1,721,078 research outputs found
The association between nitrous oxide and postoperative mortality and morbidity after noncardiac surgery
No full textNitrous oxide (N2O) has been widely used in clinical anesthesia for >150 years. However, use of N2O has decreased in recent years because of concern about the drug's metabolic side effects. But evidence that routine use of N2O causes clinically important toxicity remains elusive. We therefore evaluated the relationship between intraoperative N2O administration and 30-day mortality as well as a set of major inpatient postoperative complications (including mortality) in adults who had general anesthesia for noncardiac surgery
The association between preoperative anemia and 30-day mortality and morbidity in noncardiac surgical patients
No full textAnemia has been associated with increased postoperative morbidity and mortality. We used the American College of Surgeons National Surgical Quality Improvement Program database to retrospectively assess the relationship between preoperative anemia and 30-day postoperative mortality and morbidity in noncardiac surgical patients, careful to distinguish confounding variables from mediator variables
Morbidity and mortality after massive transfusion in patients undergoing non-cardiac surgery
No full textMassive transfusion is associated with high morbidity and mortality, yet existing reports of massive transfusion are limited. Our primary aim was to determine the incidence of complications and 30-day mortality among patients who received massive transfusions and to explore risk factors associated with 30-day mortality
Erythrocyte storage duration is not associated with increased mortality in noncardiac surgical patients: a retrospective analysis of 6,994 patients
No full textMore than 5 million patients receive erythrocyte transfusions in the United States every year. Previous studies linked the storage duration of allogeneic erythrocytes to the risk of severe postoperative complications, especially after cardiac or trauma surgery. Limited data are available for noncardiac surgical patients. We therefore evaluated the association between storage duration of transfused erythrocytes and postoperative all-cause mortality among general surgery patients
Angiotensin converting enzyme inhibitors are not associated with respiratory complications or mortality after noncardiac surgery
No full textGeneral use of angiotensin-converting enzyme inhibitors (ACEIs) is associated with upper-airway complications such as cough, angioedema, and bronchospasm; furthermore, preoperative use is associated with increased morbidity or mortality. Our primary goal in this study was thus to evaluate the association of ACEI therapy with perioperative respiratory morbidity in adult noncardiac surgical patients. Our secondary goals were to evaluate the association between preoperative use of ACEI and 30-day mortality, as well as to a composite outcome of in-hospital morbidity and mortality in adult noncardiac surgical patients having general anesthesia
Chemotherapy within 30 days before surgery does not augment postoperative mortality and morbidity
No full textPreoperative chemotherapy is frequently given to shrink or decrease the chance of metastasis. However, chemotherapy has well-recognized side effects that may complicate the perioperative period. We therefore tested the hypotheses that chemotherapy within 30 days before cancer surgery is associated with an increased risk of mortality and with a composite of major morbidities within 30 postoperative days
The clinical quandary of counseling the moribund critical care patient-a registry analysis of postsurgical outcomes
No full textTo provide outcomes data to intensivists and surgeons for counseling patients and family members when considering a surgical intervention in a moribund patient
Individualized prediction for the occurrence of acute kidney injury during the first postoperative week following cardiac surgery
No full textSupplementary data to this article can be found online at https://doi.org/10.1016/j.jclinane.2021.110596Study objective: To develop individualized dynamic predictions for the occurrence of acute kidney injury (AKI) during the first postoperative week after cardiac surgery.
Design: Observational retrospective cohort study.
Setting: Single university teaching hospital in Madrid, Spain.
Patients: 3960 cases of major cardiac surgery performed from January 2002 to December 2013.
Measurements: Baseline demographic and clinical characteristics, intraoperative risk factors, and repeated postoperative estimated glomerular filtration rates (eGFR). The primary outcome was AKI during the first postoperative week (stage 1 or higher of the Acute Kidney Injury Network). The dataset was split in two random samples (exploratory and validation). By combining time-to-event outcomes (AKI), and longitudinal data (repeated postoperative eGFR), we developed two different joint models for patients with normal and high baseline levels of serum creatinine (sCr).
Main results: AKI occurred in 1105 patients (31%, 95% confidence interval [CI] 29.5-32.5) in the exploratory sample and 128 (32.2%, 95% CI 27.6-36.8) in the validation sample. For high baseline sCr patients, the risk of an AKI event was associated with the eGFR trajectory (hazard ratio [HR] 0.91, 95% CI 0.90-0.92), as well as with age, and cardiopulmonary bypass time. The normal baseline sCr model incorporated the same covariates and intraoperative transfusion. In this second model, the risk of an AKI event was associated with both the eGFR trajectory (HR 0.91, 95% CI 0.91-0.92, for the current value of eGFR), and with its slope at that point (HR 0.96, 95% CI 0.94-0.99). So AKI risk decreased when the eGFR values increased, in accordance with the speed of this rise. Internal validation showed good discrimination and calibration of both joint models. The AUCs were always higher than 0.7.
