Anesthesia and analgesia
-
Anesthesia and analgesia · Jun 2011
Review Meta AnalysisA systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients.
Complications from major surgery are undesirable, common, and potentially avoidable. The long-term consequences of short-term surgical complications have recently been recognized to have a profound influence on longevity and quality of life in survivors. In the past 30 years, there have been a number of studies conducted attempting to reduce surgical mortality and morbidity by deliberately and preemptively manipulating perioperative hemodynamics. Early studies had a high control-group mortality rate and were criticized for this as being unrepresentative of current practice and raised opposition to its implementation as routine care. We performed this review to update this body of literature and to examine the effect of changes in current practice and quality of care to see whether the conclusions from previous quantitative analyses of this field remain valid. ⋯ The use of a preemptive strategy of hemodynamic monitoring and coupled therapy reduces surgical mortality and morbidity.
-
Anesthesia and analgesia · Jun 2011
ReviewMaintaining tissue perfusion in high-risk surgical patients: a systematic review of randomized clinical trials.
Surgical patients with limited organic reserve are considered high-risk patients and have an increased perioperative mortality. For this reason, they need a more rigorous perioperative protocol of hemodynamic control to prevent tissue hypoperfusion. In this study, we systematically reviewed the randomized controlled clinical trials that used a hemodynamic protocol to maintain adequate tissue perfusion in the high-risk surgical patient. ⋯ In high-risk surgical patients, the use of a hemodynamic protocol to maintain tissue perfusion decreased mortality and postoperative organ failure. Monitoring cardiac output calculating oxygen transport and consumption helped to guide therapy. Additional randomized controlled clinical studies are necessary to analyze the value of monitoring mixed or central venous oxygen saturation and lactate in high-risk surgical patients.
-
Anesthesia and analgesia · Jun 2011
Randomized Controlled TrialThe efficacy of a novel approach to transversus abdominis plane block for postoperative analgesia after colorectal surgery.
The analgesic efficacy of transversus abdominis plane (TAP) block has been established for patients undergoing abdominal surgery. We evaluated the efficacy of a novel approach to TAP block for postoperative analgesia after colorectal surgery. ⋯ This new approach to the TAP block provides effective postoperative analgesia after colorectal surgery.
-
Anesthesia and analgesia · Jun 2011
Randomized Controlled TrialThe effects of short interactive animation video information on preanesthetic anxiety, knowledge, and interview time: a randomized controlled trial.
We designed an interactive animated video that provides a basic explanation-including the risks, benefits, and alternatives-of anesthetic procedures. We hypothesized that this video would improve patient understanding of anesthesia, reduce anxiety, and shorten the interview time. ⋯ Our short interactive animation video helped patients' understanding of anesthesia and reduced anesthesiologists' interview time.
-
Anesthesia and analgesia · Jun 2011
Chronic kidney disease and postoperative morbidity after elective orthopedic surgery.
Reduced estimated glomerular filtration rate (eGFR) is strongly associated with increased cardiovascular risk and all-cause mortality. Associations with morbidity in elective, moderate-risk noncardiac surgery have not been explored. We hypothesized that chronic kidney disease (CKD) would be associated with excess morbidity after elective, moderate-risk orthopedic surgery. ⋯ A substantial minority of patients with CKD undergoing elective orthopedic procedures are at increased risk of prolonged morbidity and hospital stay. Preoperative eGFR may enhance perioperative risk stratification beyond traditional risk factors.