Articles: postoperative.
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Curr Opin Anaesthesiol · Dec 2024
ReviewDepth of anesthesia monitoring: an argument for its use for patient safety.
There have been significant advancements in depth of anesthesia (DoA) technology. The Anesthesia Patient Safety Foundation recently published recommendations to use a DoA monitor in specific patient populations receiving general anesthesia. However, the universal use of DoA monitoring is not yet accepted. This review explores the current state of DoA monitors and their potential impact on patient safety. ⋯ There is evidence that DoA monitoring may decrease the incidence of awareness, postoperative delirium, POCD and improve several postoperative outcomes. In children, DoA monitoring may decrease the incidence of awareness and emergence delirium, but long-term effects are unknown. While there are key limitations to DoA monitoring technology, we argue that DoA monitoring shows great promise in improving patient safety in most, if not all anesthetic populations.
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Hepatic portal venous gas(HPVG) represents a rare radiographic phenomenon frequently linked to intestinal necrosis, historically deemed to need immediate surgical intervention. The pivotal query arises about the imperative of urgent surgery when a patient manifests HPVG after gastrointestinal surgery. This inquiry seeks to elucidate whether emergent surgical measures remain a requisite in such cases. ⋯ After gastrointestinal surgery, in Computed Tomography (CT) imaging, the coexistence of HPVG and gastrointestinal dilatation, without signs of peritoneal irritation on abdominal examination, may suggest HPVG due to acute gastrointestinal injury, intestinal gas, and displacement of gas-producing bacteria. These patients can be managed conservatively under close supervision. In cases where HPVG coexists with gastrointestinal dilatation and Pneumatosis intestinalis (PI) without signs of peritoneal irritation, conservative treatment may be continued under close supervision. However, if progressive exacerbation occurs despite close monitoring and the aforementioned treatments, timely surgical exploration is deemed necessary. When HPVG is combined with signs of peritoneal irritation, prompt laparotomy and exploration are preferred.
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Curr Opin Crit Care · Dec 2024
ReviewCerebral oximetry in high-risk surgical patients: where are we?
This review aims to summarize the latest evidence on the role of near-infrared spectroscopy (NIRS) in monitoring cerebral oxygenation in high-risk surgical patients, including both cardiac and noncardiac surgeries, and to present a new algorithm for its application. ⋯ Despite its limitations, including spatial resolution and interindividual variability, NIRS is a useful tool for intraoperative cerebral monitoring. Further studies are needed to confirm its broader applicability in noncardiac surgeries, but current evidence supports its role in reducing postoperative complications especially in cardiac surgeries.
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Minerva anestesiologica · Dec 2024
Randomized Controlled TrialUltrasound-guided bilateral erector spinae plane block in the management of postoperative analgesia in living liver donors: a randomized, prospective study.
Living donor hepatectomy is a procedure associated with notable postoperative pain, impacting patient recovery and satisfaction. Addressing this challenge, we aimed to examine the effect of ultrasound-guided bilateral erector spinae plane block (ESPB) in postoperative analgesia management of patients undergoing living donor hepatectomy for liver transplantation. ⋯ ESPB displayed promise in effectively managing post-living donor hepatectomy pain, resulting in decreased opioid consumption, improved pain relief, and reduced rescue analgesia requirements. This technique holds potential to enhance recovery and patient satisfaction following donor hepatectomy.
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To investigate the long-term clinical outcomes of staged surgical resection in giant Pituitary Neuroendocrine Tumors. ⋯ Staged surgery for giant Pituitary Neuroendocrine Tumors is a safe and effective clinical surgery strategy.