Articles: post-operative.
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Randomized Controlled Trial
Cyclosporine before Coronary Artery Bypass Grafting Does Not Prevent Postoperative Decreases in Renal Function: A Randomized Clinical Trial.
Acute kidney injury is a common complication after cardiac surgery, leading to increased morbidity and mortality. One suggested cause for acute kidney injury is extracorporeal circulation-induced ischemia-reperfusion injury. In animal studies, cyclosporine has been shown to reduce ischemia-reperfusion injury in the kidneys. We hypothesized that administering cyclosporine before extracorporeal circulation could protect the kidneys in patients undergoing cardiac surgery. ⋯ Administration of cyclosporine did not protect coronary artery bypass grafting patients from acute kidney injury. Instead, cyclosporine caused a decrease in renal function compared to placebo that resolved after 1 month.
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Pain control after open abdominal surgery often includes multimodal analgesia with thoracic epidural or transversus abdominis plane (TAP) block. After liposomal bupivacaine was approved for TAP blocks in 2015, it became an alternative to indwelling catheters. However, the pharmacokinetics and safety of its use during the perioperative period have not been thoroughly investigated, especially in conjunction with parenteral opioids. We present a case report of an elderly patient having urgent laparoscopic converted to open abdominal surgery, who experienced postoperative respiratory depression in the recovery room after multimodal therapy with liposomal bupivacaine TAP blocks, intravenous (IV) opioids, and ketorolac.
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Acute pain intensity has conventionally been assessed with a patient self-reported, unidimensional pain scale. This approach can inadvertently underestimate analgesia and result in large cumulative opioid doses and greater dose-dependent side effects and complications. ⋯ The TAG comprises the level of acceptable pain intensity, the level and types of desired activities, and accomplishing other patient-centered functional goals. The TAG evolves throughout the patient's hospitalization to promote timely discharge.
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A 19-year-old man with mitral valve endocarditis and prolapse, intracerebral and intracerebellar hematoma, and a mycotic cerebral aneurysm underwent emergency mitral valve replacement during minimal cardiopulmonary bypass (total priming volume, 800 mL; autologous retropriming, activated clotting time <300 seconds) 1 day after undergoing endovascular coil embolization of the aneurysm. Postoperatively, there were no extensions of the intracerebral and intracerebellar hematoma. After intensive rehabilitation therapy, the patient recovered fully except for residual bilateral claudication because of preoperative bilateral embolism to both superficial femoral arteries.
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Peripheral nociceptors expressing the ion channel transient receptor potential cation channel, subfamily V, member 1, play an important role in mediating postoperative pain. Signaling from these nociceptors in the peri- and postoperative period can lead to plastic changes in the spinal cord and, when controlled, can yield analgesia. The transcriptomic changes in the dorsal spinal cord after surgery, and potential coupling to transient receptor potential cation channel, subfamily V, member 1-positive nociceptor signaling, remain poorly studied. ⋯ A single subcutaneous injection of resiniferatoxin before incision attenuated both evoked and nonevoked measures of postoperative pain. Surgical incision induced transcriptomic changes in the dorsal horn that persisted despite analgesia with resiniferatoxin, suggesting that postsurgical pain signals can be blocked without preventing transcription changes in the dorsal horn.