42 research outputs found
Preoperative preparation of patients, who are on a antiplatelet and/or anticoagulant therapy, for noncardiac surgery
No full text
Cost-effectiveness of the Perioperative Pain Management Bundle a registry-based study
No full textINTRODUCTION
The Perioperative Pain Management Bundle was introduced in 10 Serbian PAIN OUT network hospitals to improve the quality of postoperative pain management. The Bundle consists of 4 elements: informing patients about postoperative pain treatment options; administering a full daily dose of 1-2 non-opioid analgesics; administering regional blocks and/or surgical wound infiltration; and assessing pain after surgery. In this study, we aimed to assess the cost-effectiveness of the Bundle during the initial 24 h after surgery.
MATERIALS AND METHODS
The assessment of cost-effectiveness was carried out by comparing patients before and after Bundle implementation and by comparing patients who received all Bundle elements to those with no Bundle element. Costs of postoperative pain management included costs of the analgesic medications, costs of labor for administering these medications, and related disposable materials. A multidimensional Pain Composite Score (PCS), the effectiveness measurement, was obtained by averaging variables from the International Pain Outcomes questionnaire evaluating pain intensity, interference of pain with activities and emotions, and side effects of analgesic medications. The incremental cost-effectiveness ratio (ICER) was calculated as the incremental change in costs divided by the incremental change in PCS and plotted on the cost-effectiveness plane along with the economic preference analysis.
RESULTS
The ICER value calculated when comparing patients before and after Bundle implementation was 181.89 RSD (1.55 EUR) with plotted ICERs located in the northeast and southeast quadrants of the cost-effectiveness plane. However, when comparing patients with no Bundle elements and those with all four Bundle elements, the calculated ICER was -800.63 RSD (-6.82 EUR) with plotted ICERs located in the southeast quadrant of the cost-effectiveness plane. ICER values differ across surgical disciplines.
CONCLUSION
The proposed perioperative pain management Bundle is cost-effective. The cost-effectiveness varies depending on the number of implemented Bundle elements and fluctuates across surgical disciplines
Evaluation of the risk malignancy index diagnostic value in patients with adnexal masses
No full textBackground/Aim. Ovarian cancer is the leading cause of death from gynecologic
malignancies. Risk of malignancy index (RMI) is recommended in assessment of
patients with adnexal masses. The aim of this study was to verify the
effectiveness of the RMI in the discrimination between benign lesions and
malignant adnexal masses in clinical practice. Methods. Ultrasounds were
performed for all the patients and menopausal status, CA125 level and
calculated RMI were defined. All the patients were divided into 3 groups
depending on RMI (< 25, 25-200, > 200). After operations all adnexal masses
were analyzed histopathologically (HP) and then sensitivity, specificity and
predictive value of RMI were calculated. Results. Out of a total of 81
patients involved benign tumor had 51 (62.96%) and malignant 30 (37.04%) of
the patients. The average value of CA125 in the group of patients with benign
adnexal masses was 68.3 U/mL and in the group of patients with malignant
adnexal masses it was 581.95 U/mL. In the group of patients with benign
adnexal masses the average RMI was 284.9 and in the group of patients with
malignant adnexal masses RMI was 469.2. All the results showed a positive
correlation between both HP categories and RMI categories. The more malignant
HP result produced higher RMI and the cut off value was RMI = 200.
Sensitivity of RMI was 83.33%, specificity was 94.12%, positive predictive
value was 89.29% and negative predictive value was 90.57%. Conclusion. Our
study showed that RMI is very reliable in differentiation benign from
malignant adnexal masses.</jats:p
Extremely rapid development of transurethral resection of the prostate syndrome
No full textBackground. The transurethral resection of the prostate (TURP) syndrome is reported after ureteroscopic procedures with irrigating solutions. TURP syndrome may occur quickly or up to 24 hours postoperatively. TURP syndrome affects many systems and manifests itself mainly through acute changes in intravascular volume and plasma solute concentrations. Case report. We reported a 72- year-old patient with benign prostatic hyperplasia, diabetes mellitus and angina pectoris who underwent TURP under spinal anesthesia. Unusual marked somnolence, bradycardia (38 beats/min), disorientation and face edema indicated a diagnosis of TURP syndrome only 15 minutes after the operation had started. The diagnosis confirmed by arterial gas analyses (metabolic acidosis, pH was 7.29) and hyponatremia (96 mmol/l). Aggressive and adequate therapy with diuretic and bicarbonates decreased symptoms and saved patient's life. Conclusion. Very fast development of TURP syndrome is possible. Continuous patient monitoring is necessary to provide fast recognition of TURP syndrome. Adequate therapy can prevent considerable complications.</jats:p
Preoperative evaluation of patients with history of allergy
No full textThe prevalence of allergic reactions in general population shows a constant
rise. It has been estimated that up to 40% of surgical patients have a
positive history of some kind of allergy. These patients represent a
challenge during perioperative evaluation, since they can be exposed to a
large variety of drugs and substances during surgery and anesthesia. A lot of
adverse drug reactions show similar clinical presentation with allergic
reactions. The latter are usually poorly explored since preoperative
allergology testing is performed in a limited number of patients. Management
of patients with history of allergy is impeded by the fact that most of
allergens cross-react in a manner that is not always easy to predict.
