Articles: postoperative.
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Advances in medical care have led to an increasing elderly population. Elderly individuals should be able to participate in society as long as possible. However, with an increasing age their adaptive capacity gradually decreases, specially before and after major life events (like hospitalization and surgery) making them vulnerable to reduced functioning and societal participation. Therapeutic exercise before and after surgery might augment the postoperative outcomes by improving functional status and reducing the complication and mortality rate. ⋯ The perioperative exercise training protocol known under the name 'Better in, Better out' could be implemented in clinical care for the vulnerable group of patients scheduled for major elective surgery who are at risk for prolonged hospitalization, complications and/or death. Future research should aim to include this at-risk group, evaluate perioperative high-intensity exercise interventions and conduct adequately powered trials.
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Curr Opin Anaesthesiol · Apr 2014
ReviewPreventing and managing perioperative pulmonary complications following cardiac surgery.
To provide an update of research findings on the mechanisms underlying respiratory complications after cardiac surgery, especially acute respiratory distress syndrome, transfusion-related lung injury and ventilation-associated pneumonia. The article will review some of the preventive and therapeutic measures that can be implemented to reduce these complications, focusing on the use of protective invasive ventilation and postextubation noninvasive ventilation. ⋯ Postoperative pulmonary complications are common, but severe complications are infrequent. Their reduction requires measures to prevent infection and mechanical ventilation-associated lung injury through the use of low tidal volumes and early extubation. Noninvasive ventilation after extubation can be utilized to avoid reintubation and the associated increased morbidity and mortality. However, noninvasive ventilation should be done under rigorous conditions and by following strict criteria.
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Age-related changes in skin contribute to impaired wound healing after surgical procedures. Changes in skin with age include decline in thickness and composition, a decrease in the number of most cell types, and diminished microcirculation. The microcirculation provides tissue perfusion, fluid homeostasis, and delivery of oxygen and other nutrients. ⋯ Judicious use of fluids, maintenance of normal body temperature, pain control, and increased tissue oxygen tension are examples of adjustable variables that support the microcirculation. Anesthetic agents influence the microcirculation of a combination of effects on cardiac output, arterial pressure, and local microvascular changes. The authors examined the role of anesthetic management in optimizing the microcirculation and potentially improving postoperative wound repair in older persons.
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Paediatric anaesthesia · Mar 2014
Review Meta AnalysisEffective postoperative pain management in children after ambulatory surgery, with a focus on tonsillectomy: barriers and possible solutions.
Pain following ambulatory surgery is often poorly managed at home. Certain procedures, such as tonsillectomy, cause high levels of pain for at least 1 week postoperatively. ⋯ A number of interventions have been suggested and trialled in an effort to address these barriers, which encompass educational strategies, improved information provision, improved medication regimens, and the provision of tools to aid parents in the pain management of their children. All in all, improvements in pain outcomes have been minor, and a more holistic approach, that appreciates the complex and multifaceted nature of pain management at home, is required.
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Curr Opin Anaesthesiol · Feb 2014
ReviewCerebral protection: inflammation, endothelial dysfunction, and postoperative cognitive dysfunction.
Postoperative cognitive dysfunction (POCD) is a well recognized perioperative syndrome, with approximately 15% of patients over the age of 60 years displaying objectively measured decrease in cognitive function as a consequence of anesthesia and surgery. The exact cause, however, remains unknown. This review aims to update anesthesiologists on the recent advancements in the understanding of the pathophysiology of POCD. ⋯ Recent research points to a central role of a neuro-inflammatory cascade in POCD, with endothelial dysfunction potentially aggravating the insult. Investigating the genomic and molecular mechanisms that underlie the intervariation in the inflammatory response to surgery, improving the identification of appropriate endothelial and inflammatory biomarkers, and developing endothelial modulatory and anti-inflammatory (prevention and resolution) strategies are key areas of future translational research. This is important as the elderly, who show increased susceptibility to this and other perioperative illness syndromes, represent an ever-increasing proportion of patients presenting for surgery.