Articles: operative.
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Randomized Controlled Trial
Prophylactic Penehyclidine Inhalation for Prevention of Postoperative Pulmonary Complications in High-risk Patients: A Double-blind Randomized Trial.
Postoperative pulmonary complications are common. Aging and respiratory disease provoke airway hyperresponsiveness, high-risk surgery induces diaphragmatic dysfunction, and general anesthesia contributes to atelectasis and peripheral airway injury. This study therefore tested the hypothesis that inhalation of penehyclidine, a long-acting muscarinic antagonist, reduces the incidence of pulmonary complications in high-risk patients over the initial 30 postoperative days. ⋯ In high-risk patients having major upper-abdominal or noncardiac thoracic surgery, prophylactic penehyclidine inhalation reduced the incidence of pulmonary complications without provoking complications.
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Observational Study
Association of Pre-operative Functional Disability with Chronic Postsurgical Pain: A Prospective Observational Study.
Chronic postsurgical pain negatively affects postoperative recovery. We aimed to assess the association between preoperative functional disability and chronic postsurgical pain. ⋯ Our study showed that in patients who undergo elective abdominal surgery, 12% with preoperative functional disability experience chronic postsurgical pain after 1 year. Preoperative functional disability is associated with chronic postsurgical pain, use of preoperative pain medications and acute postoperative pain. Patients with preoperative functional disability have higher pain numerical rating scale scores at any postoperative measurement point.
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Curr Opin Crit Care · Apr 2022
ReviewImmunosuppressive drugs and associated complications in abdominal organ transplantation.
Intensive care management of patients who have undergone organ transplantation of liver, small bowel, pancreas, and/or kidney requires a basic knowledge of immunosuppression principles and the management of immunosuppressive medications. This review highlights the core principles of immunosuppression management in abdominal organ transplantation with a focus on complications arising from immunosuppressive drugs, both in the immediate postoperative period and in long-term usage. ⋯ For the intensive care professional who cares for abdominal organ transplant recipients, a foundational knowledge of the core principles of immunosuppression management is essential. In addition, an understanding of the common immunosuppressive drug regimens and the complications associated with these regimens is required for optimal management, risk assessment, and outcomes.
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Whether intra-operative hypertension causes postoperative complications remains unclear. ⋯ There was no clinically meaningful relationship between intra-operative systolic pressure and the composite of myocardial injury and mortality, or acute kidney injury, over the range from 120 and 200 mmHg.