Articles: postoperative.
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Basic science studies suggest that perioperative immune impairment may augment the risk of cancer recurrence after otherwise potentially curative surgery. Despite its immunosuppressant properties, dexamethasone is commonly given to oncologic patients in an effort to reduce postoperative nausea and vomiting. We therefore tested the hypothesis that perioperative dexamethasone administration increases the risk of ovarian cancer recurrence. ⋯ We could not find evidence for an association between perioperative systemic dexamethasone administration and ovarian cancer recurrence after primary cytoreductive surgery. Our results do not support avoiding low-dose perioperative dexamethasone for prevention of postoperative nausea, vomiting, and pain in ovarian cancer patients.
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Randomized Controlled Trial
A pilot study of cerebral tissue oxygenation and postoperative cognitive dysfunction among patients undergoing coronary artery bypass grafting randomised to surgery with or without cardiopulmonary bypass.
Coronary artery bypass surgery, performed with or without cardiopulmonary bypass, is frequently followed by postoperative cognitive decline. Near-infrared spectroscopy is commonly used to assess cerebral tissue oxygenation, especially during cardiac surgery. Recent studies have suggested an association between cerebral desaturation and postoperative cognitive dysfunction. ⋯ Three months after surgery, 11 patients (39%) in the cardiopulmonary bypass group displayed cognitive dysfunction, compared with four (14%) in the non-cardiopulmonary bypass group (p = 0.03). The use of cardiopulmonary bypass was identified as an independent risk factor for the development of late cognitive dysfunction (OR 6.4 (95% CI 1.2-33.0) p = 0.027. In conclusion, although cerebral oxygen desaturation was rare in our population, postoperative cognitive decline was common in both groups, suggesting that factors other than hypoxic neuronal injury are responsible.
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Anesthesia and analgesia · Jun 2014
Curcumin Treatment Attenuates Pain and Enhances Functional Recovery after Incision.
Acute pain after surgery remains moderate to severe for 20% to 30% of patients despite advancements in the use of opioids, adjuvant drugs, and regional anesthesia. Depending on the type of surgery, 10% to 50% of patients experience persistent pain postoperatively, and there are no established methods for its prevention. Curcumin (diferuloylmethane) is one of the phenolic constituents of turmeric that has been used in Eastern traditional medicine as an antiseptic, antioxidant, anti-inflammatory, and analgesic agent. It may be effective for treating postoperative pain. ⋯ Our studies suggest that curcumin treatment is effective in alleviating incision-induced inflammation, nociceptive sensitization, spontaneous pain, and functional gait abnormalities. Augmented transforming growth factor-β production provides one possible mechanism. These preclinical findings demonstrate curcumin's potential as a preventative strategy in postoperative pain treatment.
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Observational Study
Self-loathing aspects of depression reduce postoperative opioid cessation rate.
We previously reported that increased preoperative Beck Depression Inventory II (BDI-II) scores were associated with a 47% (95% CI 24%-64%) reduction in the rate of opioid cessation following surgery. We aimed to identify the underlying factors of the BDI-II (affective/cognitive vs somatic) associated with a decreased rate of opioid cessation after surgery. ⋯ Our results identify a set of negative cognitions predicting prolonged time to postoperative opioid cessation. Somatic symptoms captured by the BDI-II were not primarily responsible for the association between preoperative BDI-II scores and postoperative prolonged opioid use.
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Paediatric anaesthesia · Jun 2014
ReviewStrategies for preventing side effects of systemic opioid in postoperative pediatric patients.
Opioid is the gold standard for treating moderate-to-severe pain in pediatric patients. However, its undesirable side effects lead to unsatisfied postoperative pain management outcome (Pediatr Anesth, 17, 2007, 756). The most commonly reported opioid-related side effects are vomiting (40%), pruritus (20-60%) (Anesthesiology, 77, 1992, 162; Drugs, 67, 2007, 2323), and constipation (15-90%) (Int J Clin Pract, 61, 2007, 1181). The potential life-threatening adverse event, respiratory depression, is less common (0.0013%) (Pediatr Anesth, 20, 2010, 119). The aim of this review was to evaluate prevention strategies that have been shown to decrease opioid side effects in pediatric patients during the postoperative period. ⋯ Data from 62 studies were reviewed. The strategies that could effectively prevent and reduce opioid side effects in pediatric patients during the postoperative period included minimizing the amount of opioid consumption by a multimodal approach, opioid titration, using local anesthetic techniques and providing the specific prophylaxis for each side effect.