International journal of surgery
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Randomized Controlled Trial
Intraoperative monitoring of cerebral NIRS oximetry leads to better postoperative cognitive performance: a pilot study.
The aim of this study is the assessment of the regional cerebral oximetry - NIRS (near infrared spectroscopy) as an intraoperative monitoring system to protect the patient against the incidents of brain desaturations. We hypothesize that patients monitored with NIRS present a smaller range of postoperative cognitive dysfunctions (POCD) in comparison with those without NIRS monitoring during lumbar spine surgery in a prone position. ⋯ NIRS cerebral oximetry may be useful in reducing postoperative cognitive complications in patients operated on in the prone positioning.
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Randomized Controlled Trial
Early post-operative removal of urethral catheter in patients undergoing colorectal surgery with epidural analgesia – a prospective pilot clinical study.
Urethral catheter (UC) removal is often delayed following colorectal resection due to the perceived increased risk of post-operative urinary retention (POUR) in patients with post-operative epidural analgesia (POEA). We aimed to determine if UC removal at 48 h, irrespective of ongoing POEA use, altered the risk of POUR and other morbidities associated with urethral catheterisation and immobility. ⋯ NCT01508767 (http://www.clinicaltrials.gov).
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Review
Strategies to reduce deep sternal wound infection after bilateral internal mammary artery grafting.
Deep sternal wound infections (DSWI) continue to be an infrequent but potentially devastating complication after cardiac surgical procedures. Its prevalence is more after coronary artery bypass grafting using single internal mammary artery (IMA) graft. Bilateral internal mammary artery (BIMA) harvesting carries a higher risk of sternal infection than harvesting single IMA. ⋯ Strategies that reduce DSWI target the modifiable risk factors that include microbiological factors, appropriate antibiotic prophylaxis, tight glycemic control. Surgical strategies to reduce DSWI following BIMA harvest include techniques of IMA harvesting with lesser devascularization of sternum using skeletonized, semiskeletonized and modified pedicle harvest are associated with greater preservation of sternal blood supply and sternal closure and stability techniques. The various strategies to minimize sternal wound infections during preoperative, intra and postoperative periods are summarized in this article.
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Randomized Controlled Trial
Comparative study between duct to mucosa and invagination pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized study.
The ideal technical pancreatic reconstruction following pancreaticoduodenectomy (PD) is still debated. The aim of the study was to assess the surgical outcomes of duct to mucosa pancreaticojejunostomy (PJ) (G1) and invagination PJ (G2) after PD. ⋯ NCT02142517.
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To evaluate epidural analgesia role after cytoreductive surgery with peritonectomy combined with heated intraperitoneal chemotherapy. ⋯ Epidural analgesia ensures adequate pain relief and is well tolerated by patients after cytoreductive surgery with peritonectomy combined with heated intraperitoneal chemotherapy. Hypotension is common in this context and careful monitoring of coagulation parameters, especially in the first 3 days after surgery, is advisable to reduce the risk of neuraxial complications.