Articles: postoperative.
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Randomized Controlled Trial
Intraoperative tight glucose control using hyperinsulinemic normoglycemia increases delirium after cardiac surgery.
Tight intraoperative blood glucose control is associated with postop delirium after cardiac surgery.
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We observed survival after scheduled repair of abdominal aortic aneurysm in 1096 patients for a median (IQR [range]) of 3.0 (1.5-5.8 [0-15]) years: 943 patients had complete data, 250 of whom died. We compared discrimination and calibration of an external model with the Kaplan-Meier model generated from the study data. ⋯ Groups with median 5-year predicted mortality of 40% (n = 251), 18% (n = 414) and 8% (n = 164) had lower observed mortality than 114 patients with 70% predicted mortality, hazard ratio (95% CI): 0.58 (0.37-0.76), p = 0.0031; 0.30 (0.19-0.48), p = 1.7 × 10(-12) and 0.19 (0.13-0.27), p = 1.3 × 10(-10) , respectively, test for trend p = 5.6 × 10(-15). Survival predicted by the external calculator was similar to the Kaplan-Meier estimate.
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This study aimed at assessing whether measures of aerobic fitness can predict postoperative cardiac and pulmonary complications, 30-day mortality and length of hospital stay following elective abdominal aortic aneurysm repair. We prospectively collected cardiopulmonary exercise testing data over two years for 130 patients. Upon multivariate analysis, a decreased anaerobic threshold (OR (95% CI) 0.55 (0.37-0.84); p = 0.005) and open repair (OR (95% CI) 6.99 (1.56-31.48); p = 0.011) were associated with cardiac complications. ⋯ Patients who had an endovascular repair had shorter hospital and critical care lengths of stay (p < 0.001). Measures of fitness were not associated with 30-day mortality or length of hospital stay. Cardiopulmonary exercise testing variables, therefore, seem to predict different postoperative complications following abdominal aortic aneurysm repair, which adds value to their routine use in risk stratification and optimisation of peri-operative care.
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Randomized Controlled Trial Comparative Study
Postoperative Outcome Comparison Between Pudendal Nerve Block and Caudal Block After Lateral Open Internal Sphincterotomy.
To assess the postoperative outcome between pudendal nerve block and caudal block after open lateral internal sphincterotomy for chronic anal fissure. ⋯ Undergoing open lateral internal sphincterotomy with the aid of Pudendal nerve block is an excellent, easy and safe alternative anesthesia to caudal anesthesia.
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Randomized Controlled Trial
Effect of cyclooxygenase-2-specific inhibitors on postoperative analgesia after major open abdominal surgery.
The aim of this study was to examine the effect of cyclooxygenase-2 (COX-2)-specific medications on postoperative analgesia after major open abdominal surgery. This is was a prospective, randomized controlled, double-blind study conducted on 90 patients who underwent major open abdominal surgery between September 2011 and June 2012, in the General Surgery Department, Jinling Hospital. After written informed consent, patients were prospectively and randomly assigned to one of three treatment groups before surgery, and were scheduled to receive different analgesic drugs according to randomization. ⋯ The group that received intravenous parecoxib for 3 days, and continued oral celecoxib for 4 days had better postoperative analgesia than other groups. COX-2-specific inhibitors are safe and effective in reducing postoperative pain in patients who have undergone major open abdominal surgery. Additionally, sufficient postoperative analgesia, lasting for 1 week, was necessary for patients to obtain satisfactory pain control after major open abdominal surgery.