Articles: postoperative.
-
Minerva anestesiologica · Aug 2014
Percentage hematocrit variation (phevar) index as a quality indicator of patient blood management in cardiac surgery.
Severe hemodilution and perioperative bleeding are determinants of hematocrit (HCT) variations in cardiac surgery patients. These variations may be direct determinants of bad outcomes, and may trigger allogeneic blood product transfusions, which are associated with morbidity and mortality. The present study introduces the Percentage HEmatocrit VARiation (PHEVAR) index as a tool to assess the quality of patient blood management (PBM) and to possibly guide specific interventions. ⋯ The PHEVAR index reflects HCT variations during 7 days of hospital stay in cardiac surgery patients, is associated with mortality and morbidity, and may be used as a quality index for PBM.
-
Journal of anesthesia · Aug 2014
Randomized Controlled Trial Comparative StudyUltrasound-guided sciatic nerve block: a comparison between four different infragluteal probe and needle alignment approaches.
Our aim was compare onset time of sciatic nerve blockade (SNB) performed distal to the subgluteal fold using four different ultrasound (US)-guided approaches in patients undergoing foot or ankle surgery. ⋯ The LA-IP approach resulted in a rapid onset of SNB and was associated with the best satisfaction for postoperative analgesia in comparison with LA-OP, SA-IP, and SA-OP approaches for patients undergoing foot and ankle surgery.
-
Observational Study
Cerebral Regional Oxygen Saturation and Serum Neuromarkers for the Prediction of Adverse Neurologic Outcome in Pediatric Cardiac Surgery.
The aim of this study is to determine the utility of non-invasive bedside neuromonitoring, including cerebral regional oxygen saturation (rSO2) measured by near-infrared spectroscopy and serum biomarkers, in identifying children at risk from adverse neurological outcome after heart surgery. ⋯ Bedside determination of cerebral rSO2 may have some utility in identifying children at risk for adverse neurological outcome after heart surgery in children. Additional studies that are sufficiently powered to control for the many covariates in this patient population will be required to fully interrogate this important question. The role of serum neuromarkers in the immediate post-operative period do not appear to be helpful in this question, though more thorough interrogation of delayed periods may ultimately demonstrate some utility in answering this question.
-
Acta Anaesthesiol Scand · Aug 2014
Observational StudyDynamic variables and fluid responsiveness in patients for aortic stenosis surgery.
Aortic stenosis is the most common valvular disease in developed countries, but it carries an increased mortality during non-cardiac surgery underscoring the importance of adequate hemodynamic management. Further, haemodynamic management of patients immediately after surgery for aortic stenosis can be challenging. Prediction of fluid responsiveness using dynamic variables has not been sufficiently studied in patients for aortic stenosis surgery. ⋯ The arterial pressure-based variables had moderate predictive values before valve replacement, but it predicted fluid responsiveness well postoperatively. Pleth variability index did not predict fluid responsiveness preoperatively, and it had a moderate predictive value postoperatively. These results indicate that arterial pressure-based dynamic variables have limited potential to guide fluid therapy in patients with aortic stenosis. Their ability to guide fluid therapy after aortic valve replacement seems better.
-
Journal of anesthesia · Aug 2014
Randomized Controlled Trial Comparative StudyA randomised trial of oral versus intravenous opioids for treatment of pain after cardiac surgery.
Cardiac surgery and sternotomy are procedures accompanied by substantial postoperative pain which is challenging to treat. In general, intravenous (IV) opioids are used in the immediate postoperative phase, followed by oral opioids. Oral opioids are easier to use and generally less expensive. Our goal was thus to determine whether a new opioid preparation provides adequate analgesia after sternotomy. In particular, we tested the primary hypothesis that total opioid use (in morphine equivalents) is not greater with oral opioid compared with patient-controlled IV morphine. Our secondary hypothesis was that analgesic efficacy is similar with oral and IV opioids. ⋯ Analgesic quality was comparable with oral and IV opioids, suggesting that postoperative pain even after very painful procedures can be sufficiently managed with oral opioids.