Articles: postoperative-complications.
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Anesthesia and analgesia · Nov 2024
ReviewNeurological Complications After Transcatheter Aortic Valve Replacement: A Review.
Transcatheter aortic valve replacement (TAVR) has become the dominant procedural modality for aortic valve replacement in the United States. The reported rates of neurological complications in patients undergoing TAVR have changed over time and are dependent on diagnostic definitions and modalities. Most strokes after TAVR are likely embolic in origin, and the incidence of stroke has decreased over time. ⋯ In this narrative review, we summarize the available data on the incidence of stroke, delirium, and cognitive decline after TAVR and highlight potential areas in need of future research. We also discuss silent cerebral ischemic lesions (SCILs) and their association with a decline in postoperative neurocognitive status after TAVR. Finally, we describe that the risk of delirium and postoperative decline is increased when nonfemoral access routes are used, and we highlight the need for standardized imaging and valid, repeatable methodologies to assess cognitive changes after TAVR.
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Surgery under anesthesia poses a significant stress to the body, and postoperative complications occur in up to 20% of cases. An understanding of postoperative complications, including assessment of patients at risk, risk mitigation, early recognition, and evidence-based treatment, is essential to provide high-value health care. Common postoperative complications reviewed in this article include fever, cerebrovascular accident, nausea and vomiting, ileus, and urinary retention, including discussion of pathophysiology, prevention, and treatment.
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Med. Clin. North Am. · Nov 2024
ReviewEvaluation and Management of Perioperative Pulmonary Complications.
Pulmonary complications are very common after noncardiac surgery and can be easily overlooked. If not properly screened for or evaluated these can in many instances lead to postoperative respiratory failure or even death. Decisions regarding ambulatory versus inpatient surgery, modality of anesthesia, protective ventilation and method of weaning, type of analgesia, and postoperative monitoring can be crucial to avoid such complications.
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Med. Clin. North Am. · Nov 2024
ReviewThe Geriatric Patient: Frailty, Prehabilitation, and Postoperative Delirium.
Historically and for ease of classification, the geriatric patient has received a chronologic definition of a person 65 years and older. Chronologic age remains an independent risk of postoperative complications and adverse surgical outcomes. ⋯ The concept of prehabilitation has shown promise as a proactive approach to optimize a patient's functional, cognitive, nutritional, and emotional in preparation for surgical interventions. Postoperative delirium is the most common neuropsychological complication after surgery.
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Perioperative risks associated with acute hepatitis, cirrhosis, and chronic kidney disease are substantial and prevalence of underlying chronic kidney or liver disease is rising; surgeries in these populations have accordingly become more common. Optimal perioperative management in both cases is paramount; this article focuses on understanding disease pathophysiology, a targeted preoperative evaluation, accurate estimation of perioperative risk, and anticipation and management of common postoperative complications.