ANZ journal of surgery
-
ANZ journal of surgery · Apr 2019
Comparative StudyPharmacological and non-surgical renal protective strategies for cardiac surgery patients undergoing cardiopulmonary bypass: a systematic review.
Post-operative acute kidney injury after cardiopulmonary bypass (AKI-CPB) for cardiac surgery is a frequent complication. It may require renal replacement therapy (RRT), which is associated with an increased morbidity and mortality. This review explores the efficacy of proposed pharmacological and non-surgical renal protective strategies. ⋯ NAC, RIPC and VAA were found to have no statistical significant benefit in reducing either AKI-CPB or the need for RRT following CPB. There remains clinical uncertainty with all currently proposed pharmacological and non-surgical renal protective strategies for CPB. Future research in this area should analyse the effects of combined interventions or specifically focus on 'at-risk' patients.
-
ANZ journal of surgery · Apr 2019
Review Comparative StudyPoint-of-care viscoelastic assay devices (rotational thromboelastometry and thromboelastography): a primer for surgeons.
Bleeding is a common occurrence in surgery. Point-of-care testing with viscoelastic (VE) assays such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM) has become more common place. TEG and ROTEM have the potential to guide management of coagulopathy. Many healthcare professionals still rely upon standard laboratory tests (SLTs) to manage a bleeding patient. It was our aim to investigate the literature surrounding management of the surgically bleeding patient via VE assays. ⋯ VE assays are used most commonly during orthotopic liver transplantation, trauma, postpartum haemorrhage and cardiac surgery. Although the evidence is not overwhelming, we have identified recurrent themes where VE assays seem to be beneficial. VE assay use, especially when incorporated into an algorithm, appears to reduce blood product administration which in turn reduces cost and potential adverse events. They are quicker than SLTs and they can detect hyperfibrinolysis, the hallmark of coagulopathy, via in vivo clot analyses which SLTs are unable to do. Ultimately more randomized controlled trials are required.
-
Limited data Exists ? on the Australian epidemiology of renal trauma, with very few studies published in the literature. The authors aim to detail the trends of renal trauma in the coastal city of the Gold Coast. ⋯ Males accounted for the majority of renal trauma cases, similar to the 3:1 ratio of male-to-female injuries found in other studies. In line with other studies, renal trauma reviewed on the Gold Coast also revealed road trauma as the leading cause, closely followed by falls. The majority of high-grade renal trauma was managed conservatively.
-
ANZ journal of surgery · Apr 2019
Is Norton Score a useful tool for identifying high-risk patients prior to emergency surgery?
Emergency surgery in elderly patients is associated with high mortality rates. Various scoring systems may be valuable in predicting mortality and morbidity rates. It has been suggested that the Norton Score (NS) could be used to quantify frailty. We hypothesized that NS could be a useful tool for identifying high-risk patients before emergency/urgent surgeries. ⋯ NS can be a very useful and quick tool to evaluate surgical risk in emergency surgery. Our study supports the use of NS in the perioperative evaluation prior to emergency surgery.