Conclusions: The joint models obtained combining both patient risk factors and postoperative eGFR values, are useful to predict individualized risk of cardiac surgery-associated AKI. Predictions can be updated as new information is gathered.Ministerio de Ciencia e Innovación, Spain.Depto. de Estadística y Ciencia de los DatosFac. de Estudios EstadísticosTRUEpu
Comparison of the postoperative effects of adding sufentanil, tramadol and clonidine to caudal block with bupivacaine in children
No full textBu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.Tıpta UzmanlıkÖZET Çalışmamızda çocuklarda bupivakain ile yapılan kaudal bloğa sufentanil, tramadol ve klonidin ekleyerek, intraoperatif hemodinamik parametrelerde stabilite sağlama, daha uzun süreli ve yeterli bir postoperatif analjezi sağlamayı, ayrıca bu üç ilacın etkinliklerini kendi aralarında karşılaştırmayı amaçladık. Çalışmamız elektif ürolojik veya alt batın cerrahisi nedeniyle operasyona alınan 2-8 yaş grubundaki 60 olguda gerçekleştirildi. Genel anestezi indüksiyonundan sonra olgular 4 eşit gruba ayrıldı. Tüm olgulara 0.5 ml/kg total volümde olmak üzere I. gruba %0,25 bupivakain; II. gruba %0,25 bupivakain + 0,5ugr/kg sufentanil; III. gruba %0,25 bupivakain +l,5mgr/kg tramadol; IV. gruba %0,25 bupivakain +lugr/kg klonidin kaudal olarak uygulandı. Olguların intraoperatif ve postoperatif hemodinamik verileri ölçüldü. Analjezi süresi, uygulanan ek analjezik miktarı ile birlikte postoperatif 1, 2, 3, 4, 6, 8, 12, 16 ve 24. saatlerde Modifiye Toddler-Preschooler Postoperatif Ağrı Skalası ve Ağn-Rahatsızlık Skalası ile ağrı skorları, sedasyon ve yan etkiler kaydedildi. Operasyonun 20. dakikasında ortalama arteriyel basınçtaki düşme Grup H'de Grup I'den daha fazlaydı (p<0.05). Ağrı skorları postoperatif ilk 3 saatte HI. Grup'ta II. ve IV. grup'tan yüksekti (p<0.05). Ağrı/rahatsızlık skorları postoperatif ilk 2 saatte IV.grup'ta; I., II. ve III. grup'tan düşüktü (p<0.05). Sedasyon skorları postoperatif 1. saatte IV. grup'ta I., II. ve IILgrup'tan yüksekti (p<0.05). IV. Grup'ta I., II. ve III. Grup'tan daha az yan etki oluştu (p<0.05). Terleme sadece III. grupta yüksek oranda gözlendi (p<0.05). 63Sonuçta, çocuklarda uygulanan kaudal blokta bupivakain içine sufentanil, tramadol ve klonidin eklenmesi operasyon sırasında sufentanil hariç hemodinamik değişiklik yaratmamakta, postoperatif hemodinamik verileri etkilememektedir. Ayrıca postoperatif analjezi süresi ve ek analjezik miktarı değişmemektedir. Ancak klonidin ve sufentanil grubunda özellikle postoperatif ilk 3 saatte daha etkili bir analjezi sağlanmakta ve klonidin ile postoperatif ajitasyon ve yan etki daha az gözlenmektedir. Anahtar kelimeler: Pediatrik, postoperatif analjezi, kaudal blok, bupivakain, sufentanil, tramadol, klonidin. 64COMPARISON OF THE POSTOPERATIVE EFFECTS OF ADDING SUFENTANIL, TRAMADOL AND CLONIDINE TO CAUDAL BLOCK WITH BUPIVACAINE IN CHILDREN SUMMARY In our study we aimed to compare intraoperative haemodynamic stability, prolonged and adequate postoperative analgesia, in addition compare effectivity of sufentanil, tramadol and clonidine when added to bupivacaine in caudal block of children. We studied 60 children, aged 2-8 year, undergoing elective urological or low abdominal surgery. After induction of general anaesthesia the children were randomly divided into four groups. All the patients received total volume of O.SmLkg"1, group I received bupivacaine 0.25% caudally, in addition group II received 0,5 ugr kg"1 sufentanil, group III l,5mgr kg"1 tramadol, Group IV lugr kg"1 clonidine. Intraoperative and postoperative haemodynamic parameters were recorded. Analgesia duration, additional analgesic requirement, sedation, side effects and pain scores were evaluated by modified Toddler- Preschooler Postoperative Pain Scale and Pain/Discomfort Scale at postoperative 1, 2, 3, 4, 6, 8, 12, 16 and 24 hrs. Mean arterial pressure was significantly lower in group II than group I at 20th minutes. Pain scores were higher in group III than groups II and IV during first postoperative 3 hours (p<0.05). Pain/Discomfort scores were lower in group IV than groups I, II and III during first postoperative 2 hours (p<0.05). Sedation scores were lower in group IV than groups I, II and III during first postoperative 1 hours (p<0.05). Frequency of side-effects were less in group 65IV than groups I, II and III (p<0.05). Diaphoresis was observed significantly high in group III (p<0.05). As a result, the addition of sufentanil, tramadol or clonidine to bupivacaine for caudal block in children causes no haemodynamic variation during surgey except sufentanil, and does not effect postoperative haemodynamic variables. Furthermore, there were no significant difference in analgesic duration and requirement for additional analgesics. However sufentanil and clonidine provides more effective analgesia especially during postoperative first 3 hours and clonidine causes less postoperative agitation and side-effects in children. Keywords: Pediatric, postoperative analgesia, caudal block, bupivacaine, sufentanil, tramadol, clonidine. 6
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