Articles: postoperative.
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Randomized Controlled Trial
Low-Dose Ketamine Infusions for Highly Opioid-Tolerant Adults Following Spinal Surgery: A Retrospective Before-and-after Study.
Managing acute-on-chronic pain in opioid-tolerant individuals is complex and challenging; exploring new analgesia regimens for this population is essential. Ketamine is an N-methyl D-aspartate antagonist that blocks transmission of painful stimuli and could be a useful medication for this patient population. A new low-dose ketamine protocol as an adjunct to conventional pain therapy was implemented in a major urban Level 1 trauma center in Canada. ⋯ There were no statistically significant differences between conventional therapy and conventional therapy plus ketamine. Ketamine may still be of benefit to patients with acute-on-chronic pain, although this was not evident in this study. Future research using more robust assessment tools to determine effectiveness of ketamine is required.
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J Clin Monit Comput · Apr 2016
Assessment of the time-dependent need for stay in a high dependency unit (HDU) after major surgery by using data from an anesthesia information management system.
Admittance to a high dependency unit (HDU) is expensive. Patients who receive surgical treatment with 'low anterior resection of the rectum' (LAR) or 'abdominoperineal resection of the rectum' (APR) at our hospital are routinely treated in an HDU the first 16-24 h of the postoperative (PO) period. The aim of this study was to describe the extent of HDU-specific interventions given. ⋯ Another one-third of the patients had a need for HDU-specific therapies for more than ten consecutive hours, primarily an infusion of nor-epinephrine. Most patients treated with LAR or APR was in need of an HDU-specific intervention during the first 6 h of the PO-period, with a marked decline after this time period. The applied methodology, using an AIMS, demonstrates that there is great variability in individual patients' postoperative needs after major surgery, and that these needs are dynamic in their nature.
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Pediatr Crit Care Me · Apr 2016
Micro-RNA-208a, -208b, and -499 as Biomarkers for Myocardial Damage After Cardiac Surgery in Children.
To test the hypothesis that cardiac-enriched micro-RNAs can serve as accurate biomarkers that reflect myocardial injury and to predict the postoperative course following pediatric cardiac surgery. Micro-RNAs have emerged as plasma biomarkers for many pathologic states. We aimed to quantify preoperative and postoperative plasma levels of cardiac-enriched micro-RNA-208a, -208b, and -499 in children undergoing cardiac surgery and to evaluate correlations between their levels, the extent of myocardial damage, and the postoperative clinical course. ⋯ Circulating micro-RNA-208a, -208b, and -499 are detectable in the plasma of children undergoing cardiac surgery and may serve as novel biomarkers for monitoring and forecasting postoperative myocardial injury and recovery.
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Observational Study
[Relevance of preoperative anxiety for postoperative outcome in urological surgery patients : A prospective observational study].
Preoperative anxiety is not systematically assessed during premedication appointments, although it may influence the postoperative course and outcome. ⋯ Preoperative anxiety is a frequent concern and often not correctly assessed by physicians. The use of scoring systems to detect preoperative anxiety is useful in clinical routine and helps to decide on therapeutic interventions.
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Minerva anestesiologica · Mar 2016
Serious renal and urological complications in fast-track primary total hip and knee arthroplasty; a detailed observational cohort study.
Overall medical complications have been reduced after fast-track total hip (THA) and knee arthroplasty (TKA), but data on specific renal and urological (RU) complications are limited. ⋯ The overall incidence of serious RU complications after fast-track THA and TKA was 0.61 %. AKI occurred in 0.49% and was most often due to pre-existing kidney disease and postoperative hypotension, calling for increased focus on perioperative fluid management and optimisation of the perioperative care of patients with pre-existing kidney disease.