Articles: postoperative.
-
Acta Anaesthesiol Scand · Jul 2015
Twenty-four hour hyperinsulinemic-euglycemic clamp improves postoperative nitrogen balance only in low insulin sensitivity patients following cardiac surgery.
Critically ill patients often suffer from a protein catabolic state. The aim of this study was to demonstrate that nitrogen balance (NB) in cardiac patients admitted to the intensive care unit (ICU) is related to their insulin sensitivity level and that supraphysiologic doses of insulin can restore anabolism. ⋯ A negative NB was found only in insulin resistant patients admitted to the ICU for more than 7 days. A 24-h period HEC improved NB in these patients.
-
Observational Study
Influence of Centrally Mediated Symptoms on Postoperative Pain in Osteoarthritis Patients Undergoing Total Knee Arthroplasty: A Prospective Observational Evaluation.
Central sensitization plays an important role in the chronic pain experienced by osteoarthritis (OA) patients. In this prospective observational study, we investigated the influence of the level of preoperative centrally mediated symptoms measured by the Central Sensitization Inventory (CSI) on pain intensity after total knee arthroplasty (TKA) for OA. ⋯ OA patients with high levels of comorbid centrally mediated symptoms showed severe pain and increased analgesic requirements after TKA in the early postoperative period. Moreover, these patients seemed to be at higher risk of persistent pain, and a high CSI score was predictive of low patient satisfaction in terms of pain relief after surgery.
-
Vitamin D deficiency has been associated with chronic non-specific musculoskeletal pain syndromes; however, studies are lacking with respect to its relationship with postoperative pain. We tested the hypothesis that a lower preoperative vitamin D level is associated with increased postoperative pain and/or opioid consumption in morbidly obese patients who had laparoscopic bariatric surgery. ⋯ We did not find any association between preoperative vitamin D levels and postoperative pain scores/opioid consumption in morbidly obese patients undergoing bariatric surgery.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2015
[EnglischerTitel: Epidural anesthesia - complications and side effects].
Thoracic epidural anesthesia remains the gold standard of intra- and postoperative analgesia for a multitude of surgical procedures as a reliable and relatively safe procedure with a low rate of complications as long as contraindications are respected. However, if complications do occur they often result in catastrophic sequelae for the patient. ⋯ Procedural complications often result in additionally required procedures and treatments, hence increasing morbidity of the affected patient. The aim of this review is to provide the reader with a current overview of the available literature with regards to classical and procedural complications.
-
Anesthesia and analgesia · Jul 2015
Observational StudyThe Effect of Adding Functional Classification to ASA Status for Predicting 30-Day Mortality.
The functional capacity to perform the activities of daily living is identified as an independent predictor of perioperative mortality but is not formally incorporated in the American Society of Anesthesiologists (ASA) classification. Our primary objective was to assess whether functional capacity is an independent predictor of 30-day and long-term mortality in a general population and, if so, to define how it may formally be incorporated into the routine preoperative ASA classification assessment. ⋯ Functional capacity was an independent predictor of mortality within each ASA class, indicating that it should be considered for incorporation into the routine preoperative evaluation. Functional dependence may be an indication for increasing a patient's ASA class by 1 class-point to better reflect his or her perioperative risk, but prospective validation of these findings is recommended, as this is a preliminary study.