Articles: postoperative.
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Pediatr Crit Care Me · Oct 2022
Meta AnalysisEarly Peritoneal Dialysis and Postoperative Outcomes in Infants After Pediatric Cardiac Surgery: Systematic Review and Meta-Analysis.
Peritoneal dialysis (PD) is used in several cardiac surgical units after cardiac surgery, and early initiation of PD after surgery may have the potential to influence postoperative outcomes. This systematic review and meta-analysis aims to summarize the evidence for the association between early PD after cardiac surgery and postoperative outcomes. ⋯ This review suggests that early initiation of PD may be associated with beneficial postoperative outcomes in infants after cardiac surgery. However, these results were based on studies of varying qualities and risk of bias. Early identification of high-risk infants after cardiac surgery is important so that prevention or early mitigation strategies can be applied to this cohort. Future prospective studies in high-risk populations are needed to study the role of early PD in influencing postoperative outcomes.
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Anesthesia and analgesia · Oct 2022
Open Reimplementation of the BIS Algorithms for Depth of Anesthesia.
BIS (a brand of processed electroencephalogram [EEG] depth-of-anesthesia monitor) scores have become interwoven into clinical anesthesia care and research. Yet, the algorithms used by such monitors remain proprietary. We do not actually know what we are measuring. If we knew, we could better understand the clinical prognostic significance of deviations in the score and make greater research advances in closed-loop control or avoiding postoperative cognitive dysfunction or juvenile neurological injury. In previous work, an A-2000 BIS monitor was forensically disassembled and its algorithms (the BIS Engine) retrieved as machine code. Development of an emulator allowed BIS scores to be calculated from arbitrary EEG data for the first time. We now address the fundamental questions of how these algorithms function and what they represent physiologically. ⋯ The openibis algorithm finally provides definitive answers about the BIS: the reliance of the most important signal components on the low-gamma waveband and how these components are weighted against each other. Reverse engineering allows these conclusions to be reached with a clarity and precision that cannot be obtained by other means. These results contradict previous review articles that were believed to be authoritative: the BIS score does not appear to depend on a bispectral index at all. These results put clinical anesthesia research using depth-of-anesthesia scores on a firm footing by elucidating their physiological basis and enabling comparison to other animal models for mechanistic research.
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We present a case series to demonstrate proof-of-concept for the off-label use of an auricular neuromodulation device-originally developed to treat symptoms associated with opioid withdrawal-to instead provide analgesia and opioid-sparing following knee and hip arthroplasties. Within the recovery room, an auricular neuromodulation device (near-field stimulator system 2 [NSS-2] Bridge, Masimo) was applied to 5 patients. Average daily pain at rest and while moving was a median of 0 to 2 as measured on the 0 to 10 numeric rating scale, while median daily oxycodone use was 0 to 2.5 mg until device removal at home on postoperative day 5. One patient avoided opioid use entirely.
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Yonsei medical journal · Oct 2022
Tranexamic Acid and Intraoperative and Postoperative Accumulative Bleeding in Elective Degenerative Spine Surgery.
Spinal surgeries are often associated with a high incidence of perioperative blood loss, which poses several complications. Much current research focuses on the importance of antifibrinolytic drugs during spinal surgeries to reduce blood loss, which can also reduce the risk of the need for blood transfusions. We evaluated the effects of prophylactic, low-dose tranexamic acid (TXA) in spinal fusion surgeries on blood loss, blood transfusions, and associated complications. ⋯ We confirmed that low dose TXA has no effect on intraoperative blood loss volume or blood transfusion requirements and that it can significantly reduce the need for postoperative blood transfusions.
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Anesthesia and analgesia · Oct 2022
Randomized Controlled Trial Multicenter StudyA Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial of Preoperative Antithrombin Supplementation in Patients at Risk for Antithrombin Deficiency After Cardiac Surgery.
Antithrombin (AT) activity is reduced during cardiac operations with cardiopulmonary bypass (CPB), which is associated with adverse outcomes. Preoperative AT supplementation, to achieve >58% and <100% AT activity, may potentially reduce postoperative morbidity and mortality in cardiac operations with CPB. This prospective, multicenter, randomized, double-blind, placebo-controlled study was designed to evaluate the safety and efficacy of preoperative treatment with AT supplementation in patients at risk for low AT activity after undergoing cardiac surgery with CPB. ⋯ AT supplementation did not attenuate adverse postoperative outcomes in our cohort of patients undergoing cardiac surgery with CPB.