Articles: patients.
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Current practice guidelines do not address the use of neuromuscular blocking and antagonism agents in patients with renal impairment. The FDA label for sugammadex advises against use in patients with severe renal impairment (eGFR < 30 ml/min). Using a multicenter electronic health record registry, we sought to understand the modern use of neuromuscular blockade and antagonism agents in patients with significant renal impairment (eGFR < 60 ml/min). ⋯ Rocuronium-sugammadex is the primary neuromuscular blockade-antagonism strategy for patients with moderate and severe renal impairment. Variation in choice is significantly impacted by the institution and attending anesthesiologist providing care.
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Systematic literature review plus expert opinion framed on Delphi method. ⋯ In patients with BI, concomitant CMI is a modifier of surgical management. In BI with AAD, an additional foramen magnum decompression should be added to posterior C1-C2 realignment and fusion. In BI without AAD, whether treatment is restricted to FMD or C1/2 fusion is required on top or alternatively, demands further studies. Odontoid resections are reserved for patients with insufficient alignment after posterior surgery.
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We analyzed perioperative outcomes of patients undergoing pancreatectomy with portal vein resection for pancreatic cancer using temporary intraoperative mesoportal or mesocaval bypass. ⋯ Temporary intraoperative venous bypass graft first techniques are important surgical approaches for safe resection of advanced pancreatic tumors. Mesoportal and mesocaval shunts are both safe with comparable postoperative morbidity and mortality rates. The decision for mesoportal versus mesocaval bypass should be made according to the anatomy, particularly taking into account the extent of arterial involvement and the potential need for concomitant arterial resection.