Articles: postoperative.
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Review Case Reports
Valsalva hemorrhagic retinopathy presenting as a rare cause of impaired vision after a general anesthetic-a case report and review of the literature.
Postoperative visual loss from any cause is potentially catastrophic. We present a case of Valsalva hemorrhagic retinopathy (VHR) as a rare cause of impaired vision after an apparently uneventful general anesthetic. ⋯ Although VHR is considered to be rare, the events and activities with which it is associated are relatively common, both in everyday life and in the operating room. We suggest that the occurrence of VHR after anesthesia and surgery may be more frequent than previously appreciated and make recommendations for further investigations.
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We observed survival after scheduled repair of abdominal aortic aneurysm in 1096 patients for a median (IQR [range]) of 3.0 (1.5-5.8 [0-15]) years: 943 patients had complete data, 250 of whom died. We compared discrimination and calibration of an external model with the Kaplan-Meier model generated from the study data. ⋯ Groups with median 5-year predicted mortality of 40% (n = 251), 18% (n = 414) and 8% (n = 164) had lower observed mortality than 114 patients with 70% predicted mortality, hazard ratio (95% CI): 0.58 (0.37-0.76), p = 0.0031; 0.30 (0.19-0.48), p = 1.7 × 10(-12) and 0.19 (0.13-0.27), p = 1.3 × 10(-10) , respectively, test for trend p = 5.6 × 10(-15). Survival predicted by the external calculator was similar to the Kaplan-Meier estimate.
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This study aimed at assessing whether measures of aerobic fitness can predict postoperative cardiac and pulmonary complications, 30-day mortality and length of hospital stay following elective abdominal aortic aneurysm repair. We prospectively collected cardiopulmonary exercise testing data over two years for 130 patients. Upon multivariate analysis, a decreased anaerobic threshold (OR (95% CI) 0.55 (0.37-0.84); p = 0.005) and open repair (OR (95% CI) 6.99 (1.56-31.48); p = 0.011) were associated with cardiac complications. ⋯ Patients who had an endovascular repair had shorter hospital and critical care lengths of stay (p < 0.001). Measures of fitness were not associated with 30-day mortality or length of hospital stay. Cardiopulmonary exercise testing variables, therefore, seem to predict different postoperative complications following abdominal aortic aneurysm repair, which adds value to their routine use in risk stratification and optimisation of peri-operative care.
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Anesthesiology clinics · Jun 2015
ReviewObstructive sleep apnea, sleep disorders, and perioperative considerations.
Data suggest that surgical patients with obstructive sleep apnea (OSA) may be difficult to ventilate and intubate, and may be prone to postoperative complications. This article addresses the identification of patients at risk for OSA, epidemiology of the disorder, and treatment options, as well as the perioperative management of this population.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2015
Review[The addicted patient in anaesthesia -screening, diagnosis and treatment of alcohol use disorders].
Patients consuming > 60g/d of alcohol (e.g. 1.5l of beer), are 2-5 times more likely to suffer post-operative complications such as infectious, bleeding or cardiac complications or an alcohol withdrawal syndrome. By screening and a systematic evaluation risk patients can be identified that may benefit from interventions such as counseling, brief interventions, abstinence, tailored anesthesia, prophylactic treatment of withdrawal symptoms, stress reduction, harm reduction, psychosocial therapy, addiction therapy, multidisciplinary treatment.