Articles: post-operative.
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Anesthesia and analgesia · Oct 2024
Clinical Outcomes in Patients with Phosphate Abnormalities After Cardiac Surgery: A Retrospective Cohort Study.
The clinical significance and incidence of phosphate abnormalities in cardiac surgery have not been investigated extensively. We hypothesize that phosphate abnormalities are associated with a longer time to tracheal extubation. ⋯ Hyperphosphatemia in the immediate postoperative period after cardiac surgery is associated with adverse clinical outcomes. Future studies will need to investigate if actively correcting the phosphate level has an impact on clinical outcomes.
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Anesthesia and analgesia · Oct 2024
Preoperative Smoking-Cessation Interventions to Prevent Postoperative Complications: A Quality Assessment and Overview of Systematic Review Evidence.
Multiple systematic reviews have investigated the effectiveness of preoperative interventions for smoking-cessation, although relatively few have focused on the prevention of surgical complications. This overview of systematic reviews aimed to describe the types of smoking interventions studied to prevent postoperative complications, summarize the results, and evaluate the quality of the reviews and strength of evidence to inform clinicians, health practitioners, policy developers, and government bodies. Comprehensive searches of Cochrane Library, MEDLINE, EMBASE, CINAHL, and Johanna Briggs Institute databases were conducted to identify systematic reviews of preoperative smoking-cessation interventions to prevent surgical complications (inception-May 14, 2024). ⋯ This overview provides the most up-to-date summary and quality assessment of systematic review evidence on the effectiveness of preoperative smoking-cessation interventions to prevent surgical complications. The evidence supports providing smoking-cessation interventions which include multiple behavioral support sessions and pharmacotherapy implemented at least 4 weeks before surgery to reduce postoperative complications. Consequently, anesthesiologists need to work with primary care physicians, consultants, and surgeons to optimize smoking-cessation interventions way in advance of surgery.
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Tracheobronchomalacia refers to an abnormally excessive collapse of the trachea and/or bronchi during exhalation. In the pediatric population, tracheobronchomalacia is increasingly recognized as a cause of morbidity and mortality. Historically, options for medical management and surgical intervention were limited, and patient outcomes were poor. ⋯ This article reviews the posterior tracheopexy procedure, a newer but increasingly common surgery designed to address tracheobronchomalacia, and provides an overview of related anesthesia considerations and unique challenges. In addition, this article describes novel anesthesia techniques developed specifically to facilitate optimal diagnosis of tracheobronchomalacia and intraoperative management of posterior tracheopexy and similar airway surgeries. These include methods to safely enable 3-phase rigid dynamic bronchoscopy for accurate tracheobronchomalacia diagnosis, recurrent laryngeal nerve monitoring during cervical and thoracic surgical dissection, continuous intraoperative bronchoscopy to enable real-time images during airway reconstruction, and intraoperative assessment of airway repair adequacy to ensure successful correction of tracheobronchomalacia.
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Curr Opin Anaesthesiol · Oct 2024
Meta AnalysisPerioperative care of patients with recent stroke undergoing nonemergent, nonneurological, noncardiac, nonvascular surgery: a systematic review and meta-analysis.
To systematically review and perform a meta-analysis of published literature regarding postoperative stroke and mortality in patients with a history of stroke and to provide a framework for preoperative, intraoperative, and postoperative care in an elective setting. ⋯ In patients with a history of a recent stroke, anesthesiology, surgery, and neurology experts should create a shared mental model in which the patient/surrogate decision-maker is informed about the risks and benefits of the proposed surgical procedure; secondary-stroke-prevention medications are reviewed; plans are made for interruptions and resumption; and intraoperative care is individualized to reduce the likelihood of postoperative stroke or death.
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Curr Opin Anaesthesiol · Oct 2024
ReviewUpdate on the anesthesia management in adult patients with moyamoya disease.
The anesthetic management of patients with Moyamoya disease (MMD) is challenging and continues to evolve. The goal of this review is to provide updated recommendations on the anesthetic management of adult MMD patients based on the relevant existing literature. ⋯ Strategies in the preoperative, intraoperative, and postoperative anesthetic management of MMD patients should aim to maintain adequate cerebral perfusion to prevent cerebral ischemia.