolds owing to its ability to mimic the physical properties of naturally occurring human extracellular matrix in a variety of host tissues. Currently, the majority of available research on PLA nanowebs has focused on their creation through electrospinning. The goal of this study was to evaluate meltblown nonwoven webs made of nanodiameter PLA fibers for their application as a tissue engineering scaffold. Meltblown PLA fabrics were produced with a variety of different crystallinities, tensil...
Source: Annals of Plastic Surgery - Category: Cosmetic Surgery Tags: Transplantation Surgery and Research Source Type: research
Conclusions Despite many promising clinical trials on application of various stem cell–based therapies for treatment of chronic wounds, there is still a need for multicenter comparative studies assessing the dose response and the cell source response on the efficacy of chronic wound healing.
Source: Annals of Plastic Surgery - Category: Cosmetic Surgery Tags: Review Paper Source Type: research
Fight Aging! provides a weekly digest of news and commentary for thousands of subscribers interested in the latest longevity science: progress towards the medical control of aging in order to prevent age-related frailty, suffering, and disease, as well as improvements in the present understanding of what works and what doesn't work when it comes to extending healthy life. Expect to see summaries of recent advances in medical research, news from the scientific community, advocacy and fundraising initiatives to help speed work on the repair and reversal of aging, links to online resources, and much more. This content is...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
AbstractPurposeLife span and sense of well-being continue to improve post-transplantation in patients with end-stage kidney disease, despite referral of an older and more medically complex population for transplantation. In this issue of the journal, we review existing evidence about risk assessment in kidney transplant candidates from the perspective of the anesthesiologist. The authors explore cardiovascular assessment and risk in the context of intraoperative events that can influence short- and long-term outcomes.Recent FindingsThe number of patients referred for kidney transplantation continues to increase and has far...
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research
AbstractPurposeEnd-stage renal disease (ESRD) is associated with increased cardiovascular risk factors, electrolyte imbalances, and iron deficiency anemia. These factors may increase the risk of adverse outcomes in patients undergoing panniculectomy. There is a paucity of data regarding outcomes in patients with ESRD undergoing panniculectomy. The purpose of this study is to investigate whether ESRD is associated with increased rate of complications following a panniculectomy.MethodThe Nationwide Inpatient Sample database (2006 –2011) was used to identify patients who underwent a panniculectomy. Among this cohort, pa...
Source: Aesthetic Plastic Surgery - Category: Cosmetic Surgery Source Type: research
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