BMC anesthesiology
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Reported perioperative pulmonary aspiration (POPA) rates have substantial variation. Perioperative hypoxemia (POH), a manifestation of POPA, has been infrequently studied beyond the PACU, for patients undergoing a diverse array of surgical procedures. ⋯ Adult surgical patients undergoing general anesthesia with horizontal recumbency have substantial POH and POPA rates. Hospital mortality was greater with POPA and post-operative stay was increased for POH and POPA. POH rates were noteworthy for virtually all categories of operative procedures and POH and POPA were independent predictors of post-operative length of stay. A study is needed to determine if modest reverse-Trendelenburg positioning during general anesthesia has a relationship with reduced POH and POPA rates.
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Hypothermia has been used in cardiac surgery for many years for neuroprotection. Mild hypothermia (MH) [body temperature (BT) kept at 32-35°C] has been shown to reduce both mortality and poor neurological outcome in patients after cardiopulmonary resuscitation (CPR). This study investigated whether patients who were expected to benefit neurologically from therapeutic hypothermia (TH) also had improved cardiac function. ⋯ To our knowledge, this is the first study comparing cardiac function at the same BTs during cooling and rewarming. In patients experiencing ROSC following CPR, TH may improve cardiac function and promote favorable neurological outcomes.
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Observational Study
Changes in endotracheal tube cuff pressure during laparoscopic surgery in head-up or head-down position.
The abdominal insufflation and surgical positioning in the laparoscopic surgery have been reported to result in an increase of airway pressure. However, associated effects on changes of endotracheal tube cuff pressure are not well established. ⋯ An increase of endotracheal tube cuff pressure may occur during laparoscopic surgery especially in the head-down position.
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There is limited information on the impact on perioperative fluid intervention on complications and length of hospital stay following pancreaticoduodenectomy. Therefore, we conducted a detailed analysis of fluid intervention in patients undergoing pancreaticoduodenectomy at a university teaching hospital to test the hypothesis that a restrictive intravenous fluid regime and/or a neutral or negative cumulative fluid balance, would impact on perioperative complications and length of hospital stay. ⋯ In the context of pancreaticoduodenectomy, restrictive perioperative fluid intervention and negative cumulative fluid balance were associated with fewer complications and shorter length of hospital stay. These findings provide good opportunities to evaluate strategies aimed at improving perioperative care.
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In the field of anesthesia for bariatric surgery, a wide variety of recommendations exist, but a general consensus on the perioperative management of such patients is missing. We outline the perioperative experiences that we gained in the first two years after introducing a bariatric program. ⋯ The physiology and anatomy of bariatric patients demand a tailored approach from both the anesthesiologist and the perioperative team. The interaction of a multi-disciplinary team is key to achieving good outcomes and a low rate of complications.