Gestational hemostasis: a natural model for hemostasis resuscitation of major periprocedural blood loss
AbstractEarly goal-directed treatment is an evidence-based approach to guide hemostatic therapy during major periprocedural bleeding. If viscoelastic coagulation tests are not available, an algorithm, termed the pyramid of hemostatic interventions, can help manage severe bleeding. Pregnant women accumulate huge reserves of prothrombotic and antifibrinolytic hemostatic elements to avoid peripartum blood loss. We provide comparison of therapeutic hemostatic approaches and natural gestational process and identified remarkable analogy between early goal-directed management of bleeding and hemostatic adaptation of pregnant woma...
Source: Perioperative Medicine - December 13, 2021 Category: Surgery Source Type: research
Risk factors and outcomes associated with postoperative ileus following ileostomy formation: a retrospective study
ConclusionsMinimizing fluid overload, particularly in the first 48 h after surgery, may be a strategy to reduce POI in patients undergoing ileostomy formation, and thus decrease postoperative LOS and hospitalization cost. Fluid restriction, diuresis, and changes in diet advancement or early stoma intubation should be considered measures that may improve outcomes and should be studied more intensively. (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 13, 2021 Category: Surgery Source Type: research
Influences of remote ischemic preconditioning on postoperative delirium and cognitive dysfunction in adults after cardiac surgery: a meta-analysis of randomized controlled trials
ConclusionsCurrent evidence from RCTs did not support that RIPC could prevent the incidence of POD or POCD in adults after cardiac surgery. Although these findings may be validated in large-scale RCTs, particularly for the results of POCD, based on these findings, RIPC should not be routinely used as a preventative measure for POD and POCD in adult patients after cardiac surgery. (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 10, 2021 Category: Surgery Source Type: research
Comparison of the TOFscan and the TOF-Watch SX during pediatric neuromuscular function recovery: a prospective observational study
ConclusionsTOFscan reliably demonstrated lack of bias and good concordance with TOF-Watch SX throughout the neuromuscular recovery, especially when normalized. Despite technical limitations, the two devices were unbiased along the path of spontaneous and pharmacological reversal in pediatric patients.Trial registrationClinicalTrials.gov NCT03775603. Registered on 13 March 2018 (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 10, 2021 Category: Surgery Source Type: research
Electroencephalography-demonstrated mechanisms of dexmedetomidine-mediated deepening of propofol anesthesia: an observational study
ConclusionsProfound EEG changes support the supposition that Dex enhances propofol-induced GA from a moderate to a deeper state. The present findings provide a theoretical basis and reference regarding protocols aimed at reducing anesthetic/sedative dosage while maintaining sufficient depth of GA.Clinical trial registrationChiCTR,ChiCTR1900026955. Registered on 27 October 2019 (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 9, 2021 Category: Surgery Source Type: research
Deep neuromuscular block reduces the incidence of intra-operative complications during laparoscopic donor nephrectomy: a pooled analysis of randomized controlled trials
ConclusionsOur data indicate that the use of deep neuromuscular blockade could increase safety during laparoscopic donor nephrectomy. Future randomized clinical trials should be performed to confirm this and to pursue whether it also applies to other types of laparoscopic surgery.Trial registrationClinicaltrials.gov LEOPARD-2 (NCT02146417), LEOPARD-3 trial (NCT02602964), and RELAX-1 study (NCT02838134), Klop et al. (NTR 3096), Dols et al.2014 (NTR1433). (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 9, 2021 Category: Surgery Source Type: research
Preoperative anxiety as predictor of perioperative clinical events following carotid surgery: a prospective observational study
ConclusionsThe present study indicates that preoperative anxiety is associated with the occurrence of intra- and postoperative neurological events in patients undergoing CEA. Patients who had a preoperative HADS-A score of 6 or less had a very low probability of experiencing these complications. (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 8, 2021 Category: Surgery Source Type: research
5-HT3 receptor antagonists decrease the prevalence of postoperative delirium in older patients undergoing orthopedic lower limb surgery