Allergies can manifest themselves with a broad spectrum of clinical symptoms,
ranging from mild skin symptoms such as itch and urticaria, to a
life-threatening anaphylactic reactions followed by hypotension, bronchospasm
and cardiovascular collapse. Prevention of allergic reactions during
perioperative period requires detailed history taking in order to identify
patients at risk, optimization of anesthesia strategy, pharmacological
premedication and further allergology diagnostic work-up in selected cases.</jats:p
Application of transvaginal sacrospinous colpopexy in the treatment of pelvic organs prolapse
No full textIntroduction. The incidence of uterovaginal and vaginal vault prolapse appears to be higher due to the increased longevity of women. Sacrospinous ligament colpopexy is a surgery procedure which suspends the vagina up to the sacrospinous ligament and brings upper vagina over the levator plate. This technique is very useful for the primary treatment of uterovaginal prolapse in young women who want to preserve their fertility. The main aim of our study was to present the effectiveness of the us of this technique at our clinic, to investigate the possible intraoperative and postoperative complications of this technique, and to find out its effectiveness in the prevention of repeated vaginal vault prolapse. Methods. Patients were treated with sacrospinous colpopexy with uterine conservation, vaginal hysterectomy with simultaneous sacrospinous colpopexy or obliteration of the enterocele sac, and sacrospinous colpopexy. Follow-up examinations of the patients we performed at 4 weeks, 6 months and 12 months after the surgery and yearly thereafter. Results. Thirtyseven women were treated with sacrospinous ligament suspension of vaginal vault. The 5 women had vault prolapse following the hysterectomy (the 3 of then had abdominal, and the 2 vaginal hysterectomy), and another 32 women had the various degrees of uterovaginal prolapse. We obtained satisfactory results in 33 patients, in the 3 we noticed asymptomatic cystocele, and the 1 (2,7%) had partial vaginal vault prolapse six months after the surgery. With regard to postoperative complications, 3 patients had urination disturbance, 3 patients had urinary tract infection, 2 patients had febrile temperature, and the 2 patients had low back pain. Discussion. We performed sacrospinous fixation on the right side, and the postoperative results demonstrated no disturbance in vaginal axis and vault prolapse except in 1 patient. We had no intraoperative complications noted related to sacrospinous ligament colpopexy, such as the damage to the pudendal vessels and nerve, the sciatic nerve and rectum. The possibility of injury to the vessels and nearby nerves was preventid with the careful placement of suture through the sacrospinous ligament in the two fingerbreadths medial to its insertion in the ischial spine. In our series, we had 3 patients with conservation of the uterus. The 3 asymptomatic cystocele in our series were diagnosed 6 months after the operation. Our results were satisfactory, since we hade only one postoperative vault prolapse (2,7%). Conclusion. The results of numerous studies, as well as the results of our study, showed that transvaginal sacrospinous colpopexy could be performed along with vaginal hysterectomy and the anterior and posterior vaginal wall repair in the patients with uterovaginal prolapse because of its high success in the prevention of postoperative vaginal vault prolapse and the low intra- and postoperative complication rates. This operative technique is successful in prevention of repeated vaginal vault prolapse.</jats:p
Preoperative assessment of patients with end stage renal failure
No full textPatients with end stage renal failure (ESRF) present a number of challenges
to the anesthesiologist. They may be chronically ill and debilitated and have
the potential for multisystem organ dysfunction. Patients with primary renal
disease are likely younger and have good cardiopulmonary reserve. Older
patients with renal failure secondary to diabetes mellitus or hypertension
may suffer the ravages of diffuse atherosclerosis and heart disease. To
safely manage these patients we need to understand the benefits and
limitations of dialysis, problems related with primary disease,
pathophysiological effects of ESRF, and the altered pharmacology of commonly
used anesthetic agents and perioperative medications in ESRF. Problems
encountered by anesthesiologist in ESRF patients include hypertension,
ischemic heart disease, congestive heart failure, anemia, metabolic acidosis,
hyperkaliemia, hyponatremia and circulatory collapse. All surgical procedure
in patients with ESRF carries significant risk of peri- and postoperative
complications (mostly cardiovascular) and even fatal outcome.</jats:p
Low Back Pain among Medical Students in Belgrade (Serbia): A Cross-Sectional Study
No full textAim. To examine the prevalence of low back pain, to identify self-perceived triggers of low back pain, and to investigate the impact of perceived pain on the daily activities and mood among medical students. Methods. This cross-sectional study enrolled 459 fourth year students at the Faculty of Medicine in Belgrade during December 2014. The anonymous questionnaire was used for data collection. In data analysis, the chi-square test and t-test were used. Results. The lifetime prevalence of low back pain was 75.8%, 12-month prevalence 59.5%, and point prevalence 17.2%. Chronic low back pain was experienced by 12.4% of the students. Both the lifetime (p=0.001) and the 12-month (p=0.001) low back pain prevalence rates were significantly higher among female medical students. Mental stress during an exam period (p=0.001), sitting at the university (p=0.002), fatigue (p=0.043), improper body posture (p=0.005), and lack of exercise (p=0.001) as self-perceived triggers of low back pain were significantly more often reported by female students, compared to males. Regarding daily functioning, the experience of low back pain mostly affects students sleeping (14.6%) and walking (12.0%). Conclusions. The prevalence of LBP is high among Belgrade medical students and significantly affects their everyday functioning
