Articles: post-operative.
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The development of pulmonary atelectasis is common in the surgical patient. Pulmonary atelectasis can cause various degrees of gas exchange and respiratory mechanics impairment during and after surgery. In its most serious presentations, lung collapse could contribute to postoperative respiratory insufficiency, pneumonia, and worse overall clinical outcomes. ⋯ Interventions such as noninvasive positive pressure ventilatory support may be beneficial in specific patients at high risk for pulmonary atelectasis (e.g., obese) or those with clinical presentations consistent with lung collapse (e.g., postoperative hypoxemia after abdominal and cardiothoracic surgeries). Preoperative interventions may open new opportunities to minimize perioperative lung collapse and prevent pulmonary complications. Knowledge of pathophysiologic mechanisms of atelectasis and their consequences in the healthy and diseased lung should provide the basis for current practice and help to stratify and match the intensity of selected interventions to clinical conditions.
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Chronic postsurgical pain (CPSP) affects an estimated 10% to 50% of adults depending on the type of surgical procedure. Clinical prediction models can help clinicians target preventive strategies towards patients at high risk for CPSP. Therefore, the objective of this systematic review was to identify and describe existing prediction models for CPSP in adults. ⋯ The most common predictors identified in final prediction models included preoperative pain in the surgical area, preoperative pain in other areas, age, sex or gender, and acute postsurgical pain. Clinical prediction models may support prevention and management of CPSP, but existing models are at high risk of bias that affects their reliability to inform practice and generalizability to wider populations. Adherence to standardized guidelines for clinical prediction model development is necessary to derive a prediction model of value to clinicians.
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Acta Anaesthesiol Scand · Apr 2021
ReviewFluid escapes to the "third space" during anesthesia, a commentary.
The "third fluid space" is a concept that has caused much confusion for more than half a century, dividing anesthesiologists into believers and non-believers. ⋯ During anesthesia and surgery one third of the infused crystalloid fluid is at least temporarily unavailable for excretion, which probably contributes to postoperative weight increase and edema.
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Curr Opin Anaesthesiol · Apr 2021
ReviewDoes thoracic epidural anaesthesia constitute over-instrumentation in video- and robotic-assisted thoracoscopic lung parenchyma resections?
Effective and sustained perioperative analgesia in thoracic surgery and pulmonary resection is beneficial to patients by reducing both postoperative pulmonary complications and the incidence of chronic pain. In this review, the indication of thoracic epidural anaesthesia in video- (VATS) and robotic-assisted (RATS) thoracoscopy shall be critically objectified and presented in a differentiated way. ⋯ Since clear evidence-based recommendations for optimal postoperative analgesia are still lacking in VATS and RATS, there can be no universal recommendation that fits all centres and patients. In this context, thoracic epidural analgesia is the most effective analgesia procedure for perioperative pain control in VATS and RATS-assisted surgery for patients with pulmonary risk factors.
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Minerva anestesiologica · Jun 2019
Meta Analysis Comparative StudyInhalation versus intravenous anesthesia for adults undergoing heart valve surgery: a systematic review and meta-analysis.
Many studies have found that volatile anesthetics are associated with improved clinical outcomes for adults undergoing coronary artery bypass grafting. However, the effect of volatile anesthetics for adults after heart valve surgery has been unclear. So we conducted a meta-analysis of randomized controlled trials (RCTs) to explore whether the choice of an anesthetic regimen might influence patients' outcomes after valve surgery. ⋯ Among patients undergoing heart valve surgery, the use of inhalation anesthesia compared with TIVA failed to demonstrate superiority for survival and major postoperative complications, and the evidence was insufficient to draw firm conclusions due to the limited sample size. A determination of equivalence or superiority between these two anesthetic regimens requires further researches.