Conclusion5-HT3 receptor antagonists may be related with a significantly reduced risk for POD in older patients undergoing orthopedic lower limb surgery. Notably, palonosetron was more effective for POD prevention. (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 8, 2021 Category: Surgery Source Type: research
Do ARISCAT scores help to predict the incidence of postoperative pulmonary complications in elderly patients after upper abdominal surgery? An observational study at a single university hospital
ConclusionsPPCs are common in elderly patients. They are associated with increased levels of postoperative morbidities and extended ICU and hospital stays. Using the ARISCAT score as an assessment tool facilitates the classification of Thai patients into PPC risk groups. The ARISCAT scoring system might be able to be similarly applied in other Southeast Asian countries. (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 8, 2021 Category: Surgery Source Type: research
High-flow nasal oxygenation reduces the risk of desaturation in adults receiving procedural sedation: a meta-analysis of randomized controlled trials
ConclusionsCompared with standard oxygen therapy, HFNO may reduce the risk of desaturation and increase the lowest SpO2 in adult patients undergoing sedation for medical procedures. (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 6, 2021 Category: Surgery Source Type: research
Hyperspectral imaging for perioperative monitoring of microcirculatory tissue oxygenation and tissue water content in pancreatic surgery — an observational clinical pilot study
ConclusionThis is the first study using HSI skin measurements to visualize tissue oxygenation and tissue water content in patients undergoing pancreatic surgery. HSI was able to measure short-term changes of tissue oxygenation during anaesthetic induction and pre- to postoperatively. TWI indicated a perioperative increase of tissue water content. Perioperative use of HSI could be a useful extension of haemodynamic monitoring to assess the microcirculatory response during haemodynamic therapy and major surgery.Trial registrationGerman Clinical Trial Register,DRKS00017313 on 5 June 2019 (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 1, 2021 Category: Surgery Source Type: research
Feasibility of a randomized hypertension screening initiative in the perioperative setting
ConclusionsThis feasibility study suggests that interventional blood pressure trials in the preoperative clinic are feasible, but telephone follow-up leads to significant gaps in outcome ascertainment.Trial registrationClinicaltrials.gov,NCT03634813. Registered 16 of August 2018. (Source: Perioperative Medicine)
Source: Perioperative Medicine - November 22, 2021 Category: Surgery Source Type: research
Enhanced recovery after surgery protocol and postoperative opioid prescribing for cesarean delivery: an interrupted time series analysis
ConclusionAlthough ERAS implementation reduced the overall proportion of patients receiving a discharge opioid prescription after cesarean delivery, for the subset of patients receiving an opioid prescription, ERAS implementation may have inadvertently increased the prescribing of daily doses greater than 90 OME. This finding highlights the importance of early and continued evaluation after new policies are implemented. (Source: Perioperative Medicine)
Source: Perioperative Medicine - November 15, 2021 Category: Surgery Source Type: research
Association between preoperative serum homocysteine and delayed neurocognitive recovery after non-cardiac surgery in elderly patients: a prospective observational study
ConclusionsElderly patients with high homocysteine levels who underwent general anesthesia for non-cardiac surgery have an increased risk of dNCR. This knowledge could potentially assist in the development of preventative and/or therapeutic measures.Trial registrationNCT03084393 (https://www.clinicaltrials.gov) (Source: Perioperative Medicine)
Source: Perioperative Medicine - November 8, 2021 Category: Surgery Source Type: research
The effect of the family presence on anxiety and agitation of patients under mechanical ventilation after open heart surgery: a randomized clinical trial
ConclusionAccording to the findings of the present study, the presence of a family member does not reduce the level of anxiety and agitation of patients undergoing cardiac surgery. However, it can be concluded that this intervention is feasible in acute and complex situations after open heart surgeries.Trial registrationThis study has been registered in the Iranian Registry of Clinical Trials with the codeIRCT201609014299N4. (Source: Perioperative Medicine)
Source: Perioperative Medicine - November 1, 2021 Category: Surgery Source Type: research
