Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Nov 2008
Review[Perioperative risk reduction in vascular surgery via cardio-protective medication].
Cardiovascular complications are the leading cause of death after noncardiac surgery. Preoperative identification of patients with underlying coronary artery disease is important, and appropriate treatment strategies should be implemented in these patients in order to reduce the risk of perioperative complications. ⋯ Recently, statins have emerged as drugs with perioperative cardioprotective properties, but more randomized clinical trials are needed before routine administration ofstatins can be recommended. Perioperative medical management should focus on improvements not only in the short-term but also in the long-term.
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Ned Tijdschr Geneeskd · Nov 2008
[Prevention of perioperative cardiac complications in non-cardiac surgery: an evidence-based guideline].
Approximately 2.5% of the patients undergoing non-cardiac surgery suffer from perioperative cardiac complications. These are associated with a mortality of 20.60%, a longer stay in hospital and higher costs. ⋯ Currently, the prevention of cardiac problems consists of identification of the patients at risk, optimisation of the preoperatieve condition by modification of underlying risk factors, optimisation of the perioperative medication with adrenergic beta-antagonists, statins, and acetylsalicylic acid, adequate perioperative monitoring and measures to prevent myocardial ischaemia. These include adequate sedation and analgesia, adequate oxygenation, oxygen transport, and ventilation, and if necessary additional cardiac medication.
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Ned Tijdschr Geneeskd · Nov 2008
Comment[Use of medicines to reduce the risk of postoperative cardiac death: too early for guidelines].
In a review in this journal, Feringa et al. focused on the prevention of cardiovascular complications after non-cardiac surgery. Beta-blockers and statins appear to be the most effective in reducing post-operative mortality due to cardiac events. ⋯ Guidelines based upon such studies are 'premature', possibly dangerous and unethical, since the acceptance of such guidelines would preclude large scale studies to confirm the conclusions of the small studies so far performed. Perioperative beta-blockade is only needed in a subgroup of patients with a high-risk cardiac profile.
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Ned Tijdschr Geneeskd · Nov 2008
[Perioperative beta-blockade for reduction of cardiovascular complications in non-cardiac surgery: advantages and disadvantages].
The results of the recently published PeriOperative ISchemic Evaluation (POISE) trial show that perioperative use of metoprolol in patients with atherosclerosis undergoing major non-cardiac surgery reduces the risk of cardiovascular complications. This effect was primarily produced by a 1.5% reduction in non-fatal myocardial infarction (MI), but this advantage was outweighed by a 0.8% increase in total mortality and a 0.5% increase in nonfatal stroke. ⋯ These findings call for judicious perioperative use of adrenergic beta-antagonists in cardiac-high-risk patients undergoing high risk non-cardiac surgery. Dosage should be lower and administration should be implemented longer before the operation.
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Ned Tijdschr Geneeskd · Nov 2008
Case Reports[A woman with right-sided lower abdominal pain due to intussusception of the appendix].
A 38-year-old woman presented with mild abdominal pain in the right inferior quadrant. Ultrasonography and CT scan suggested intussusception in the ileocoecal region. ⋯ Pathological findings were: presence of peri-appendicitis and foci ofendometriosis in the peri-appendiceal fatty and connective tissue. Intussusception of the appendix is mostly found in children, particularly in boys.