Articles: postoperative.
-
Comparative Study
Intradural spinal tumors - a review of post-operative outcomes comparing intramedullary and extramedullary tumors from a single institution's experience.
Intradural spinal tumors are rare and can be classified into extramedullary or intramedullary. They commonly present with symptoms such as intractable back pain or neurologic deficits. We retrospectively reviewed 91 cases of intradural spinal tumors that underwent surgery in our institution from 2011 to 2016 and assessed their clinical outcomes. ⋯ We achieved gross total resection in the majority of patients with both extramedullary and intramedullary tumors (65.4% vs. 70%, P = 0.91). Patients younger than 65 years (odds ratio [OR] 4.40, confidence interval [CI] 0.72-26.9, P = 0.11) and those who had complete resection of tumor (OR 2.92, CI 0.61-14.0, P = 0.18) were associated with higher odds of improved clinical outcomes, but the results were not statistically significant. The use of intraoperative neurophysiologic monitoring was not associated with improved neurologic outcomes compared with cases where it was not used (OR 0.56, CI 0.10-3.05, P = 0.50).
-
Pediatr Crit Care Me · Jan 2018
Measurement of Dead Space Fraction Upon ICU Admission Predicts Length of Stay and Clinical Outcomes Following Bidirectional Cavopulmonary Anastomosis.
Increased alveolar dead space fraction has been associated with prolonged mechanical ventilation and increased mortality in pediatric patients with respiratory failure. The association of alveolar dead space fraction with clinical outcomes in patients undergoing bidirectional cavopulmonary anastomosis for single ventricle congenital heart disease has not been reported. We describe an association of alveolar dead space fraction with postoperative outcomes in patients undergoing bidirectional cavopulmonary anastomosis. ⋯ Following bidirectional cavopulmonary anastomosis, alveolar dead space fraction in excess of 0.28 or arterial oxyhemoglobin saturation less than 78% upon ICU admission indicates an increased likelihood of requiring intervention prior to hospital discharge. Increasing alveolar dead space fraction and decreasing arterial oxyhemoglobin saturation are associated with increased lengths of stay.
-
OPRM1-A118G polymorphism (A > G, rs1799971) is associated with interindividual variability in both response to postoperative pain and opioid treatment. The aim of this meta-analysis is to identify the predictive strength in the current literature of OPRM1-A118G polymorphism to postoperative anesthetic reactions, including nausea, vomiting, pruritus and dizziness. ⋯ OPRM1-A118G polymorphism (A > G) is associated with a reduced risk of postoperative vomiting, but not nausea, pruritus and dizziness. The results should be interpreted with caution due to limited sample and possible heterogeneity between the included studies. Well-designed and large-scale studies are necessary to confirm our results.
-
Clinical case reports · Jan 2018
Case ReportsLiposomal bupivacaine for the management of postsurgical donor site pain in patients with burn injuries: a case series from two institutions.
Donor site pain associated with skin graft procedures is frequently intense and difficult to treat. Liposomal bupivacaine, a prolonged-release local anesthetic indicated for single-dose administration to produce postsurgical analgesia, may be a viable option in managing donor site pain.
-
To identify and describe the characteristics of existing practices for postoperative weight bearing and management of tibial plateau fractures (TPFs), identify gaps in the literature, and inform the design of future research. ⋯ Postoperative rehabilitation for TPFs most commonly involves significant non-weight bearing time before full weight bearing is recommended at 9-12 weeks. Partial weight bearing protocols and brace use were varied. Type of rehabilitation may be an important factor influencing recovery, with future high quality prospective studies required to determine the impact of different protocols on clinical and radiological outcomes.